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Nau mai, haere mai! This website is a learning resource that is primarily designed for Musculoskeletal Medicine training in New Zealand. It also aims to be useful for GPs, other doctors, and medical students. It is not written for patients but they are welcome to read the articles. Click on a body region on the skeleton or a portal below to get started.
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Featured Wiki Article for 1 May 2025
Causes and Sources of Chronic Thoracic Pain
Chronic thoracic spine pain is an often perplexing clinical problem. While less common than neck or low back pain, mid-back pain is still significant – about 15% of people report thoracic spine pain at any given time.[1] Importantly, thoracic pain is sometimes associated with serious underlying pathology more often than neck or low back pain.[2] Understanding the sources versus the causes of thoracic pain is critical for an anatomical diagnosis (a “reductionist” approach advocated by Bogduk.[1] In this context, “source” refers to the specific anatomical structure generating nociceptive signals, whereas “cause” refers to the pathophysiological process affecting that structure (e.g. degeneration, inflammation, fracture). For example, a thoracic zygapophysial (facet) joint may be the pain source, while osteoarthritic degeneration of that joint is the cause. - Read More
New and Updated Articles
- Migraine
- Neck-Tongue Syndrome
- Cervicogenic Headache
- Indomethacin Responsive Headaches
- Trigeminal Neuralgia
- Pain Oriented Sensory Testing
- Clonidine
- Neuropathic and Nociplastic Pain Pharmacotherapy
- Lumbar Transforaminal Epidural Steroid Injection
- Offset Analgesia
- Etoricoxib
- Gabapentinoids
- Nonsteroidal Anti-Inflammatory Drugs
- Pain Modulation Profile
- Peripheral Neuropathic Pain
- Classifying Pain
- Erythromelalgia
- Impulse Pain
- Deafferentation Pain
- Radicular Pain and Radiculopathy
Featured Open Access Journal Article for 1 April 2025
Intraosseous basivertebral nerve ablation: A 5-year pooled analysis from three prospective clinical trials
Interventional Pain Medicine
ABSTRACT - Vertebrogenic pain, caused by damaged vertebral endplates and transmitted via the basivertebral nerve (BVN), is linked to chronic low back pain (CLBP) and is identifiable by Modic changes on MRI. Intraosseous radiofrequency ablation of the BVN (BVNA) has previously shown clinical benefit in three prospective studies.
This report aggregates 5-year follow-up outcomes from those three trials. Out of 320 BVNA-treated patients, 249 (78%) completed 5-year follow-up (mean 5.6 years). Key baseline characteristics: 71.9% had back pain ≥5 years, 27.7% used opioids, 61.8% had prior spinal injections.
Results at 5 years:
- Pain (NPS) improved by a mean of 4.32 points (p < 0.0001).
- Disability (ODI) improved by a mean of 28 points (p < 0.0001).
- 32.1% of patients were pain-free.
- 72.7% reported improvement; 68.7% resumed pre-CLBP activity levels.
- Of the opioid users at baseline, 65.2% had stopped opioids.
- Spinal injections reduced by 58.1%.
- 13.2% underwent further lumbosacral interventions, including 6% lumbar fusion.
- No serious device-related adverse events were reported.
“I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.”
— The Hippocratic Oath: Modern Version, Lasagna 1964
