Monday, November 28, 2011

Matthias Weinberger's Mirror Therapy Series.

Matthias Weinberger has the blog Neurotropian. He is a Physiotherapist extraordinaire in my opinion, is passionate about the new science of pain management and promotes awareness and educates in this brilliant blog. Matthias is also a very talented photographic artist. I encourage you to bookmark his site and visit often. I go back and read his posts several times as there is so much information and good sense in them.

Neurotropian blog has a series of invaluable posts about
"mirror therapy". Mirror therapy has been proven to create new neural pathways, retraining the brain, important for those with CRPS. I recommend you watch the video of Ramachandran before Mirror Box Therapy Part I.

  • Mirror Box Therapy Part I describes how easily the brain can be changed by vision. Click on rotating spiral to show you how. He presents the science of "Somatosensory maps being re-modeled so that the pain is gone (forever)" because the brain is restructured. Please note that from my observation, if pain returns as soon as you stop mirror therapy, there may be an ongoing pathology or mechanical problem which needs addressing. Note the fantastic results with Iraq veterans in Walter Reid trials.

  • Mirror Box Therapy Part II talks again of the brain's plasticity. With his gift for making the difficult seem simple Mathias helps us understand just how our brain can change in ways that benefit us.
  • Mirror Box Therapy Part III talks about the virtual body in the brain and distortion of images. In my case if I've had pain for a long time my image of my body part becomes distorted eg I become convinced that my leg is swollen. Measuring shows me that it's not but in my mind it is. Mirror therapy stops the pain and returns the image in my brain to normal. Again this section is interesting and explained in such a way that it is easy to understand.
  • Mirror Box Therapy Part IV specifically talks about CRPS and mentions the limb laterality left/right recognition problem. This is the best explanation I've found about this. In previous posts I talked about Noi Group's Recognize program. I think the cards they now have would have been much better for me as I have a big problem with recognizing left and right hands. This post is devoted to feedback from the body to the brain and is most important. I recommend you take time and read this section.
  • Mirror Box Therapy Part V has some really good links. Hubmed is brilliant. I've bookmarked a number of other links thanks to Neurotopian.
  • Mirror Box Therapy Part VI - as the expression goes "from pain to possibilities". This section is just fascinating. Read it and bookmark "Neurotopian" in your favourites. I'll be checking regularly and hope at some point there will be the opportunity to get updates by email as you can with Blogger.
  • Mirror Box Therapy Part VII covers frequently asked questions. It provides answers about side effects, lengths of sessions, where to get boxes and what to do.
  • Mirror Box Therapy Part VIII covers questions people might have such as about side effects, what to do and length of sessions, where to get a mirror box and who can help.

Friday, November 25, 2011

Pain - A disease in its own right? Professor Michael Cousins commented on Body in Mind

Dr Lorimer Moseley originally posted the topic "Is chronic pain a disease in its own right?" on the Body in Mind website. Professor Michael Cousins' comment was presented as a new post "In response to 'Is chronic pain a disease in its own right'". 
It may help you to know a little more about Professor Cousins and his work. Professor Cousins was interviewed on Catalyst in July 2009.
ABC Local Conversations with Richard Fidler interviewed Professor Cousins in June 2010.

BBC News also reported on thie topic "Pain should be a diesease in its own right."

To put this into perspective,  The International Association for the Study of Pain (IASP) in 2001 recommended the Global Adoption of the European Federation of IASP's declaration on Chronic Pain as a Major Healthcare Problem a Disease in its Own Right.
I recommend viewing this Swiss Presentation. 

Please do not take this post to mean that I believe the primary treatment for pain is medication and invasive procedures. I believe physical and new brain retraining techniques offer real and cost efective promise. However having pain declared a disease in its own right has significant implications for access to funding for much need research. As I posted recently, scientifically rigorous trials require large funding budgets. Raising the profile of Pain will allow access to more funds.

Thursday, November 24, 2011

Wednesday, November 23, 2011

Difinitive Link Library for CRPS and similar conditions.

Howard Black has a Ph.D. in Medicinal and Organic Synthetic Chemistry. On a personal level he has been dealing with Complex Regional Pain Syndrome for 15 years and is now in remission. There's a link to his story if you scroll to the bottom of the main site, Definitive Links Library for Reflex Sympathetic Dystrophy CRPS, chronic pain and similar conditions
This website is a wonderful source of up to date information. Howard also gives you the opportunity to ask a question by signing the "guest book" by clicking on the link. I encourage you to visit and if interested in latest research to click on the "newsletter" link to the left.

Howard is interested in anyone who has had remission. Scroll down through the site for a link to tell your story and help research.

Harvard Medical School - Complementary and Alternative Medicine for Pain: An Evidence-based Review

Published in November 2010 this Evidence-based Review of Complementary and Alternative Medicine for Pain: considers the literature on complementary and alternative medicine for pain, with particular emphasis on evidence-based assessments pertinent to the most common alternative therapies, including acupuncture,
herbal therapy, massage therapy, hypnosis, tai chi, and biofeedback.

The authors conclude that as "therapies are increasingly sought by patient, it is incumbent upon physicians and other health care providers to acquire some knowledge of the current state of complementary and alternative therapies for pain.

Netherlands and others study - The clinical aspects of mirror therapy in rehabilitation: a systematic review of the literature.

The study (This link is from a google search on the topic.) was publishsed in International Journal of Rehabilitation Research 34:1–13  2011 with the objective of evaluating "the clinical aspects of mirror therapy (MT) interventions after stroke, phantom limb pain and complex regional pain syndrome."

As with much written about mirror therapy, firm conclusions were not drawn and the suggestion is for more rigorous testing. Funding for research is limited and competitive. Mirror therapy is free once taught so is not finantially lucrative thus not attracting funds from those who seek to finantially benefit.

German Study on Complex Interaction of Sensory and Motor Signs and Symptoms in chronic CRPS.

Published April 2011, this Greman study of  the Complex Interaction of Sensory and Motor Signs and Symptoms in chronic CRPS  was devised to "characterize the interaction of symptoms in 118 patients. The summary concludes that "chronic CRPS is characterized by a combination of chronic ongoing as well as evoked pain, a distinct level of stress and depression, resulting in a disabled hand function even years after the impressive symptoms of acute CRPS like edema and sympathetic dysfunction subside. It suggested that "in the future enhanced efforts should be made to set up tailored treatment strategies targeting underlying pathomechanisms in order to improve long term outcome even in severe cases of CRPS."

Netherlands study on 'The safety of "pain exposure" physical thgerapy in patients with CRPS Type 1.'

In September 2010 Netherlands study on 'The safety of "pain exposure" physical thgerapy in patients with CRPS Type 1.' was published. The following is taken from the published material.

‘‘Pain exposure’’ physical therapy (PEPT) is a new treatment for patients with complex regional pain syndrome type 1 (CRPS-1) that consists of a progressive-loading exercise program and management of pain avoidance behavior without the use of specific CRPS-1 medication or analgesics. The aim of this study
was to investigate primarily whether PEPT could be applied safely in patients with CRPS-1.
The data from this study do illustrate that this type of therapy is tolerated by patients with CRPS-1.

The study was designed as a preliminary study for a controlled randomized trial and was necessary to determine possible harmful side effects. Because the current standard among many physicians and physical therapists treating CRPS used loading exercises under the ‘‘with pain, no gain’’ concept, this study was a prerequisite for larger trials. Even with the restricted number of included patients, the study was able to demonstrate that no harmful side effects exist, and the power was sufficient to demonstrate that most treatment effects are clinically relevant (MCIC > 30%) and some treatment effects are statistically significant. The clinical implication of this study is that PEPT may now be performed without restrictions with respect to safety. Further randomized clinical trials are necessary to demonstrate the superiority
of PEPT to existing treatment strategies.
This study was financially supported by a grant from the Scientific College Physical therapy (WCF) of the Royal Dutch Association of Physical Therapy, The Netherlands and there is no conflict of interest in this study.

Saturday, November 05, 2011

Meredith's story - helping her to understand RSD

Recently Meredith left this comment here. 
"Hi my name is Meredith and I have been following your blog Ive been pretty bad at keeping up, but have some really great ideas for us RSD patients, Im working on setting up a support group online since there isnt one in our town, and since its online of course anyone with RSD is welcome. I would love if you would follow me as well I also started a page under my facebook and its getting a lot of love and positive eneregy wich is exactly what we need."

I'll post the link when Meredith lets me know that here group is up and running. I've met so many special people with chronic pain and all of them show great determination to move on with their lives. Many, like Meredith, are inspired to help others. I guess life really is what you make of it. Thank you to all who have shared their stories, endeavouiring to help others as they help themselves.

Meredith, if you read this I clicked on "follow" on your blog but the link didn't work. You could reset it in "design" in blogger.
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