Pain improved but function stays the same. Did anything happen?

Pain improved but function stays the same. Did anything happen?

Reposted after a 3/22/16 site crash.

Why do we hurt? Pain exists in part so we do not cause further trauma. If you have tennis elbow or low back back after an injury, it hurts and that pain prevents you from causing more damage.

At least partly.

Pain is odd. There can be a strong psychological component to pain and how it is perceived.

As I have mentioned too many times to count, placebos such as acupuncture alter the perception of pain, but have no effect on the underlying pathology that caused the pain. And if the underlying pathology is unchanged it should manifest with no change in function.

Function is effort dependent and can be hard to know if patients are making the same effort each time their function is tested. And if the stakes are high enough, people will overcome their pain. A classic example is Willis Reed in game 7 of the NBA finals, playing with a torn muscle in this thigh and leading the Kicks to a championship.

Noninvasive Treatments for Low Back Pain was released by the Pacific Northwest Evidence-based Practice Center.   Not science-based, mind you,  but evidence-based, given that they included  low level lasers and magnets in their review

The interesting aspect is the conclusion

A number of pharmacological and nonpharmacological noninvasive treatments for low back pain are associated with small to moderate, primarily short-term effects on pain versus placebo, sham, wait list, or no treatment. Effects on function were generally smaller than effects on pain.

For acupunctures (for there were a variety of styles) for acute or chronic back pain, most of the data suggested no or minimal improvement of function, although given the great heterogeneity of the studies and reports it was not a universal result.

There were similar findings for spinal manipulation.

For both acupuncture and spinal manipulation, any effect on function was usually around the time of the intervention and not sustained, suggesting the improvement may have been more to effort (unconsciously trying to please the researcher) than any real effect on the pathology that caused the pain.

None of the studies included were considered high quality; most were moderate or poor, so any effects could well have been due to bias rather than a real effect.

Pain relief is important but this review raises a question. If the intervention only has effect upon the subjective aspect of the pain but there are no improvements on the objective/functional results of the pain, the intervention really doing anything?

Points of Interest 03/24/2016
Points of Interst 03/22/2016

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