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Old 13-09-2005, 01:48 PM   #1
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Default Lorimer MOSELEY

Lorimer MOSELEY

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Simplicity is the ultimate sophistication. L VINCI
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If you can't explain it simply, you don't understand it well enough. Albert Einstein
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Old 13-09-2005, 05:19 PM   #2
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Who is this guy?
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Old 13-09-2005, 06:01 PM   #3
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Lin,
Some results to read! Enjoy

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Simplicity is the ultimate sophistication. L VINCI
We are to admit no more causes of natural things than such as are both true and sufficient to explain their appearances. I NEWTON

Everything should be made as simple as possible, but not a bit simpler.
If you can't explain it simply, you don't understand it well enough. Albert Einstein
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Old 13-09-2005, 06:09 PM   #4
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Clin J Pain. 2005 Jul-Aug;21(4):323-9. Related Articles, Books, LinkOut
Are the changes in postural control associated with low back pain caused by pain interference?

Moseley GL, Hodges PW.

The University of Queensland, Brisbane, Australia. l.moseley@fhs.usyd.edu.au

BACKGROUND: Voluntary limb movements are associated with involuntary and automatic postural adjustments of the trunk muscles. These postural adjustments occur prior to movement and prevent unwanted perturbation of the trunk. In low back pain, postural adjustments of the trunk muscles are altered such that the deep trunk muscles are consistently delayed and the superficial trunk muscles are sometimes augmented. This alteration of postural adjustments may reflect disruption of normal postural control imparted by reduced central nervous system resources available during pain, so-called "pain interference," or reflect adoption of an alternate postural adjustment strategy. METHODS: We aimed to clarify this by recording electromyographic activity of the upper (obliquus externus) and lower (transversus abdominis/obliquus internus) abdominal muscles during voluntary arm movements that were coupled with painful cutaneous stimulation at the low back. If the effect of pain on postural adjustments is caused by pain interference, it should be greatest at the onset of the stimulus, should habituate with repeated exposure, and be absent immediately when the threat of pain is removed. Sixteen patients performed 30 forward movements of the right arm in response to a visual cue (control). Seventy trials were then conducted in which arm movement was coupled with pain ("pain trials") and then a further 70 trials were conducted without the pain stimulus ("no pain trials"). RESULTS: There was a gradual and increasing delay of transversus abdominis/obliquus internus electromyograph and augmentation of obliquus externus during the pain trials, both of which gradually returned to control values during the no pain trials. CONCLUSION: The results suggest that altered postural adjustments of the trunk muscles during pain are not caused by pain interference but are likely to reflect development and adoption of an alternate postural adjustment strategy, which may serve to limit the amplitude and velocity of trunk excursion caused by arm movement.

PMID: 15951650 [PubMed - indexed for MEDLINE]

2:
Aust J Physiother. 2005;51(1):49-52. Related Articles, Books, LinkOut
Widespread brain activity during an abdominal task markedly reduced after pain physiology education: fMRI evaluation of a single patient with chronic low back pain.

Moseley GL.

Department of Physiotherapy, Royal Brisbane and Women's Hospital & The University of Queensland, Brisbane, Australia. l.moseley@fhs.usyd.edu.au

The way people with chronic low back pain think about pain can affect the way they move. This case report concerns a patient with chronic disabling low back pain who underwent functional magnetic resonance imaging scans during performance of a voluntary trunk muscle task under three conditions: directly after training in the task and, after one week of practice, before and after a 2.5 hour pain physiology education session. Before education there was widespread brain activity during performance of the task, including activity in cortical regions known to be involved in pain, although the task was not painful. After education widespread activity was absent so that there was no brain activation outside of the primary somatosensory cortex. The results suggest that pain physiology education markedly altered brain activity during performance of the task. The data offer a possible mechanism for difficulty in acquisition of trunk muscle training in people with pain and suggest that the change in activity associated with education may reflect reduced threat value of the task.

Publication Types:
  • Case Reports
  • Evaluation Studies
PMID: 15748125 [PubMed - indexed for MEDLINE]

3: Pain. 2005 Mar;114(1-2):54-61. Epub 2005 Jan 26. Related Articles, Books, LinkOut
Is successful rehabilitation of complex regional pain syndrome due to sustained attention to the affected limb? A randomised clinical trial.

Moseley GL.

School of Physiotherapy, The University of Sydney, Lidcombe, Sydney, NSW 1825, Australia. l.moseley@fhs.usyd.edu.au

In complex regional pain syndrome (CRPS1) initiated by wrist fracture, a motor imagery program (MIP), consisting of hand laterality recognition followed by imagined movements and then mirror movements, reduces pain and disability, but the mechanism of effect is unclear. Possibilities include sustained attention to the affected limb, in which case the order of MIP components would not alter the effect, and sequential activation of cortical motor networks, in which case it would. Twenty subjects with chronic CRPS1 initiated by wrist fracture and who satisfied stringent inclusion criteria, were randomly allocated to one of three groups: hand laterality recognition, imagined movements, mirror movements (RecImMir, MIP); imagined movements, recognition, imagined movements (ImRecIm); recognition, mirror movements, recognition (RecMirRec). At 6 and 18 weeks, reduced pain and disability were greater for the RecImMir group than for the other groups (P<0.05). Hand laterality recognition imparted a consistent reduction in pain and disability across groups, however, this effect was limited in magnitude. Imagined movements imparted a further reduction in pain and disability, but only if they followed hand laterality recognition. Mirror movements also imparted a reduction in pain and disability, but only when they followed imagined movements. The effect of the MIP seems to be dependent on the order of components, which suggests that it is not due to sustained attention to the affected limb, but is consistent with sequential activation of cortical motor networks.

Publication Types:
  • Clinical Trial
  • Randomized Controlled Trial
PMID: 15733631 [PubMed - indexed for MEDLINE]

4: Clin J Pain. 2004 Sep-Oct;20(5):324-30. Related Articles, Books, LinkOut
A randomized controlled trial of intensive neurophysiology education in chronic low back pain.

Moseley GL, Nicholas MK, Hodges PW.

University of Queensland, Brisbane, Australia. l.moseley@mailbox.uq.edu.au

OBJECTIVES: Cognitive-behavioral pain management programs typically achieve improvements in pain cognitions, disability, and physical performance. However, it is not known whether the neurophysiology education component of such programs contributes to these outcomes. In chronic low back pain patients, we investigated the effect of neurophysiology education on cognitions, disability, and physical performance. METHODS: This study was a blinded randomized controlled trial. Individual education sessions on neurophysiology of pain (experimental group) and back anatomy and physiology (control group) were conducted by trained physical therapist educators. Cognitions were evaluated using the Survey of Pain Attitudes (revised) (SOPA(R)), and the Pain Catastrophizing Scale (PCS). Behavioral measures included the Roland Morris Disability Questionnaire (RMDQ), and 3 physical performance tasks; (1) straight leg raise (SLR), (2) forward bending range, and (3) an abdominal "drawing-in" task, which provides a measure of voluntary activation of the deep abdominal muscles. Methodological checks evaluated non-specific effects of intervention. RESULTS: There was a significant treatment effect on the SOPA(R), PCS, SLR, and forward bending. There was a statistically significant effect on RMDQ; however, the size of this effect was small and probably not clinically meaningful. DISCUSSION: Education about pain neurophysiology changes pain cognitions and physical performance but is insufficient by itself to obtain a change in perceived disability. The results suggest that pain neurophysiology education, but not back school type education, should be included in a wider pain management approach.

Publication Types:
  • Clinical Trial
  • Randomized Controlled Trial
PMID: 15322439 [PubMed - indexed for MEDLINE]

5: Brain. 2004 Oct;127(Pt 10):2339-47. Epub 2004 Jul 28. Related Articles, Books, LinkOut
Does anticipation of back pain predispose to back trouble?

Moseley GL, Nicholas MK, Hodges PW.

Prince of Wales Medical Research Institute, Randwick, Sydney, Austalia. l.moseley@fhs.usyd.edu.au

Limb movement imparts a perturbation to the body. The impact of that perturbation is limited via anticipatory postural adjustments. The strategy by which the CNS controls anticipatory postural adjustments of the trunk muscles during limb movement is altered during acute back pain and in people with recurrent back pain, even when they are pain free. The altered postural strategy probably serves to protect the spine in the short term, but it is associated with a cost and is thought to predispose spinal structures to injury in the long term. It is not known why this protective strategy might occur even when people are pain free, but one possibility is that it is caused by the anticipation of back pain. In eight healthy subjects, recordings of intramuscular EMG were made from the trunk muscles during single and repetitive arm movements. Anticipation of experimental back pain and anticipation of experimental elbow pain were elicited by the threat of painful cutaneous stimulation. There was no effect of anticipated experimental elbow pain on postural adjustments. During anticipated experimental back pain, for single arm movements there was delayed activation of the deep trunk muscles and augmentation of at least one superficial trunk muscle. For repetitive arm movements, there was decreased activity and a shift from biphasic to monophasic activation of the deep trunk muscles and increased activity of superficial trunk muscles during anticipation of back pain. In both instances, the changes were consistent with adoption of an altered strategy for postural control and were similar to those observed in patients with recurrent back pain. We conclude that anticipation of experimental back pain evokes a protective postural strategy that stiffens the spine. This protective strategy is associated with compressive cost and is thought to predispose to spinal injury if maintained long term.

PMID: 15282214 [PubMed - indexed for MEDLINE]

6:
Man Ther. 2004 Aug;9(3):157-63. Related Articles, Books, LinkOut
Impaired trunk muscle function in sub-acute neck pain: etiologic in the subsequent development of low back pain?

Moseley GL.

Division of Physiotherapy, The University of Queensland, Australia. l.moseley@uq.edu.au

Low back pain (LBP) and neck pain are associated with dysfunction of the trunk and neck muscles, respectively, and may involve common or similar mechanisms. In both cases, dysfunction may compromise spinal control. Anecdotally, neck pain patients commonly develop LBP. This study investigated the possibility that trunk muscle function is compromised in neck pain patients and that compromised trunk muscle function is associated with increased risk of LBP. Fifty-four neck pain patients and 52 controls were assessed on an abdominal drawing-in task (ADIT) and on self-report tests. Performance on the ADIT was able to detect neck pain patients with 85% sensitivity and 73% specificity. Catastrophizing and McGill pain questionnaire (affective) scores were higher in patients with an abnormal task response than in patients with an uncertain or normal response, although the self-report data did not predict task performance. Fifty subjects from each group were contactable by telephone at 2 years. They were asked whether they had experienced persistent or recurrent LBP since the assessment. Subjects (patients and controls) who obtained an abnormal response on the ADIT were 3 to 6 times more likely to develop persistent or recurrent LBP than those who obtained an uncertain or normal response. ADIT performance was the main predictor of development of LBP in patients. The results suggest that reduced voluntary trunk muscle control in neck pain patients is associated with an increased risk of developing LBP.

PMID: 15245710 [PubMed - indexed for MEDLINE]

7:
Neurology. 2004 Jun 22;62(12):2182-6. Related Articles, Books, LinkOut
Why do people with complex regional pain syndrome take longer to recognize their affected hand?

Moseley GL.

Department of Physiotherapy, The University of Queensland, and Royal Brisbane & Women's Hospital, Brisbane, Australia. l.moseley@uq.edu.au

BACKGROUND: People with complex regional pain syndrome (CRPS) take longer to recognize the laterality of a pictured hand when it coincides with their affected hand. The author explored two aspects of this phenomenon: whether the duration of symptoms relates to the extent of the delay and whether guarding-type mechanisms are involved. METHODS: Eighteen patients with CRPS type 1 of the wrist and 18 matched control subjects performed a hand laterality recognition task. McGill pain questionnaire, Neuropathic Pain Scale, and response time (RT) to recognize hand laterality were analyzed. Regressions related 1) mean RT for patients to the duration of symptoms and to pain intensity; and 2) mean RT for each picture to the predicted pain on executing that movement as judged by the patient, and to the awkwardness of the movement that would be required. RESULTS: For patients, the duration of symptoms correlated with mean RT (Spearman rho = 0.44; p = 0.02). Predicted pain rating explained 45% of the variance in RT for each picture for each patient (p < 0.01). CONCLUSIONS: The results suggest that in patients with complex regional pain syndrome type 1, delayed recognition of hand laterality is related to the duration of symptoms and to the pain that would be evoked by executing the movement. The former is consistent with chronic pain and disuse and may involve reorganization of the cortical correlate of body schema. The latter is consistent with a guarding-type response that probably occurs upstream of the motor cortex at a motor planning level.

PMID: 15210879 [PubMed - indexed for MEDLINE]

8: Neurology. 2004 May 11;62(9):1644. Related Articles, Books, LinkOut
Imagined movements cause pain and swelling in a patient with complex regional pain syndrome.

Moseley GL.

University of Queensland and Royal Brisbane & Women's Hospital, Brisbane, Australia. l.moseley@uq.edu.au

Publication Types:
  • Case Reports
PMID: 15136704 [PubMed - indexed for MEDLINE]

9:
Eur J Pain. 2004 Feb;8(1):39-45. Related Articles, Cited in PMC, Books, LinkOut
Evidence for a direct relationship between cognitive and physical change during an education intervention in people with chronic low back pain.

Mosel ey GL.

Departments of Physiotherapy, Royal Brisbane Hospital and The University of Queensland, Herston, 4029, Australia. l.moseley@mailbox.uq.edu.au

BACKGROUND: Unhelpful pain cognitions of patients with chronic low back pain (LBP) may limit physical performance and undermine physical assessment. It is not known whether a direct relationship exists between pain cognitions and physical performance. AIMS: To determine if a relationship exists between change in pain cognitions and change in physical performance when chronic LBP patients participate in a single one-to-one education intervention during which they have no opportunity to be active. METHODS: In a quasi-experiment using a convenience sample, moderately disabled chronic LBP patients (n=121) participated in a one-to-one education session about either lumbar spine physiology or pain physiology. Multiple regression analysis evaluated the relationship between change in pain cognitions measured by the survey of pain attitudes (SOPA) and the pain catastrophising scale (PCS) and change in physical performance, measured by the straight leg raise (SLR) and standing forward bending range. RESULTS: There was a strong relationship between cognitive change and change in straight leg raise (SLR) and forward bending (r=0.88 and 0.79, respectively, P<0.01), mostly explained by change in the conviction that pain means tissue damage and catastrophising. CONCLUSIONS: Change in pain cognitions is associated with change in physical performance, even when there is no opportunity to be physically active. Unhelpful pain cognitions should be considered when interpreting physical assessments.

PMID: 14690673 [PubMed - indexed for MEDLINE]

10:
Exp Brain Res. 2004 May;156(1):64-71. Epub 2003 Dec 19. Related Articles, Books, LinkOut
Pain differs from non-painful attention-demanding or stressful tasks in its effect on postural control patterns of trunk muscles.

Moseley GL, Nicholas MK, Hodges PW.

Department of Physiotherapy, Royal Brisbane Hospital, 4029, Herston, Queensland, Australia. l.moseley@uq.edu.au

Pain changes postural activation of the trunk muscles. The cause of these changes is not known but one possibility relates to the information processing requirements and the stressful nature of pain. This study investigated this possibility by evaluating electromyographic activity (EMG) of the deep and superficial trunk muscles associated with voluntary rapid arm movement. Data were collected from control trials, trials during low back pain (LBP) elicited by injection of hypertonic saline into the back muscles, trials during a non-painful attention-demanding task, and during the same task that was also stressful. Pain did not change the reaction time (RT) of the movement, had variable effects on RT of the superficial trunk muscles, but consistently increased RT of the deepest abdominal muscle. The effect of the attention-demanding task was opposite: increased RT of the movement and the superficial trunk muscles but no effect on RT of the deep trunk muscles. Thus, activation of the deep trunk muscles occurred earlier relative to the movement. When the attention-demanding task was made stressful, the RT of the movement and superficial trunk muscles was unchanged but the RT of the deep trunk muscles was increased. Thus, the temporal relationship between deep trunk muscle activation and arm movement was restored. This means that although postural activation of the deep trunk muscles is not affected when central nervous system resources are limited, it is delayed when the individual is also under stress. However, a non-painful attention-demanding task does not replicate the effect of pain on postural control of the trunk muscles even when the task is stressful.

PMID: 14689133 [PubMed - indexed for MEDLINE]

11:
Aust J Physiother. 2003;49(4):263-7. Related Articles, Books, LinkOut
The threat of predictable and unpredictable pain: differential effects on central nervous system processing?

Moseley GL, Brhyn L, Ilowiecki M, Solstad K, Hodges PW.

Department of Physiotherapy, Royal Brisbane Hospital, Brisbane, Australia. l.moseley@uq.edu.au

Central nervous system performance is disrupted by pain and by the threat of pain. It is not known whether disruption caused by the threat of pain is dependent on the likelihood of pain occurring. We hypothesised that when a painful stimulus is possible but unpredictable central nervous system performance is reduced, but when the pain is predictable and unavoidable it is not. Sixteen healthy subjects performed a reaction time task during predictable and unpredictable conditions (100% and 50% probability of pain, respectively). Group data showed increased reaction time with the threat of pain by 50 ms (95% CI 16 to 83 ms) for the predictable condition and 46 ms (95% CI 12 to 80 ms) for the unpredictable condition (p lt 0.01 for both), but there was no difference between predictable and unpredictable conditions (p = 0.41). However, individual data showed that there was a differential effect in 75% of subjects (p lt 0.05 for all) and that there was a greater effect of predictable pain for some subjects and a greater effect of unpredictable pain for others. Reaction time was related to reported anxiety (r = 0.49, p = 0.02 for both conditions). The predictability of a painful stimulus may have a differential effect on central nervous system performance within individuals, but anxiety about the impending pain appears to be important in determining this effect.

Publication Types:
  • Clinical Trial
  • Randomized Controlled Trial
PMID: 14632625 [PubMed - indexed for MEDLINE]

12:
J Pain. 2003 May;4(4):184-9. Related Articles, Books, LinkOut
Unraveling the barriers to reconceptualization of the problem in chronic pain: the actual and perceived ability of patients and health professionals to understand the neurophysiology.

Moseley L.

Department of Physiotherapy, The University of Queensland and Royal Brisbane Hospital, Herston, Australia. l.moseley@mailbox.uq.edu.au

To identify why reconceptualization of the problem is difficult in chronic pain, this study aimed to evaluate whether (1) health professionals and patients can understand currently accurate information about the neurophysiology of pain and (2) health professionals accurately estimate the ability of patients to understand the neurophysiology of pain. Knowledge tests were completed by 276 patients with chronic pain and 288 professionals either before (untrained) or after (trained) education about the neurophysiology of pain. Professionals estimated typical patient performance on the test. Untrained participants performed poorly (mean +/- standard deviation, 55% +/- 19% and 29% +/- 12% for professionals and patients, respectively), compared to their trained counterparts (78% +/- 21% and 61% +/- 19%, respectively). The estimated patient score (46% +/- 18%) was less than the actual patient score (P <.005). The results suggest that professionals and patients can understand the neurophysiology of pain but professionals underestimate patients' ability to understand. The implications are that (1) a poor knowledge of currently accurate information about pain and (2) the underestimation of patients' ability to understand currently accurate information about pain represent barriers to reconceptualization of the problem in chronic pain within the clinical and lay arenas.

PMID: 14622702 [PubMed - indexed for MEDLINE]

13:
J Electromyogr Kinesiol. 2003 Aug;13(4):361-70. Related Articles, Books, LinkOut
Pain and motor control of the lumbopelvic region: effect and possible mechanisms.

Hodges PW, Moseley GL.

Department of Physiotherapy, The University of Queensland, Brisbane, Qld 4072, Australia. p.hodges@shrs.uq.edu.au

Many authors report changes in the control of the trunk muscles in people with low back pain (LBP). Although there is considerable disagreement regarding the nature of these changes, we have consistently found differential effects on the deep intrinsic and superficial muscles of the lumbopelvic region. Two issues require consideration; first, the potential mechanisms for these changes in control, and secondly, the effect or outcome of changes in control for lumbopelvic function. Recent data indicate that experimentally induced pain may replicate some of the changes identified in people with LBP. While this does not exclude the possibility that changes in control of the trunk muscles may lead to pain, it does argue that, at least in some cases, pain may cause the changes in control. There are many possible mechanisms, including changes in excitability in the motor pathway, changes in the sensory system, and factors associated with the attention demanding, stressful and fearful aspects of pain. A new hypothesis is presented regarding the outcome from differential effects of pain on the elements of the motor system. Taken together these data argue for strategies of prevention and rehabilitation of LBP.

PMID: 12832166 [PubMed - indexed for MEDLINE]

14:
Exp Brain Res. 2003 Jul;151(2):262-71. Epub 2003 Jun 3. Related Articles, Cited in PMC, Books, LinkOut
Experimental muscle pain changes feedforward postural responses of the trunk muscles.

Hodges PW, Moseley GL, Gabrielsson A, Gandevia SC.

Department of Physiotherapy, The University of Queensland, Brisbane, QLD 4072, Australia. p.hodges@shrs.uq.edu.au

Many studies have identified changes in trunk muscle recruitment in clinical low back pain (LBP). However, due to the heterogeneity of the LBP population these changes have been variable and it has been impossible to identify a cause-effect relationship. Several studies have identified a consistent change in the feedforward postural response of transversus abdominis (TrA), the deepest abdominal muscle, in association with arm movements in chronic LBP. This study aimed to determine whether the feedforward recruitment of the trunk muscles in a postural task could be altered by acute experimentally induced LBP. Electromyographic (EMG) recordings of the abdominal and paraspinal muscles were made during arm movements in a control trial, following the injection of isotonic (non-painful) and hypertonic (painful) saline into the longissimus muscle at L4, and during a 1-h follow-up. Movements included rapid arm flexion in response to a light and repetitive arm flexion-extension. Temporal and spatial EMG parameters were measured. The onset and amplitude of EMG of most muscles was changed in a variable manner during the period of experimentally induced pain. However, across movement trials and subjects the activation of TrA was consistently reduced in amplitude or delayed. Analyses in the time and frequency domain were used to confirm these findings. The results suggest that acute experimentally induced pain may affect feedforward postural activity of the trunk muscles. Although the response was variable, pain produced differential changes in the motor control of the trunk muscles, with consistent impairment of TrA activity.

Publication Types:
  • Clinical Trial
PMID: 12783146 [PubMed - indexed for MEDLINE]

15:
J Physiol. 2003 Mar 1;547(Pt 2):581-7. Epub 2002 Dec 20. Related Articles, Books, LinkOut
External perturbation of the trunk in standing humans differentially activates components of the medial back muscles.

Mosel ey GL, Hodges PW, Gandevia SC.

Prince of Wales Medical Research Institute, Sydney, Australia.

During voluntary arm movements, the medial back muscles are differentially active. It is not known whether differential activity also occurs when the trunk is perturbed unpredictably, when the earliest responses are initiated by short-latency spinal mechanisms rather than voluntary commands. To assess this, in unpredictable and self-initiated conditions, a weight was dropped into a bucket that was held by the standing subject (n = 7). EMG activity was recorded from the deep (Deep MF), superficial (Sup MF) and lateral (Lat MF) lumbar multifidus, the thoracic erector spinae (ES) and the biceps brachii. With unpredictable perturbations, EMG activity was first noted in the biceps brachii, then the thoracic ES, followed synchronously in the components of the multifidus. During self-initiated perturbations, background EMG in the Deep MF increased two- to threefold, and the latency of the loading response decreased in six out of the seven subjects. In Sup MF and Lat MF, this increase in background EMG was not observed, and the latency of the loading response was increased. Short-latency reflex mechanisms do not cause differential action of the medial back muscles when the trunk is loaded. However, during voluntary tasks the central nervous system exerts a 'tuned response', which involves discrete activity in the deep and superficial components of the medial lumbar muscles in a way that varies according to the biomechanical action of the muscle component.

PMID: 12562944 [PubMed - indexed for MEDLINE]

16:
Aust J Physiother. 2002;48(4):313-4. Related Articles, Books, LinkOut
Comment on:
Promotion of knowledge leads to better patient outcomes. (Comment on Refshauge et al, Australian Journal of Physiotherapy 48: 171-179).

Moseley L.

Publication Types:
  • Comment
  • Letter
PMID: 12443527 [PubMed - indexed for MEDLINE]

17:
Aust J Physiother. 2002;48(4):297-302. Related Articles, Books, LinkOut
Combined physiotherapy and education is efficacious for chronic low back pain.

Moseley L.

The University of Queensland and Royal Brisbane Hospital, Australia. l.moseley@mailbox.uq.edu.au

Manual therapy, exercise and education target distinct aspects of chronic low back pain and probably have distinct effects. This study aimed to determine the efficacy of a combined physiotherapy treatment that comprised all of these strategies. By concealed randomisation, 57 chronic low back pain patients were allocated to either the four-week physiotherapy program or management as directed by their general practitioners. The dependent variables of interest were pain and disability. Assessors were blind to treatment group. Outcome data from 49 subjects (86%) showed a significant treatment effect. The physiotherapy program reduced pain and disability by a mean of 1.5/10 points on a numerical rating scale (95% CI 0.7 to 2.3) and 3.9 points on the 18-point Roland Morris Disability Questionnaire (95% CI 2 to 5.8), respectively. The number needed to treat in order to gain a clinically meaningful change was 3 (95% CI 3 to 8) for pain, and 2 (95% CI 2 to 5) for disability. A treatment effect was maintained at one-year follow-up. The findings support the efficacy of combined physiotherapy treatment in producing symptomatic and functional change in moderately disabled chronic low back pain patients.

Publication Types:
  • Clinical Trial
  • Randomized Controlled Trial
PMID: 12443524 [PubMed - indexed for MEDLINE]

18:
Spine. 2002 Jan 15;27(2):E29-36. Related Articles, Cited in PMC, Books, LinkOut
Deep and superficial fibers of the lumbar multifidus muscle are differentially active during voluntary arm movements.

Moseley GL, Hodges PW, Gandevia SC.

Prince of Wales Medical Research Institute and the University of New South Wales, Sydney, Australia.

STUDY DESIGN: A cross-sectional study was conducted. OBJECTIVE: To determine the activity of the deep and superficial fibers of the lumbar multifidus during voluntary movement of the arm. SUMMARY OF BACKGROUND DATA: The multifidus contributes to stability of the lumbar spine. Because the deep and superficial parts of the multifidus are near the center of lumbar joint rotation, the superficial fibers are well suited to control spine orientation, and the deep fibers to control intervertebral movement. However, there currently are limited in vivo data to support this distinction. METHODS: Electromyographic activity was recorded in both the deep and superficial multifidus, transversus abdominis, erector spinae, and deltoid using selective intramuscular electrodes and surface electrodes during single and repetitive arm movements. The latency of electromyographic onset in each muscle during single movements and the pattern of electromyographic activity during repetitive movements were compared between muscles. RESULTS: With single arm movements, the onset of electromyography in the erector spinae and superficial multifidus relative to the deltoid was dependent on the direction of movement, but the onset in the deep multifidus and transversus abdominis was not. With repetitive arm movements, peaks in superficial multifidus and erector spinae electromyography occurred only during flexion for most subjects, whereas peaks in deep multifidus electromyography occurred during movement in both directions. CONCLUSIONS: The deep and superficial fibers of the multifidus are differentially active during single and repetitive movements of the arm. The data from this study support the hypothesis that the superficial multifidus contributes to the control of spine orientation, and that the deep multifidus has a role in controlling intersegmental motion.

PMID: 11805677 [PubMed - indexed for MEDLINE]
__________________
Simplicity is the ultimate sophistication. L VINCI
We are to admit no more causes of natural things than such as are both true and sufficient to explain their appearances. I NEWTON

Everything should be made as simple as possible, but not a bit simpler.
If you can't explain it simply, you don't understand it well enough. Albert Einstein
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Old 14-09-2005, 02:22 AM   #5
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Bernard, you are faster than light... FANTASTIC

Are you HUMAN? Or just Bernard?

Very good... very very good... no more commentaries! No need!!!


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Old 15-09-2005, 07:04 AM   #6
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Quote:
Originally Posted by Flavio
Are you HUMAN? Or just Bernard?
Some people think that I am an alien.
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Simplicity is the ultimate sophistication. L VINCI
We are to admit no more causes of natural things than such as are both true and sufficient to explain their appearances. I NEWTON

Everything should be made as simple as possible, but not a bit simpler.
If you can't explain it simply, you don't understand it well enough. Albert Einstein
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Old 15-09-2005, 03:50 PM   #7
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Bernard,

my girlfriend and I agree... you are a kind of alien!


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Old 27-01-2006, 08:55 AM   #8
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Neurology. 2005 Sep 13;65(5):751-3. Related Articles, Links
Comment in:Dysynchiria: watching the mirror image of the unaffected limb elicits pain on the affected side.

Acerra NE, Moseley GL.

Division of Physiotherapy, The University of Queensland, Department of Physiotherapy, Royal Brisbane and Women's Hospital, Brisbane, Australia.

People with complex regional pain syndrome type 1 (CRPS1) watched a reflected image of their unaffected limb being touched and felt pain or paresthesia at the corresponding site on the affected limb. The authors suggest that allodynia and paresthesia can be mediated by the brain and that dysynchiria has implications for the understanding and management of CRPS1.

PMID: 16157911 [PubMed - indexed for MEDLINE]
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Old 27-01-2006, 08:57 AM   #9
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BMC Musculoskelet Disord. 2005 Nov 4;6:54. Related Articles, Links
The effect of motor control exercise versus placebo in patients with chronic low back pain [ACTRN012605000262606].

Maher CG, Latimer J, Hodges PW, Refshauge KM, Moseley GL, Herbert RD, Costa LO, McAuley J.

Back Pain Research Group, School of Physiotherapy, The University of Sydney, PO Box 170, Lidcombe, NSW, 1825, Australia. c.maher@fhs.usyd.edu.au

BACKGROUND: While one in ten Australians suffer from chronic low back pain this condition remains extremely difficult to treat. Many contemporary treatments are of unknown value. One potentially useful therapy is the use of motor control exercise. This therapy has a biologically plausible effect, is readily available in primary care and it is of modest cost. However, to date, the efficacy of motor control exercise has not been established. METHODS: This paper describes the protocol for a clinical trial comparing the effects of motor control exercise versus placebo in the treatment of chronic non-specific low back pain. One hundred and fifty-four participants will be randomly allocated to receive an 8-week program of motor control exercise or placebo (detuned short wave and detuned ultrasound). Measures of outcomes will be obtained at follow-up appointments at 2, 6 and 12 months after randomisation. The primary outcomes are: pain, global perceived effect and patient-generated measure of disability at 2 months and recurrence at 12 months. DISCUSSION: This trial will be the first placebo-controlled trial of motor control exercise. The results will inform best practice for treating chronic low back pain and prevent its occurrence.

PMID: 16271149 [PubMed - in process]
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Old 17-12-2007, 04:07 AM   #10
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Tactile discrimination, but not tactile stimulation alone, reduces chronic limb pain

G. Lorimer Moseley, Nadia M. Zalucki, Katja Wiech,
Received 28 June 2007; revised 11 October 2007; accepted 22 October 2007. Available online 3 December 2007.

Abstract

Chronic pain is often associated with reduced tactile acuity. A relationship exists between pain intensity, tactile acuity and cortical reorganisation. When pain resolves, tactile function improves and cortical organisation normalises. Tactile acuity can be improved in healthy controls when tactile stimulation is associated with a behavioural objective. We hypothesised that, in patients with chronic limb pain and decreased tactile acuity, discriminating between tactile stimuli would decrease pain and increase tactile acuity, but tactile stimulation alone would not. Thirteen patients with complex regional pain syndrome (CRPS) of one limb underwent a waiting period and then not, vert, similar2 weeks of tactile stimulation under two conditions: stimulation alone or discrimination between stimuli according to their diameter and location. There was no change in pain (100 mm VAS) or two-point discrimination (TPD) during a no-treatment waiting period, nor during the stimulation phase (p > 0.32 for both). Pain and TPD were lower after the discrimination phase [mean (95% CI) effect size for pain VAS = 27 mm (14–40 mm) and for TPD = 5.7 mm (2.9–8.5 mm), p < 0.015 for both]. These gains were maintained at three-month follow-up. We conclude that tactile stimulation can decrease pain and increase tactile acuity when patients are required to discriminate between the type and location of tactile stimuli.
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Old 17-12-2007, 04:18 AM   #11
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Here is a link to the study referred to by Eric in post 10.
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Old 07-01-2008, 05:53 AM   #12
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The context of a noxious stimulus affects the pain it evokes.
Pain. Volume 133, Issues 1-3
pp. 1-240 (15 December 2007)
G. Lorimer Moseley and Arnoud Arntz

Abstract
The influence of contextual factors on the pain evoked by a noxious stimulus is not well defined. In this study, a −20 °C rod was placed on one hand for 500 ms while we manipulated the evaluative context (or ‘meaning’) of, warning about, and visual attention to, the stimulus. For meaning, a red (hot, more tissue damaging) or blue (cold, less tissue damaging) visual cue was used. For warning, the stimulus occurred after the cue or they occurred together. For visual attention, subjects looked towards the stimulus or away from it. Repeated measures ANCOVA was significant (α = 0.0125). Stimuli associated with a red cue were rated as hot, with the blue cue as cold (difference on an 11 point scale 5.5). The red cue also meant the pain was rated as more unpleasant (difference 3.5) and more intense (difference 3). For stimuli associated with the red cue only, the pain was more unpleasant when the stimulus occurred after the cue than when it didn’t (difference 1.1). Pain was rated as more intense, and the stimulus as hotter, when subjects looked at the red-cued stimulus than when they didn’t (difference 0.9 for pain intensity and 2 for temperature). We conclude that meaning affects the experience a noxious stimulus evokes, and that warning and visual attention moderate the effects of meaning when the meaning is associated with tissue-damage. Different dimensions of the stimulus’ context can have differential effects on sensory-discriminative and affective-emotional components of pain.
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Old 06-04-2008, 02:58 AM   #13
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I had the pleasure of attending one of Lormier Moseley's seminars last evening. He is a very entertaining speaker and has done some great research to advance the neurobiological revolution.

It was disappointing that only about 6 physiotherapists from our city thought it worthy of showing up. The change will be slow, but it is happening. The people there were very receptive to the message that we, as physiotherapists, should know something about the brain. That there might be something else to consider besides a joint glide and a locking technique.

Lorimer is a great representative for what physiotherapy can become. A scientist!

Has he been invited here for an interview?
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Old 06-04-2008, 03:23 AM   #14
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Nick,
Lucky you!! I would love to hear to him speak!! What was the event?
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Old 06-04-2008, 03:45 AM   #15
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Michael Maxwell, a DC from the West Coast, contacted him and asked him to come to Canada for a couple of seminars. I just checked his website (www.somaticsenses.com) and Mosely will be in Victoria on Monday evening. I guess it's a quick cross-country tour.
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Old 06-04-2008, 03:53 AM   #16
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Default Mind's control of the pain

Moseley is an impressive clinical scientist...

He is working in this "new concept" that we can relief the pain with our mind's control... He has papers about treatment of neuropathic pain with a mirror therapy based on RAMACHANDRAN, and the results is impressive within complex regional pain syndrome Types I and II and in paraplegic patients with pain in lower limbs.

He uses also imagery within the mirror...


Gustavo

See article posted by Gustavo here

Last edited by Jon Newman; 06-04-2008 at 04:20 PM. Reason: Redirected articles to the SoS
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Old 06-04-2008, 02:14 PM   #17
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Here is an interview of a quick overview of some of the things he is working on.
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Old 06-04-2008, 06:01 PM   #18
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Hi Gustavo, welcome to the board.
Here is a link to the Moseley articles Gustavo brought to this thread - they are in a safe, copyright-protected zone. (You will be issued a key to them and a bunch of others shortly, Gustavo. )
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"Rene Descartes was very very smart, but as it turned out, he was wrong." ~Lorimer Moseley

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Old 07-04-2008, 01:06 AM   #19
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Default Mosely in Philadelphia

Lorimer Mosely is scheduled to come to Philadephia PA, USA this summer to address the Greater Philadelphia Pain Society(GPPS).THe date is July 23, in the evening in center city philadelphia. THe meeting is open to members and nonmembers. More info can be had by contacting the GPPS. The website does not yet have the details but the contact info is listed there.
http://www.ampainsoc.org/societies/gpps/

I plan on attending.
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Old 07-04-2008, 01:46 AM   #20
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I'm fairly certain the lecture in Victoria this week has been sold out for quite a while. Fortunately I saw him when he came through here a few years ago.

A trend towards calling an approach to understanding pain and dysfunction after the name of the individual who is its primary proponent has certainly has some precedence in our profession. I've lately heard therapists talking about the Moseley method. I have no problem with assigning credit where it is due, although I do hope the neurophysiological model does no become to attached to any one individual. I wonder how Lorimer feels about this?
The problem I'm seeing among those referring to the Moseley Method is that they appear to study only those articles authored by Lorimer himself, so they're obviously missing out great quantities of information that completes ones understanding. Has anyone else noticed this trend in your area?
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Old 07-04-2008, 02:06 AM   #21
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Eric,

I understood what you said, but these kind of therapy whose use the brain to improve some function or relief the pain is used since 1972 when GLICK used imagery in hypnosis and then another areas used too!

Nowadays the "imagery" is used by athletes to improve movement; in dancers ( there is some books wrote about that ); in patients to improve motor function...

I think you already used this technique but you didn't now. For example, when you play some sports you need to think where you will throw the ball, you are using imagery... that's the idea...

But Moseley is doing this approach within some kind of patients. He is clinical researcher... You can find for SIRIGU A., GIRAUX P., REILLY K., CRAIGHERO L., FADIGA L.....

Don't forget that Moseley has some papers with Australian's researchers who works with chronic low back pain...
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Old 07-04-2008, 02:13 AM   #22
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Eric, I agree. It may encourage a lack of both diversity and honest evaluation. I think this could be a worry for folk like Butler, Shacklock, Mulligan and other antipodean leaders in the field; but it would be good to hear their thoughts on the matter.

I keep remembering that passive mobilisation simply came to be called 'Maitland'. Same with Kaltenborn et al.

I recall the words of a friend of mine who was asked by a student whether she practised Carr and Shepherd or..X..or..Y.. My friend's reply was: They're not keyboards.

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Old 07-04-2008, 04:10 AM   #23
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For all,

There will be a Congress here in Rio de Janeiro/Brazil on September - World Congress for Neurorehabilitation with some speechs about the "cognition therapies" like imagery

If interest the site is http://www.sarah.br/wfnr%2Drio2008/index.htm
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Old 20-04-2008, 08:39 PM   #24
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Check out Lorimer's latest - an article in Scientific American, The Mirror Cure for Phantom Pain.
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"Rene Descartes was very very smart, but as it turned out, he was wrong." ~Lorimer Moseley

“Comment is free, but the facts are sacred.” ~Charles Prestwich Scott, nephew of founder and editor (1872-1929) of The Guardian , in a 1921 Centenary editorial

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Old 29-04-2008, 03:29 AM   #25
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I just came across this new abstract from Moseley et al. Looks like a good study, does anyone have access to the article?
http://www3.interscience.wiley.com/j...TRY=1&SRETRY=0

Rehabilitation
Thinking about movement hurts: The effect of motor imagery on pain and swelling in people with chronic arm pain

G. Lorimer Moseley 1 *, Nadia Zalucki 2, Frank Birklein 3, Johan Marinus 4, Jacobus J. van Hilten 4, Hannu Luomajoki 51Oxford University, Oxford, UK
2University of Sydney, Sydney, Australia
3University of Mainz, Mainz, Germany
4Leiden University Medical Centre, Leiden, The Netherlands
5Physiotherapy Reinach, Reinach, Switzerland
email: G. Lorimer Moseley (lorimer.moseley@medsci.ox.ac.uk)
*Correspondence to G. Lorimer Moseley, Department of Physiology, Anatomy & Genetics, Oxford University, South Parks Road, Oxford OX1 3QX, UK
Funded by:
Nuffield Dominions Trust, UK
German Research Foundation
German Research Network on Neuropathic Pain

Abstract
ObjectiveChronic painful disease is associated with pain on movement, which is presumed to be caused by noxious stimulation. We investigated whether motor imagery, in the absence of movement, increases symptoms in patients with chronic arm pain.
MethodsThirty-seven subjects performed a motor imagery task. Pain and swelling were measured before, after, and 60 minutes after the task. Electromyography findings verified no muscle activity. Patients with complex regional pain syndrome (CRPS) were compared with those with non-CRPS pain. Secondary variables from clinical, psychophysical, and cognitive domains were related to change in symptoms using linear regression.
ResultsMotor imagery increased pain and swelling. For CRPS patients, pain (measured on a 100-mm visual analog scale) increased by a mean ± SD of 5.3 ± 3.9 mm and swelling by 8% ± 5%. For non-CRPS patients, pain increased by 1.4 ± 4.1 mm and swelling by 3% ± 4%. There were no differences between groups (P > 0.19 for both). Increased pain and swelling related positively to duration of symptoms and performance on a left/right judgment task that interrogated the body schema, autonomic response, catastrophic thoughts about pain, and fear of movement (r > 0.42, P < 0.03 for all).
ConclusionMotor imagery increased pain and swelling in patients with chronic painful disease of the arm. The effect increased in line with the duration of symptoms and seems to be modulated by autonomic arousal and beliefs about pain and movement. The results highlight the contribution of cortical mechanisms to pain on movement, which has implications for treatment.Received: 17 July 2007; Accepted: 26 November 2007
Digital Object Identifier (DOI)
10.1002/art.23580 About DOI

Here is the link to the article http://www.somasimple.com/forums/showthread.php?t=6076

Last edited by chad; 05-09-2008 at 07:04 PM. Reason: add link to article in S S
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Old 29-04-2008, 03:59 AM   #26
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Hi CHad,
I tried but it doesn't seem to be up on Medline quite yet.
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"Rene Descartes was very very smart, but as it turned out, he was wrong." ~Lorimer Moseley

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Old 04-05-2008, 05:13 PM   #27
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Default Lorimer Moseley in CHicago July 19-20

Lorimer Moseley is personally giving the NOI "Explain Pain... and the Brain" seminar in Chicago July 19-20. I for one have placed it on my calendar after all the articles I have read both by and about him.
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Old 07-07-2008, 04:39 AM   #28
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Default moseley at magee rehab philly

Here is the registration form for the lecture on july 23 at magee rehabilitation in center city philadelphia, I am looking forward to hearing him speak. Anyone else planning to attend?
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Old 07-07-2008, 05:15 AM   #29
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Chad
I will be there and would be happy to meet you.
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Old 07-07-2008, 05:31 PM   #30
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look forward to meeting you as well,
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Old 10-06-2009, 04:52 PM   #31
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Lorimer Moseley is looking for therapists familiar with GMI/mirror therapy in the Seattle area. If you or anyone you know is interested PM me and I will forward your contact info.

Thanks,
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Old 01-09-2009, 08:48 PM   #32
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Lorimer Moseley is coming to Spain to give a lecture about "Explain Pain" in Madrid 25th September. I am very interested in this lecture. Is anyody else going???
Estherderu, are you going to this lecture, perhaps it could be a good place to meet you
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Old 02-09-2009, 01:21 PM   #33
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dear Javier,
would love to, but am still on holidays in Australia at that time.

Would you send me the details of the conference in Zaragoza?

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Old 24-11-2009, 05:10 PM   #34
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Everyone must clear their agendas and listen to this radio program, an interview, about an hour long, done Nov 24/09, with Lorimer, in Aus. You might have to hunt up the date once calendar time has elapsed.

It's a very personal portrait of a PT who turned his back on being a PT and went for research in biological sciences instead. Thank goodness there are people out in the world capable of breaking their own 'spells'.

It's fabulous. Ten thumbs up.


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"Rene Descartes was very very smart, but as it turned out, he was wrong." ~Lorimer Moseley

“Comment is free, but the facts are sacred.” ~Charles Prestwich Scott, nephew of founder and editor (1872-1929) of The Guardian , in a 1921 Centenary editorial

“If you make people think they're thinking, they'll love you, but if you really make them think, they'll hate you." ~Don Marquis

"In times of change, learners inherit the earth, while the learned find themselves beautifully equipped to deal with a world that no longer exists" ~Roland Barth

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Old 24-11-2009, 06:22 PM   #35
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Diane,

Great find. Covered many topics in clear and concise manner.

Thanks

Gary
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Old 24-11-2009, 07:59 PM   #36
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I listened yesterday (by chance) and it was great. Margaret Throsby is a supreme interviewer and she selects her guests with acumen.

What I didn't know is that Lorimer is an ex-Canberra fellow; paper cut pain and the paradox of labour pain remains something of a mystery.

Should be mandatory listening for those who still believe in tissue pain.

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Old 24-11-2009, 10:15 PM   #37
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Yes, Nari, I thought of you when I heard that his dad was an urban planner.
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Old 25-11-2009, 04:41 AM   #38
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A photo of his dad was lurking in an ACT gazette online and L looks just like him. Graham Moseley seems to have been a significant contributor to planning in the ACT and environs during the 1980s.

By the way, Diane, I had been thinking of Shacklock and not Moseley when I thought about NZ origin. My blue..

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Old 25-11-2009, 05:04 AM   #39
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Originally Posted by nari View Post
A photo of his dad was lurking in an ACT gazette online and L looks just like him. Graham Moseley seems to have been a significant contributor to planning in the ACT and environs during the 1980s.

By the way, Diane, I had been thinking of Shacklock and not Moseley when I thought about NZ origin. My blue..

Nari

OK, was wondering. For sure Shack is NZ.
Lorimer was your next door neighbour!
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"Rene Descartes was very very smart, but as it turned out, he was wrong." ~Lorimer Moseley

“Comment is free, but the facts are sacred.” ~Charles Prestwich Scott, nephew of founder and editor (1872-1929) of The Guardian , in a 1921 Centenary editorial

“If you make people think they're thinking, they'll love you, but if you really make them think, they'll hate you." ~Don Marquis

"In times of change, learners inherit the earth, while the learned find themselves beautifully equipped to deal with a world that no longer exists" ~Roland Barth

"Doubt is not a pleasant mental state, but certainty is a ridiculous one."~Voltaire
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Old 25-11-2009, 06:10 AM   #40
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Lorimer was your next door neighbour!
Close...about 11km away across the lake. Fascinating.

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Old 25-11-2009, 10:10 PM   #41
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Thanks Diane,

Very interesting interview with Lorimer. I really liked the part where he states the clinical models of painful conditions doesn't fit with the known human physiology.
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Old 25-11-2009, 10:35 PM   #42
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I liked that part too. I liked the part where he mentioned that he left PT because he didn't think the pain model was any good, or even right.
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"Rene Descartes was very very smart, but as it turned out, he was wrong." ~Lorimer Moseley

“Comment is free, but the facts are sacred.” ~Charles Prestwich Scott, nephew of founder and editor (1872-1929) of The Guardian , in a 1921 Centenary editorial

“If you make people think they're thinking, they'll love you, but if you really make them think, they'll hate you." ~Don Marquis

"In times of change, learners inherit the earth, while the learned find themselves beautifully equipped to deal with a world that no longer exists" ~Roland Barth

"Doubt is not a pleasant mental state, but certainty is a ridiculous one."~Voltaire
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Old 26-11-2009, 11:33 PM   #43
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I downloaded the interview and listened to it during my travel to work today.
Great interview and a great little repetition from the Explain pain book and discussions here on Soma. It kept me with a good feeling and a reminder of the great metaphors you can use when trying to explain pain. It has hit me before, but today it hit me harder for some reason, that many patients and especially the more acute pain patients are not interested in this.
They want you to fix them with as little activity from them as possible. It’s hard when after explaining they still ask the same questions. –but more concrete what’s really wrong with my back?
Sometimes I wish I wouldn't have swallow that red pill…or was it green

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Old 27-11-2009, 12:00 AM   #44
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I think we all have to do whatever we can to change the world for the better. If we all do a little, like understand the issues better, understand pain better, we can teach/help our patients better. It won't be fast, but it will be unstoppable.
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"Rene Descartes was very very smart, but as it turned out, he was wrong." ~Lorimer Moseley

“Comment is free, but the facts are sacred.” ~Charles Prestwich Scott, nephew of founder and editor (1872-1929) of The Guardian , in a 1921 Centenary editorial

“If you make people think they're thinking, they'll love you, but if you really make them think, they'll hate you." ~Don Marquis

"In times of change, learners inherit the earth, while the learned find themselves beautifully equipped to deal with a world that no longer exists" ~Roland Barth

"Doubt is not a pleasant mental state, but certainty is a ridiculous one."~Voltaire
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Old 27-11-2009, 01:15 AM   #45
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Mike,

It is somewhat easier to inform patients about pain physiology than one's next of kin and close others. Or so I have found....my tribe look at me as if I am a major tooth fairy.

When you think you have hit a wall with patients, try dismantling rock by rock (or brick by brick). The major misconception they have is that their 'pain is in their mind' or similar. See if you can run with that brick first. I recall one patient who was convinced her back was falling apart, although there was no evidence.

When I started to explain pain, she looked miserable and said: "So this pain in my back is not real?" I almost snapped at her that it certainly was 'real' and when she looked a bit shocked, I calmed down and continued with ed.
There was no time for any 'treatment' that day, but she returned smiling next time, saying that she was much much better. The message had sunk home.
On the other hand, snapping at patients is not recommended....

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Old 27-11-2009, 01:28 AM   #46
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Dualism makes everything such a double-visioned blur.
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"Rene Descartes was very very smart, but as it turned out, he was wrong." ~Lorimer Moseley

“Comment is free, but the facts are sacred.” ~Charles Prestwich Scott, nephew of founder and editor (1872-1929) of The Guardian , in a 1921 Centenary editorial

“If you make people think they're thinking, they'll love you, but if you really make them think, they'll hate you." ~Don Marquis

"In times of change, learners inherit the earth, while the learned find themselves beautifully equipped to deal with a world that no longer exists" ~Roland Barth

"Doubt is not a pleasant mental state, but certainty is a ridiculous one."~Voltaire
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Old 28-11-2009, 03:49 PM   #47
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Great interviewer and interviewee Diane....

He seems to suffer from the same issues as many here do i.e being aware of complexity and questioning the status quo...
I think the issues that Lorimer referred to as the Cab Sav ones at the end ie anguish /social issues etc are the ones most people skirt round as they are really complex but unfortunately perplexing and common . I don't think neuroscience and even pain management are the answers here ......Thomas Egnew has a lot to say in this area and the comments and article i found to be of interest.....http://www.annfammed.org/cgi/content/abstract/7/2/170
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Old 28-11-2009, 04:49 PM   #48
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If anyone gets a chance, please stick that Egnew article in the sounds of silence, it looks excellent. Thanks Ian!
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Old 28-11-2009, 05:44 PM   #49
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If anyone gets a chance, please stick that Egnew article in the sounds of silence, it looks excellent. Thanks Ian!
Don't need to Eric. Just click on full text.
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"Rene Descartes was very very smart, but as it turned out, he was wrong." ~Lorimer Moseley

“Comment is free, but the facts are sacred.” ~Charles Prestwich Scott, nephew of founder and editor (1872-1929) of The Guardian , in a 1921 Centenary editorial

“If you make people think they're thinking, they'll love you, but if you really make them think, they'll hate you." ~Don Marquis

"In times of change, learners inherit the earth, while the learned find themselves beautifully equipped to deal with a world that no longer exists" ~Roland Barth

"Doubt is not a pleasant mental state, but certainty is a ridiculous one."~Voltaire
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Old 04-12-2009, 07:59 PM   #50
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Default gene expression and social issues

I thought this article (which is open access) is relevant to my last post ....Here is empirical evidence for the effect of isolation and 'poor coping' in terms of gene expression and enhanced inflammation. I bet a whole raft of 'conditions' fit into this spectrum?
http://www.ncbi.nlm.nih.gov/pmc/arti...7/?tool=pubmed
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