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Integrative Diagnosis and Pain Science

Exit forum ID Forum Discussion Integrative Diagnosis and Pain Science

This topic contains 2 replies, has 3 voices, and was last updated by   Adam Holen D.C. May 8, 2020 at 1:22 pm.

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    Brandon Cohen DC, CSCS

      As some of you may have seen, I was in a mild back and forth on an EB Chiroprator Facebook group with a couple of heavy pain science guys. I have several anecdotal comments that really don’t add to the conversation, but because we are among friends….

      It’s interesting that the majority of those involved in the movement are relatively new graduates and believe they have all the right answers because the rest of the profession is stuck in their ways and can’t see the truth that is in front of them. The smugness of the whole thing is exhausting. Also, the concept that you can be right because you have the longest responses on Facebook is nauseating. If you keep making the same point over and over without any additional thought or rationale, you are not right, you are stupid.

      Well, that was unnecessary. Here’s how pain science works in the real world. I had an established patient come in the other day. I have previously treated him for his lumbar spine, and am currently treating his lateral elbow. So the great news is that I know his starting point for his flexibility and know his ending/max ranges of motion for his lumbar spine.

      He had an acute flare in his lumbar spine over the weekend, and came in for an exam for the exacerbation. We talked about what caused it (unknown) and that it was really bad and scary for about 2 days, but that it was getting better. He is under Corona Virus related stressors at home and with work, and just purchased a pool that he will be setting up the next weekend.

      I’m concerned that he has exacerbated his previous disc injury, and that things are moving in a negative direction. He is also concerned for the same things.

      We did an exam, and his ranges were at least 90% of his max range for all his low back tests. We talked about inflammation and how that works, did a little treatment for QLF which had decreased 5% since the last time I saw him for this 4 months ago, and scheduled one follow up visit at the end of the week. He came back on Friday, reported 0/10 pain, and his ranges were back to his max QLF.

      This is what the pain science crowd assumes everyone to be, and its dangerous.


      William Brady, DC

        Thanks for sharing. I have had similar experiences. I just quit the “exploring pain science” and “evidence based chiropractic” facebook groups. I quit because I had not learned one valuable thing and it seems not one person learned a things from me. Just lots of disagreement without pause to consider the facts.

        Yes, it seems most of these people don’t have a degree to diagnose or any degree at all. Plenty of yoga instructors, students, interested members of the public… It reminds me of the podcast I did a few years back. The other providers had no data just lots of opinions and strong emotion. Afterwards a peripheral neurosurgeon emailed me and said “Those guys would be eaten alive in medicine. They are completely wrong.”

        What worries me the most is that pain science is permeating the scientific community and the associations. A paper titled “evaluation is treatment for low back pain” was just published. With conclusions that are completely unsupported by the data. I even looked up the lead author. He has a track record of “research” with no control groups, majority of changes below the clinical useful level and concludes that there is a significant therapeutic effect. Shame on this author, the journal editors and the peer reviewers- but hey we live in the times of click bait science. If you are interested:

        Probably best to keep your head down and keep treating patients. Thanks for trying.


        Adam Holen D.C.

          What I would love to know (from the pain scientologists) is what constitutes a “successful” patient case. From what I gather, reducing pain is not their MO because they seem to confuse what’s common for what’s normal. This is likely why all of these conversations devolve into pissing matches of whos cherry-picked research is better.
          So how do you have a successful pain science practice? Patients that buy into the therapeutic alliance crap and enjoy lifting weights? Confidence in the fact that although you have pain, it won’t be the cause of death? Karen can now attribute all of her problems to the manager?
          I don’t get it. Some of these people are very intelligent, yet their rationale/logic is literally skewed by data.
          I’ve boiled it down to, no one is paying me to prove random people on the internet wrong, so it’s ultimately a waste of time.
          We sell reality and solutions to people who genuinely need them. Although our message is not a sexy or simple one, it’s literally life-changing. Our time is best spent on improving our skills and delivering this care to those who need it most.

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