Empowered Beyond Pain

Surgery is often a consideration for many people with back pain, it's the top of the medical triangle, and many believe it will fix them. But Orthopaedic Surgeon, Scientist and Author, Professor Ian Harris, see's it differently. In this episode, he talks to Prof. Peter O'Sullivan, Dr JP Caneiro and Kevin Wernli about all things surgery, placebo, research and pain. We also hear the story of Steve, a 26year old who had disabling back pain for 6 years, was on strong opioids, had multiple surgeries including a spinal fusion, but was still battling. Fortunately, he found his way onto a study researching back pain that Kevin Wernli completed as part of his PhD. Key things discussed: - The effectiveness (or not) of spinal surgery. - Why there are such differences in outcomes in workers compensation patients.- Is pain all in your head? - Alarming rates of increasing surgery rates in the private sector vs public sector, and why that might be. - A call for better evidence (and who should fund it!).- The key question patients NEED to ask their healthcare professionals. Show notes available at https://www.bodylogic.physio/podcast A huge thanks to ABC and ABC 730 for granting us permission to use their content for educational purposes. Twitter handles @EBPPodcast @PeteOSullivanPT @JPCaneiro @KWernliPhysio *Peter O’Sullivan and JP Caneiro were awarded specialisation by the Australian College of Physiotherapists in 2005 and 2013 respectively. Theme music by Fervun and Cash. For educational purposes only. Created and produced by Kevin Wernli

Pain flare ups are unfortunately common, and they can be really distressing, especially if your feeling like you've been making good progress. But there are some misconceptions which can keep you in a loop. Professor Peter O'Sullivan and Dr JP Caneiro discuss patient voice Jamie's journey through the ups and downs of flare ups. My take homes:- Flare ups, while not pleasant, are unfortunately common and a pretty normal part of recovery. - While they can be terrifying in the moment, the don’t last forever, and can be an incredible learning opportunity. - They are usually more related to things that sensitise our system, like poor sleep, stressful times, being more sedentary, working longer hours, not having time to recover or doing too much too soon, and infrequently relate to creating further damage - even though it may be really painful. - Although it can feel like a big step back and that you’ve un-done all your progress, this is rarely the case, you may find it helpful to think of it as a temporary ‘pause’ on your progress, not a restart. Show notes available at https://www.bodylogic.physio/podcast Twitter handles @EBPPodcast @PeteOSullivanPT @JPCaneiro @KWernliPhysio *Peter O’Sullivan and JP Caneiro were awarded specialisation by the Australian College of Physiotherapists in 2005 and 2013 respectively. Theme music by Fervun and Cash. For educational purposes only. Created and produced by Kevin Wernli

It's common to believe that movement, loading and bending causes 'wear & tear' of the spine - especially if it's painful. But that belief hugely undermines our body's capacity to adapt. Learn more about fact 8 from the 10 facts every person should know about low back pain scientific paper with co-author's Dr JP Caneiro and Kevin Wernli.

*Apologies for the scratchy audio, we'll aim to rectify it in future recordings*

Show notes available at https://www.bodylogic.physio/podcast Twitter handles @EBPPodcast @PeteOSullivanPT @JPCaneiro @KWernliPhysio *Peter O’Sullivan and JP Caneiro were awarded specialisation by the Australian College of Physiotherapists in 2005 and 2013 respectively. Theme music by Fervun and Cash. For educational purposes only. Produced by Kevin Wernli

We used to think core stability was important for low back pain, but modern research questions this common belief. Professor Peter O'Sullivan is in many ways the perfect guest for this podcast. He's had a lived experience of trying to fix his debilitating low back pain through core exercises, he researched core stability as an early career researcher and has almost come full circle as a distinguished Professor of Musculoskeletal pain and Specialist clinician.

Show notes available at https://www.bodylogic.physio/podcast Twitter handles @EBPPodcast @PeteOSullivanPT @JPCaneiro @KWernliPhysio *Peter O’Sullivan and JP Caneiro were awarded specialisation by the Australian College of Physiotherapists in 2005 and 2013 respectively. Theme music by Fervun and Cash. For educational purposes only. Produced by Kevin Wernli

Learn the truth about posture and low back pain. Sleeping posture, sitting posture, lifting posture, it's all covered in this episode with patient voice Joe, researcher and physiotherapist Nic Saraceni, and co-hosts Professor Peter O'Sullivan and Kevin Wernli.

Show notes available at https://www.bodylogic.physio/podcast Twitter handles @EBPPodcast @PeteOSullivanPT @JPCaneiro @KWernliPhysio *Peter O’Sullivan and JP Caneiro were awarded specialisation by the Australian College of Physiotherapists in 2005 and 2013 respectively. Theme music by Fervun and Cash. For educational purposes only. Produced by Kevin Wernli

What's the best posture? Are posture correctors good/bad/safe? There are many outdated beliefs still commonplace among society, so what does the evidence say? In today's episode, we talk to Diane Slater and Dr Kieran O'Sullivan all about posture, and how reading and conducting research into posture made us all move on from those old beliefs.

Show notes available at https://www.bodylogic.physio/podcast

Twitter handles @EBPPodcast @PeteOSullivanPT @JPCaneiro @KWernliPhysio *Peter O’Sullivan and JP Caneiro were awarded specialisation by the Australian College of Physiotherapists in 2005 and 2013 respectively. Theme music by Fervun and Cash. For educational purposes only. Produced by Kevin Wernli

What does pain with movement mean? Many think it's a warning that harm is being done and a signal to stop. This week, clinician-researchers Professor Peter O’Sullivan and Kevin Wernli are joined by Megan who has a lived experience with chronic low back pain that resulted in 3 spinal surgeries.

Take homes:

- Megan's reframing of pain as danger meaning stop, to pain as being okay to move was important.

- Learning modern pain science (especially that the brain produces pain) helped her move forward.

- Having a trusted coach to hold her hand was imperative.

- Ergonomic advice such as 'keep your back straight', 'brace your core' and 'sit up straight' wasn't helpful nor is it evidence-based.

Show-notes available at https://www.bodylogic.physio/

Twitter handles @EBPPodcast @PeteOSullivanPT @JPCaneiro @KWernliPhysio *Peter O’Sullivan and JP Caneiro were awarded specialisation by the Australian College of Physiotherapists in 2005 and 2013 respectively. Theme music by Fervun and Cash. Produced by Kevin Wernli

How relevant are scans (MRI, CT, X-RAY etc) for low back pain? Imaging is commonplace these days, but is it actually doing more harm than good?

This week, patient voice Joe joins clinician-researchers Professor Peter O’Sullivan and Kevin Wernli as they discuss the evidence around imaging for low back pain. As well as the negative emotional and physical impact Joe's scan had on him - a common story among many with low back pain. The show-notes (www.bodylogic.physio/podcast) for this page share 3 imaging infographics, as well as links to all the references discussed in this episode.

Take homes were:

- Imaging is important, but only for ~5-10% with back pain

- Imaging findings are common in people without pain, and don’t predict future pain or function

- MRI reports don’t appear to be that consistent between MRI centres

- Routine imaging is not associated with better outcomes, and is in fact often harmful, not to mention costly.

Twitter handles @EBPPodcast @PeteOSullivanPT @JPCaneiro @KWernliPhysio

*Peter O’Sullivan and JP Caneiro were awarded specialisation by the Australian College of Physiotherapists in 2005 and 2013 respectively. Theme music by Fervun and Cash. Produced by Kevin Wernli

Professor Rachelle Buchbinder is a world-leading back pain clinician and researcher, today she discusses the current understanding and management of low back pain. Rachelle, who is a rheumatologist, clinical epidemiologist, and NHMRC Senior Principal Research Fellow at Monash University in Melbourne was kind enough to have a conversation with Professor Peter O’Sullivan and Kevin Wernli. Rachelle led the distinguished low back pain series of research papers in the prestigious medical journal ‘The Lancet’ (https://www.thelancet.com/series/low-back-pain), a series that was highly publicised and highly regarded in the low back pain field. Rachelle has been at the forefront of promoting better, and eliminating wasteful, musculoskeletal pain management and has been tenacious in this endeavour.

Key take-homes were: Social sharing and mass media campaigns can be pivotal at moving the needle in a positive direction Vested and conflicts of interest are rife in the low back pain industry, presenting a big barrier for high-value care Back pain due to serious tissue damage is incredibly rare (less than 1% in primary care), but this doesn’t mean people can’t have serious pain. For the overwhelming majority, you don’t need imaging, it is safe to stay at work, and safe to keep moving, even if you have serious pain (which can be influenced by lots of different physical, emotional and lifestyle factors).

You can find the show notes at: www.bodylogic.physio/podcast which features over 20 references to the studies discussed in this episode!

Twitter handles: https://twitter.com/EBPPodcast https://twitter.com/RachelleBuchbin https://twitter.com/PeteOSullivanPT https://twitter.com/JPCaneiro https://twitter.com/KWernliPhysio *Peter O’Sullivan and JP Caneiro were awarded specialisation by the Australian College of Physiotherapists in 2005 and 2013 respectively. Theme music by Fervun and Cash. Produced by Kevin Wernli

We've made the decision to move to fortnightly releases. This is to give us a bit more breathing room between episodes so we can ensure we keep bringing you high-quality content. Let us know what you think via @EBPpodcast on social media. It'll also give you time to revisit some older episodes, or browse the show notes which are always packed full of resources, videos or infographics. www.bodylogic.physio/podcast It'll also give you more time to ask... is there more to pain than damage. Produced by Kevin Wernli