Artikkel som går igjennom svært mye forskning fra mange år tilbake og beskriver hvordan MRI, røntgen og lignende diagnosekriterier ikke har noen som helst sammenheng med smerteproblemer. Dette bidrar heller til fryktmaksimering og deigjennom mer smerte.
http://www.chirogeek.com/000_MRI-Abnormalities_Asymptomatic-Pats.htm
Nevner at placebo bør inkluderes som en del av behandling for å maksimere smertedempende effekt og behandlingsresultater.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3172952/pdf/jmt-19-01-011.pdf
«We suggest that manual therapists conceptualize placebo not only as a comparative intervention, but also as a potential active mechanism to partially account for treatment effects associated with manual therapy. We are not suggesting manual therapists include known sham or ineffective interventions in their clinical practice, but take steps to maximize placebo responses to reduce pain.»
Nevner sammenhengen mellom nervebetennelser, stress, depresjon, m.m. i kroniske smerter. Bl.a. at «varm» vs «kald» tilstand i hånden viser til om det er i starten eller har pågått lenger enn 1 år. Den «kalde» tilstanden er mer smertefull.
http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0018775#pone-0018775-g007
«we developed a model based on interaction analysis suggesting a complex hierarchical interaction of peripheral (injury/sensory loss) and central factors (pain/disability/stress/depression) predicting motor dysfunction and hyperalgesia.»
«As the presence of an inducible autonomic nervous system autoantigen has been recently demonstrated in CRPS patients, one may speculate about possible interactions between autoimmune and inflammatory processes dominating the acute phase of CRPS, whereas in chronic CRPS the clinical signs of peripheral neurogenic inflammation and autonomic dysfunction may have mostly subsided due to post-inflammatory burn-out.»
«Furthermore, it has been demonstrated that patients initially classified as “cold” CRPS showed more pain when re-evaluated several years after the initial assessment [3]. “Warm” CRPS seems to be predominant in the acute phase of CRPS, where signs of peripheral neurogenic inflammation dominate»
Studie som viser at kontekst som vi pakker behandlingen inn i er viktig som smertedempende effekt.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3590449/
«Furthermore, the change in outcome hedonics correlated with activity in the periacqueductal grey (PAG) of the descending pain modulatory system (DPMS). The context manipulation also significantly increased functional connectivity between reward circuitry and the PAG, consistent with a functional change of the DPMS due to the altered motivational state. The findings of this study point to a role for brainstem and reward circuitry in a context-induced “hedonic flip” of pain.»
Verkstedet Bodywork & Breathing System 