Thursday, August 9, 2018

Heel Pain-Plantar Fasciitis and Neurodynamics

This is a fascinating read on a subject near and dear to me.
It was pain diagnosed as Plantar Fasciitis that sent me on a path that eventually led me to study massage, and my fascination with painscience and neuroscience
In my case, I may have had inflamed plantar fascia--but I definitely had a neurodynamic disorder/nerve entrapment, which was relieved by a medical massage therapist (my hero!) and self-massage and mobilization.

Some key points from this article:

>However in relation to the more physical and benign causes, there are some key facts about neurodynamic problems at the ankle that are important when considering foot pain:

  • clearly not all foot/heel pain comes from nerves, but some does.
  • nerve abnormality is an underestimated cause of foot pain. Research shows that patients with foot pain can show reduced nerve conduction in various nerves in the ankle/foot region (Schon et al 1993)).
  • nerve problems can masquerade as plantar fasciitis and other local causes of heel pain.
  • there should be a distinction between 'nerve entrapment' and 'neurodynamic disorders' around the ankle and foot. Nerve entrapment is frank trapping of the nerve which is mostly likely a compressive lesion (eg. tarsal tunnel syndrome). But, whilst the term 'neurodynamic disorders' includes 'nerve entrapment', the term should be used to denote other types of mechanical and physiological problems in nerve function at this location, eg. nerve irritation and inflammation due to excessive use of the ankle combined with excessive pronation. This may produce a neurodynamic disorder (probably neuritis) caused by mechanical irritation.
  • tissue changes in the foot/heel eg. swelling and tenderness DO NOT EXCLUDE a neurodynamic cause. This is because the nerves can produce inflammatory changes in the tissues they innervate by a mechanism called 'neurogenic inflammation'.<

>Nerves that are exposed to excessive or repeated mechanical force may become hypersensitive and produce impulses in both afferent and efferent directions. Afferent impulses may cause pain and efferent ones may cause inflammation in the tissues innervated by the sensitised nerve (neurogenic inflammation).<

Thursday, August 2, 2018

Antidepressants Work for Major Depression! Not so Fast...

A recent article in Medscape states:
>The latest attempt to trick ourselves into believing that the past few decades of prescribing antidepressants has been an effective strategy comes from one of the most prestigious medical journals, The Lancet. The published meta-analysis' basic finding—since repeated all over the press—is that antidepressants work because they are all better than placebo. What they don't tell you is that they are hardly any better than placebo, and that the only drugs with clinically meaningful benefits are the ones that are used rarely today, the older tricyclic agents.<
The effect sizes seen are about a 2-point improvement versus placebo on the Hamilton Depression Rating Scale, which is lower than the minimum threshold of a 3-point improvement for clinically meaningful benefit set by an earlier 2004 guidance by the UK's then-named National Institute for Health and Clinical Excellence.[3]
They have found, repeatedly, that antidepressants either are not more effective than placebo, or they are slightly more effective.>Because of this, their results are not limited to or mostly influenced by the published literature, which is known to be markedly biased in favor of antidepressant drug efficacy. (This is because pharmaceutical companies usually have not published negative studies of antidepressants.)<


Read it all:
Antidepressants Work for Major Depression! Not so Fast

About the older tricyclics:
from Mayo Clinic: Tricyclic antidepressants and tetracyclic antidepressants

Mental health: Videos I recommend

What I watch. GREAT resource: For example: ...