Marathon des Sables

The Narrative Series (1) | Marathon de Sables by George Griffin

Marathon des Sables

My old friend George Griffin has kindly agreed to write about his incredible experience of running the Marathon des Sables. This is part of a series of guest blogs, The Narrative Series, where I have asked individuals to tell their stories that feature pain in different contexts and environments. Pain perception is influenced by the meaning that we ascribe to the feeling and there is of course an enormous difference between a pain that we know will end and a pain that appears to have no end in sight. The understanding of pain is moving on rapidly via the research being undertaken worldwide, followed by newer treatments and approaches that tackle the different dimensions–physical, cognitive & emotional. We know that pain can change and that we can positively influence the experience by creating the right conditions.

In April 2008, I took part in the 23rd Marathon des Sables (MdS), a 150-mile footrace across the Moroccan Sahara, reputedly the toughest on earth. The MdS is undoubtedly a grueling undertaking. The distance is split into six stages ranging from 12 to 50 miles and covers a mix of terrain including energy-sapping dunes, roasting salt-flats and steep, rocky jebels. Temperatures often peak at over 50°C and can drop to near freezing at night. Competitors must carry all their own food and equipment, which can tip the scales at about 15kg including your water ration.

Although there is a first class medical set up, competitors need to be pretty self-sufficient when it comes to looking after their health and wellbeing. I was pretty sure I could get to the finish line but wasn’t sure what state I’d be in. My biggest concern was being withdrawn by the medical team due to blisters, dehydration and/or sickness.

Ultimately, I finished 281st out of the 747 who completed the race (801 started) having covered the distance in a cumulative time of 40 hours and 20 minutes. I was the 30th of 250 British competitors, which sounds a bit better! Fortunately, I had avoided illness but my feet had suffered badly and certainly slowed me down. Both heels and insteps were badly blistered (and infected) and I had lost four toenails. Psychologically, it had been a complete rollercoaster – the joys of new friendships and the beauty of the Sahara contrasted with the mental exhaustion and periods of loneliness and isolation.

And yet I would consider the MdS to be one of the most wonderful experiences of my life. This often surprises people, particularly when they see the pictures of my post-race feet! I think that I got through the MdS using a combination of imagination and curiosity. Imagining crossing the finish line. Imagining the deep, warm bath and cool beer back at the hotel. Imagining how much money I was raising with every mile covered. And imagining how proud my family and friends would be.

Marathon des SableI think, with a vivid imagination and a deep sense of curiosity, I was able to short-circuit the ‘you need to stop, NOW!’ messages that my feet and muscles were sending to my brain with every step. Each morning, when shuffling to the start line, I was curious about the day ahead. Who would I meet? What new sights would I see? What would I learn? How much would it hurt?

Did I think of quitting? Yes, many, many times (along with the elaborate excuses I would use), but ultimately I knew that the blisters, sore muscles and fatigue weren’t going to kill me. They would hurt but they weren’t terminal. Eventually, it would be over and I would be sipping a beer back at the hotel.

And, of course, it’s all relative. There are people who suffer constant pain and don’t volunteer for it like I did. In that respect, the MdS is a warm, sandy run in the desert rather than the toughest footrace on earth.

George started his career as an Army Officer where he spent eight years in various roles before making the transition to the commercial world in 2004. After a short period as Operations Manager for a corporate events firm, George joined an HR consultancy in a business development role before taking over the Learning and Development practice in 2010. George joined Merryck in April 2013 and is responsible for ensuring that our clients receive the best possible service.

Follow George on Twitter here and @painphysio here

Keble coll

Tackling dystonia | British Neurotoxin Network Conference 2013 | Keble College, Oxford

Keble collIt was a pleasure to speak at the British Neurotoxin Network conference this week, a meeting for specialists in dystonia who use botulinum toxin as a form of treatment. Held at Keble College in Oxford, the surroundings were perfect for meeting, discussion and the sharing of ideas.

BNN Conference Programme here

Before dining in the magnificent hall, the audience was entertained by a talk from Dr. Marion on facial expressions, referring to Duchenne, Darwin and the work of Paul Ekman. Much of our communication relies on body language with facial expression revealing much about the emotional state. This is useful to communicate effectively, to demonstrate empathy and to determine threat—i.e. an angry face. Equally, a loss of facial expression due to cosmetic Botox treatment or facial paralysis affects one’s ability to show genuine emotion. A lesser known feature is that we can change our expression to alter our emotion. A simple technique to improve one’s mood is to grip a pencil between your teeth thereby forcing a smile. The feedback from the face to the brain persuades it it sense something good and hence our mood alters.

The focus of my talk was upon the reconceptualisation of pain, looking at whether this process can be considered as a way to progress the rehabilitation of dystonia. The slow move away from a biomedical model to the comprehensive biopsychosocial model has changed both the way we think about and tackle the problem of pain. Understanding that pain is multidimensional (physical, cognitive and emotional) means that there are a number of considerations that are unique to the patient. This makes it key to address the person as much as the condition.

In addition to the tissue based therapies that play role in the treatment of chronic pain, the modern brain based techniques are becoming increasingly recognised as part of a comprehensive programme. Discussing these therapies for pain in the light of what we know about the underlying mechanisms, it has been apparent that they could apply in dystonia and other movement disorders. The cortical reorganisation that we understand in both pain and dystonia is an important focus of a training programme. Graded motor imagery, tactile discrimination training and other brain targeted strategies not only seek to ‘re-organise’ but also to desensitise. Pain is all about a perceived threat by the brain, so any change or learning that reduces the threat can change pain and also movement.

With movement being an expression of who we are, how we are feeling, what we are doing and what we intend to do (we may not realise this fully), when we have difficulty because of pain or a lack of voluntary control, this impacts upon the way we feel. Our movement and posturing interface with the World, so reflect the situation that we are in as much as how we feel about that situation. The bidirectional nature of this interface offers different ways of changing our emotional state and retraining normal movement.

The science based talks focused upon genes (Dr Sean O’Riordan, Consultant Neurologist), cortical reorganisation, the effects of vibration (Dr Richard Grunewald) and deep brain stimulation (Mr Alex Green, Neurosurgeon), all of which are ‘neuroimmune’ lines of thought. Tying this basic science with what we can do therapeutically is a key way in which we can seek to move forward and cultivate new ideas. Clearly we need further research to look at all of these paradigms and develop our knowledge but we are in an excellent position to use some of the existing pain therapies that target the central nervous system to improve body sense and motor control via sensorimotor congruence.

Thanks to Dr Marion and Mondale Events for a great two days.

Here is some information on our treatment, training and coaching for dystonia


Back pain and neck pain | Common problems that we treat

BBC Horizon ‘The Secret World of Pain’ | #pain

Back pain and neck pain | Common problems that we treatBBC’s Horizon programme in 2011 that looked at the latest research in pain. Understanding has rolled on since this time, but some interesting features nonetheless. It is worth remembering that pain is a conscious experience that emerges from the body although the actual representation is within the brain–a widespread matrix of neurons in the brain. The bottom line is ‘threat’. When the brain determines that our body is in danger, we will feel pain in the area that needs protecting. This is of course very useful biologically in an acute situation (although the intensity of the pain or even the existence of pain is hugely–consider the many tales in A & E and on the battlefield where significant trauma causes no pain) but not so if it persists. The underlying activity and certainly the focus of treatment is very different.

Exercise for health and performance

‘Gentle’ exercise is good for the brain | #performance #health

Exercise for health and performanceWe know only too well how important it is to be physically active. This may mean formal exercise or sports, but equally we can be on the move and using our bodies when undertaking day-to-day tasks.

Researchers have previously found that exercise affects the brain in positive ways, including enhancing learning and memory. How to go about exercising is yet to be defined, the reality being that it is likely to be influenced by our genetic make-up, i.e. ‘personal training programmes’. It has been thought that the benefits come from vigorous exercise, however this may not only be the case.

A recent study by Michelle McDonnell and her team has found that gentle exercise affects the brain in very good ways. Low to moderate physical activity for 30 minutes stimulated neuroplastic activity. This is the basis for how we learn.

This is also excellent news for chronic pain sufferers who are trying to become more active. It shows that we can use low intensity exercise to affect the brain positively. Many people in pain describe a loss of energy, resources, focus, concentration, memory and resilience. To improve this situation, exercise is needed yet often feared. By creating a baseline and reducing the threat of being active by developing understanding of pain, you can gradually build tolerance and confidence as well as improve brain function. This usually takes the focus away from the pain as you are able to engage in more meaningful activities.

For those seeking to improve their performance at work there are a number of strategies that can be used. Developing improved focus and attention using mindfulness training, taking refreshers and renewal breaks to sustain energy levels, cultivating skills of resilience and clear thinking to deal with situations and regular exercise to sharpen the brain and maintain physical fitness.

For details on programmes that incorporate these techniques for chronic pain, injury and developing performance, contact us on 07932 689081.

See the article below:

A single bout of aerobic exercise promotes motor cortical neuroplasticity.

J Appl Physiol (1985). 2013 May;114(9):1174-82. doi: 10.1152/japplphysiol.01378.2012. Epub 2013 Mar 14.

McDonnell MN, Buckley JD, Opie GM, Ridding MC, Semmler JG.


International Centre for Allied Health Evidence, University of South Australia, Adelaide, South Australia, Australia. [email protected]


Regular physical activity is associated with enhanced plasticity in the motor cortex, but the effect of a single session of aerobic exercise on neuroplasticity is unknown. The aim of this study was to compare corticospinal excitability and plasticity in the upper limb cortical representation following a single session of lower limb cycling at either low or moderate intensity, or a control condition. We recruited 25 healthy adults to take part in three experimental sessions. Cortical excitability was examined using transcranial magnetic stimulation to elicit motor-evoked potentials in the right first dorsal interosseus muscle. Levels of serum brain-derived neurotrophic factor and cortisol were assessed throughout the experiments. Following baseline testing, participants cycled on a stationary bike at a workload equivalent to 57% (low intensity, 30 min) or 77% age-predicted maximal heart rate (moderate intensity, 15 min), or a seated control condition. Neuroplasticity within the primary motor cortex was then examined using a continuous theta burst stimulation (cTBS) paradigm. We found that exercise did not alter cortical excitability. Following cTBS, there was a transient inhibition of first dorsal interosseus motor-evoked potentials during control and low-intensity conditions, but this was only significantly different following the low-intensity state. Moderate-intensity exercise alone increased serum cortisol levels, but brain-derived neurotrophic factor levels did not increase across any condition. In summary, low-intensity cycling promoted the neuroplastic response to cTBS within the motor cortex of healthy adults. These findings suggest that light exercise has the potential to enhance the effectiveness of motor learning or recovery following brain damage.


Chronic pain to #dystonia: how physiotherapy can target cortical reorganisation – speaking this week at BNN Conference

DystoniaI am delighted to be speaking at the British Neurotoxin Network conference this coming week, giving an opportunity to talk about how we can target the higher centres with wise action and therapy for dystonia. The more recent literature has identified functional changes in a widespread network (e.g./ cerebral cortex, basal ganglia, cerebellum), cortical reorganisation and the importance of non-motor factors. In essence, a biopsychosocial look at this hugely impacting condition.

With a background in pain neuroscience it is fundamental to consider the physical, cognitive and emotional dimensions of any condition. The integrated nature of these dimensions are often key points and areas to target with education, therapy and strategies that seek to create the conditions for change and development, i.e. the treatment and training.

Dystonia is not about the basal ganglia as much as pain is not about damaged tissue. It is about an individual with a conscious experience that has evolved as a consequence of the combination of genes and the life story so far (epigenetics). To seek to change the experience we must consider the biology of the condition such as changes in the neuronal activity, the way in which the person thinks about their problem and the emotional responses. In comprehensively tackling the individual’s situation we can make headway by tapping into our neuroplastic mechanisms that underpin learning and adaptation but for the better. This equally applies for both chronic pain and dystonia, the similarities of which I will be discussing and drawing upon to provoke thought and advancement of the treatment for the latter.

Dystonia Clinic in London

Next: Interesting matters arising from the BNN Conference


Chronic pain treatment programmes

You’ve had an intervention for pain – what is next?

Chronic pain treatment programmesMany people with persisting and chronic pain elect to have an intervention for pain relief. This can include steroid injections, facet joint injections, nerve root blocks, epidurals, denervations and sympathetic blocks to name but a few. These procedures are usually administered by a pain consultant (a doctor who specialises in pain management), an orthopaedic surgeon, a radiologist or a rheumatologist.

Undoubtedly, the interventions can afford pain relief but of course the results do tend to vary from person to person. Ideally, the procedure forms part of a multidimensional treatment programme that aims to reduce symptoms, increase activity levels and improve quality of life in the patient’s eyes.

So, what happens next?

In some cases nothing and in others patients are advised to reactivate with the help of a physiotherapist. In the former scenario, the expectation is that the procedure will solve the problem, the pain will ease and life returns to normal. Unfortunately there is an error with this thinking as in the vast majority of cases this leaves the patient with a host of unanswered questions: how much should I do? Can I do this or that? Is it safe? etc etc. If the pain persists in any shape or form, this increases the threat value of these questions. They must be answered with practical solutions.

Undoubtedly to follow a comprehensive programme that addresses the physical and cognitive dimensions of pain is desirable. The intensity and length of a programme will vary from person to person, but as a minimum, the patient should know what they can do and how they can do it as a way of moving forward.

Within the programme there are fundamental issues that must be tackled. For example, in many cases of persisting pain, the way in which movement is controlled has changed as has body perception. This has to be retrained and there are specific ways of achieving this goal. We know that these mechanisms play a role in sensitivity and hence need to be targeted.

Concurrent with physical training is the absolute need to create the right mindset and deal with any associated fears of movement. This may include working upon resilience, motivation and coping so that the training outcomes are optimised.

In summary, the understandable use of pain interventions should be part of a multidimensional treatment and training programme that tackles the physical, cognitive and emotional aspects of the pain problem.

Murray to have back surgery

A few thoughts on Andy Murray and his ‘minor back surgery’.

MurrayThe news that Andy Murray is to have a minor back operation hit the back pages last week. It is understood that he will undergo a microdiscectomy, a technique that minimises the tissue trauma in order to access the injured disc and the nerve that is being impacted upon by this structure.

Microdiscectomy – what is it?

For the decision to be made, it is likely that a disc has been seen on a scan to be affecting the health and physiology of a nerve root (where the nerve emerges between the vertebrae). In some people this will occur without causing pain but if pain and sensitivity does arise, then it is due to a gradual change in disc health over many months. Of course, it is very possible that repeated movements and in particular rotations with force will impact under certain circumstances. In fact, with any injury that is gradual, one has to consider the combination of circumstance (‘environment’) and genetics–termed epigenetics.

It seems that Murray has been experiencing back pain for several years. Many people who I see are in a similar situation having had pain for some time, often punctuated with more acute episodes. These acute bursts of pain are highly unpleasant and can make moving, working, sleeping and functioning very difficult for a few days and sometimes longer. When it comes to sports people, we can think about the injury or pain as threatening their career, however this is the same for others who plan to return to work following a back operation. Clearly the end point is different but the preparation and early rehabilitation need not be.

Preparing for surgery – see here

I make a point of encouraging a proactive approach to pre-op preparation both physically and mentally. Where possible, you want to be fit and healthy with ‘prehabilitation’, which is a structured programme of exercises to maximise tissue function. Picking up on the rehabilitation after surgery can be far easier if this is done in an orgainsed manner.

Equally, dealing with the mindset and fears that can encroach on one’s ability to train is as important. Understanding the pain, procedure, goals of the surgery and the recovery process will go a long way to reduce the stress and anxiety of an operation – or rather, the thought of an operation prior to the procedure. Using techniques such as mindfulness and relaxed breathing can be potently effective in reducing stress that occurs as a result of negative thinking. Certainly catastrophising about pain can lead to greater inflammation and thereby affect the healing process. We are seeking to optimise healing and therefore dealing with thinking that is overly worrisome can impact upon the immune system in the right way.

Early recovery

This will vary from person to person but in the initail stages it is all about allowing the tissues to go about their healing process, orchestrated by the neuroimmune system and certainly affected by other body systems. Beyond the gradual increases in movement, and tissues certainly need this for good healing, considering factors such as adequate rest, relaxation, good nutrition and a positive outlook are all key ingredients in creating the best possible conditions for moving forward. A range of strategies and techniques can be used including simple mobilisations but alongside motor imagery,  mindfulness, movement of other body areas, the use of music and motivational techniques and cognitive tools to fortify resilience and coping to name but a few.

Rehabilitation is not just about exercising. It is about understanding, learning, motivating, creating the right context for movement with confidence and many more factors that can lead to optimised outcomes.

* Naturally, you should take the advice of your health professional when it comes to your treatment and rehabilitation.

If you are about to have an operation or are recovering, contact us now to learn about our comprehensive treatment and training programmes: 07932 689081

Diet and pain

Can diet fight chronic pain? | Guest blog by Kaitlin Colucci, Student Dietitian @kaitlincolucci

Thanks to Kaitlin for writing this guest blog on diet. @kaitlincolucci

As a current student at the University of Nottingham studying a Masters in Nutrition and Dietetics, I have an interest in all fields of work to do with nutrition and diet. I aim to lead a healthy lifestyle and promote fitness and nutrition in all forms. I want to be able to inform the public and make them more aware of how diet is tied into every aspect of life. My blog aims to get people to think about how diet can influence men and women in new ways, and in ways that they would have never thought of before.

The internet and popular health magazines nowadays are littered with all sorts of nutritional advice on how some foods or supplements can help with chronic pain – arthritis, headaches, osteoporosis to name a few.

There are many foods that have anti-inflammatory properties, of which many are scientifically proven. Plans like the Mediterranean diet are built on the principles of the anti-inflammatory theory. When you talk about a diet that emphasises foods that are said to have an anti-inflammatory effect, the diets are going to look very similar. Each diet emphasises slightly different things but there is a main focus on antioxidant-rich fruits and vegetables, whole grains, little to no processed or refined foods, and an emphasis on omega-3 fatty acids like those found in fish oils.

For example, red grapes contain a powerful compound, Resveratrol, which blocks the enzymes that contribute to tissue degeneration. There is evidence that resveratrol is particularly useful in the prevention of osteoporosis, especially in women who do not benefit from hormone replacement therapy. The compound of resveratrol also found in red wine, which is popular in the Mediterranean, is more easily absorbed due to the form it is in.

Olive oil is another popular food used in the Mediterranean diet that due to its high content of mono-unsaturated fatty acids (the good fats) has favourable properties of antioxidant and anti-inflammatory effects. This is due to the compound known as olive oil phenols that have been shown to reduce the rate of cell death.

One thing we must be aware of is that the majority of studies linking diet to disease are either too small or not reliable in the information they are receiving from the participants, such as an inaccurate recall of the foods they consumed. But this doesn’t mean anti-inflammatory diets are all bad. However, patients shouldn’t expect a miracle cure.

When it comes to pain caused by arthritis, which much of the ageing population is suffering from, it is evident that a bigger contributor to the worsening of this condition is body weight rather than diet. Physical activity has been shown to be significantly more effective at improving tiredness and pain caused by arthritis than any other diet including omega-3 supplementation, the Mediterranean diet and herbal medicine.

For decades old Chinese remedies and herbal medicines have been said to help with pain throughout the entire body. This is something that interests me more and more as old herbal doctors have sworn by these passed down family traditions, and they seem to work without fail. Proper clinical studies to date that have delved into this topic further have shown that herbs like turmeric work the same way in the body as ibuprofen to reduce inflammation and pain. Similar effects have also been found in ginger, long known as a digestive aid. In a recent study, ginger was proved to significantly help women with severe menstrual pain and also reduce muscle soreness after exercise. 

Experts warn that diet is meant to enhance, not replace treatments that have been shown to work for eliminating chronic pain. However, following the advice that is out there won’t hurt, and most evidence leads people towards following a healthy and balanced diet, encouraging them to have a healthier lifestyle.



Endometriosis & melatonin | Women and pain series

Endometriosis & Melatonin | Women and Pain Series

Chronic pelvic pain is a troubling condition for many women. The reason for pelvic pain varies but certainly includes endometriosis where the lesions impact upon nerve health and function (see here) with consequential sensitisation. The purported mechanisms of pain include inflammatory pain and neuropathic pain with subsequent central sensitisation that underpins the persistance and variance often described.

Pain is an output, a response to the brain’s perception of what is happening in the body. The sensation of pain emerges from that part of the body deemed in need of protection. The pain itself is modulated by a range of factors including stress, fatigue, anxiety and the environment. The actual feeling of pain is the end result of the brain’s analysis of what is going on ‘now’ on the basis of what it already knows and has learned. Hence, prior experience can flavour the pain. Changes in the spinal cord and higher centres can amplify danger signals, modulate normal signals (begin as normal and communicate with nociceptors, therefore the brain receives a danger signal despite the initiating impulse being one of touch; i.e./ allodynia) and are responsible for the varying patterns of pain such as when a treatment helps on one occasion yet seemingly worsens the pain on a subsequent occasion.

Alongside the painful experience there are other body and brain responses to the perceived threat. Altered control of movement that includes guarding and protective posturing that leads to patterns of on-going chronic tension. In the case of pelvic pain this emerges around the pelvic girdle, in the abdomen and in the spinal muscles and often across the body. It is not unusual to find that there are many tender and tight areas when the body has been protected for some time, demonstrating a more widespread pattern. Often there is sensitivity expressed via other body systems , for example the gastrointestinal system in IBS, headaches, migraine and recurring bladder infections to name but a few. General health can often be impacted upon, with levels of activity diminishing alongside a fear of moving and socialising (a gradual withdrawal from being out with friends and family). This typically leads to a downward spiral affecting mood, self-esteem and manifesting with anxiety in many situations. It is really a ‘hyper-protective’ state physically and mentally where many cues become threatening and hence we protect, sometimes consciously by making choices and frequently automatically or habitually. Breaking this pattern however, is entirely possible.

We are fundamentally designed to change, evolve and grow. When we set the right conditions physically and mentally (and it has to be both), then we can move forward and change our outlook and experience. I know that an individual is going to progress when they start changing their language, metaphor use and at the same time their appearance changes via posture, facial expression and general demeanour. The spark returns.

The optimal approach requires that we consider all the dimensions of pain: physical, cognitive and emotional. This must be integrated and a programme created to meet the unique needs of the person. Concomitant with a range of strategies and training techniques to retrain normal movement, tension patterns, ease pain, tackle stress and anxiety etc, medication can play a role. The efficacy of pain medication is varied and often there are side-effects to consider. A recent study looked at the use of melatonin for endometriosis-associated pain with some very interesting results.

The commentary of Timothy Ness in Pain 154 (2013) 775 summarises the study below: ‘The article by Schwertner et al..demonstrated efficacy of the hormone, melatonin, in the treatment of endometriosis-associated pain…..one of the few medications which have proven useful in the treatment of endometriosis-associated pelvic pain but it is also notable as an example of the back-and-forth translational process associated with preclinical models of pain/analgesia and the clinical demonstration of treatment efficacy.’ And, ‘In this particular example the information flow went in both directions from humans to non-humans and then back again’. He refers to the fact that the data produced in rats was also found in humans. Many studies use rodents as subjects with obvious limitations in terms of extrapolating data for humans.

Pain. 2013 Jun;154(6):874-81. doi: 10.1016/j.pain.2013.02.025. Epub 2013 Mar 5.

Efficacy of melatonin in the treatment of endometriosis: a phase II, randomized, double-blind, placebo-controlled trial.

Schwertner A, Conceição Dos Santos CC, Costa GD, Deitos A, de Souza A, de Souza IC, Torres IL, da Cunha Filho JS, Caumo W.


Laboratory of Pain & Neuromodulation at Hospital de Clínicas de Porto Alegre (HCPA)/Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.


Endometriosis-associated chronic pelvic pain (EACPP) presents with an intense inflammatory reaction. Melatonin has emerged as an important analgesic, antioxidant, and antiinflammatory agent. This trial investigates the effects of melatonin compared with a placebo on EACPP, brain-derived neurotrophic factor (BDNF) level, and sleep quality. Forty females, aged 18 to 45 years, were randomized into the placebo (n = 20) or melatonin (10 mg) (n = 20) treatment groups for a period of 8 weeks. There was a significant interaction (time vs group) regarding the main outcomes of the pain scores as indexed by the visual analogue scale on daily pain, dysmenorrhea, dysuria, and dyschezia (analysis of variance, P < 0.01 for all analyses). Post hoc analysis showed that compared with placebo, the treatment reduced daily pain scores by 39.80% (95% confidence interval [CI] 12.88-43.01%) and dysmenorrhea by 38.01% (95% CI 15.96-49.15%). Melatonin improved sleep quality, reduced the risk of using an analgesic by 80%, and reduced BNDF levels independently of its effect on pain. This study provides additional evidence regarding the analgesic effects of melatonin on EACPP and melatonin’s ability to improve sleep quality. Additionally, the study revealed that melatonin modulates the secretion of BDNF and pain through distinct mechanisms.

For further information about our proactive treatment, training and coaching programmes for chronic pain and injury, or to book an appointment please call us on 07932 689081 | Women in Pain Clinic in Harley Street


J Pain Symptom Manage. 2012 Nov 27. 

Analgesic and Sedative Effects of Melatonin in Temporomandibular Disorders: A Double-Blind, Randomized, Parallel-Group, Placebo-Controlled Study.

Vidor LP, Torres IL, de Souza IC, Fregni F, Caumo W.


Postgraduate Program in Medical Sciences, Faculty of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.



The association between myofascial temporomandibular disorder (TMD) and nonrestorative sleep supports the investigation of therapies that can modulate the sleep/wake cycle. In this context, melatonin becomes an attractive treatment option for myofascial TMD pain.


To investigate the effects of melatonin on pain (primary aim) and sleep (secondary aim) as compared with placebo in a double-blind, randomized, parallel-group trial.


Thirty-two females, aged 20-40 years, with myofascial TMD pain were randomized into placebo or melatonin (5mg) treatment groups for a period of four weeks.


There was a significant interaction (time vs. group) for the main outcomes of pain scores as indexed by the visual analogue scale and pressure pain threshold (analysis of variance; P<0.05 for these analyses). Post hoc analysis showed that the treatment reduced pain scores by -44% (95% CI -57%, -26%) compared with placebo, and it also increased the pressure pain threshold by 39% (95% CI 14%, 54%). The use of analgesic doses significantly decreased with time (P<0.01). The daily analgesic doses decreased by -66% (95% CI -94%, -41%) when comparing the two groups. Additionally, melatonin improved sleep quality, but its effect on pain was independent of the effect on sleep quality.


This study provides additional evidence supporting the analgesic effects of melatonin on pain scores and analgesic consumption in patients with mild-to-moderate chronic myofascial TMD pain. Furthermore, melatonin improves sleep quality but its effect on pain appears to be independent of changes in sleep quality.


Shoulder injuries: rotator cuff | Our new article in press

Shoulder anatomy

Rotator cuff tendinopathy & CNS considerations | our new paper in press here ow.ly/20Tpy3

Authors: Chris Littlewood (@PhysioChris), Peter Malliaras, Marcus Bateman, Richmond Stace, Stephen May, Stephen Walters.

Similar to any injury that persists we must ask ‘why?’ and seek the mechanisms that underpin the on-going experience of pain and altered movement that come hand in hand. One mechanism that has been identified is central sensitisation – see here. In this paper (in press), we consider the role of the central nervous system in rotator cuff injuries, a problem that is often painful and can persist.

Rotator cuff injuries & shoulder pain are common persisting injuries

Chronic injuries require a different approach to treatment and training. As well as improving the health and mobility of the tissues, we must look at the reasons why the body and brain continue to protect the area. Modern pain science has revealed a range of reasons why pain continues including sensorimotor incongruence, central sensitisation, changes in specific cell activity in the brainstem, mechanisms as a result of nerve injury and inflammation, neurogenic inflammation, beliefs about pain, fear of movement and stress to name but a few. These factors are revealed in a detailed assessment with the subsequent creation of a tailored treatment and training programme to tackle the problems at source.

For more details or to book an appointment call 07932 689081

Specialist physiotherapy in London for chronic pain, persisting pain and injuries: clinics in Chelsea | Harley Street | Temple | New Malden