• PSed.

A Beautiful Mistake Is Still A Mistake - written by Morten Høgh #Original blog on videnomsmerter.dk

Updated: Feb 14, 2020

A few days back, I was exposed to a beautiful illustration showing the (hypothetical) mechanisms of radiculopathy. While the content is well-written and a testament to the dedication and high level of scientific knowledge among the authors, it neglects the complexity of neurobiology and has no clinical relevance.





Conclusion

Science does not translate very well into clinical practice. When research is communicated to a broader audience, the bigger picture is often more relevant than the naked results. However, when pain and neuroscience are welded together and used interchangeably as professional jargon, science is turned into mere speculation. Therefore, the clinician should possess scientific skepticism and call bluff when research-jargon is ‘clinified’. This is best done by understanding the theories of pain and the premise of basic research. 

…when pain and neuroscience are welded together and used interchangeably as professional jargon, science is turned into mere speculation.

Scientists know about science, clinicians know about the clinical world – and patients know about pain.


Before I justify my critique of the review article “Lumbar Radiculopathy and Its Neurobiological Basis”, let me first explain why I think this is important. There is massive pressure on researchers to “disseminate” their research to the world outside academia. But let’s face it, dissemination is not an academic discipline and researchers do not automatically know what it is like to be a clinician (or to be in chronic pain). It’s as if you ask a group of middle-aged white men to solve the problems of a 25-year old Asian woman: Their knowledge is not automatically compatible with hers, and simply “disseminating” their understanding of the world will not necessarily be of any help to her. 


…dissemination is not an academic discipline and researchers do not automatically know what it is like to be a clinician (or to be in chronic pain).

Basic Science not Clinical

I’m fascinated by the world we live in, and think that neuroscience is amazing because  unites thoughts from almost any discipline to study how our experiences relate to the world we can measure. Despite my fascination, I realise that basic science (or any science for that matter) cannot look at the details without losing sight of the whole.



Scientist are just people

Like any other person, the scientist needs to make an educated guess about how their observations fit into the world (i.e. the bigger picture). And since each study is only a small piece in a very large puzzle, the details of each study is only truly interesting for a relatively small number of people. So, when research is disseminated to a broad audience, it is rarely the results and more often the big picture which is explained (i.e. the educated guess). Sometimes, it’s to the extent that complex processes are transformed into mainstream metaphors, which leave the impression that pain (or whatever you are studying) really isn’t that complicated at all. Consider the concept of ‘central sensitization’ (Woolf CJ, 1984), which has been conceptualised into something that supposedly can be detected and treated in the clinic (Nijs J et al. 2019).


For a detailed discussion about the clinical usefulness of CS see this blog post (references are in English) and this recent commentary by prof Michele Curatolo.


In this video Lorimer Moseley and Morten Hoegh share their opinions on the matter.


…since each study is only a small piece in a very large puzzle, the details of each study is only truly interesting for a relatively small number of people.<