Rib pain referral patterns

June 29, 2016 by · Leave a Comment
Filed under: Research, Spinewave Bulletin 

Costovertebral (rib) joints are starting to be recognised as a source of pain.

Mid-back pain is often misdiagnosed as either spinal (vertebral) pain or muscular pain. The figure below depicts pain referral patterns of various costovertebral joints – where the rib head joins the spine. This is a joint that when subluxated can induce its own pain patterns.

rib pain referral


Young, B.A., et al., Thoracic costotransverse joint pain patterns: a study in normal volunteers. BMC Musculoskelet Disord., 2008. 9 (1): p140.

When Pain Persists

June 29, 2016 by · Leave a Comment
Filed under: Spinewave Bulletin 

Persistent pain: It’s the same as if you ride a bike a lot, you get better at riding a bike. Play the piano a lot, you get better at it. Send danger messages a lot, you get better at it. That’s an adaptation, and the same thing occurs in the brain.

Catalyst investigates recent advances in science and medical engineering that are transforming our understanding of chronic pain and opening the door to new treatments in the hope of bringing relief to so many people.

Why all migraine patients should be treated with magnesium

June 22, 2016 by · Leave a Comment
Filed under: Research, Spinewave Bulletin 

magnesiumMagnesium, the second most abundant intracellular cation, is essential in many intracellular processes and appears to play an important role in migraine pathogenesis.

Routine blood tests do not reflect true body magnesium stores since <2% is in the measurable, extracellular space, 67% is in the bone and 31% is located intracellularly. Lack of magnesium may promote cortical spreading depression, hyperaggregation of platelets, affect serotonin receptor function, and influence synthesis and release of a variety of neurotransmitters.

Migraine sufferers may develop magnesium deficiency due to genetic inability to absorb magnesium, inherited renal magnesium wasting, excretion of excessive amounts of magnesium due to stress, low nutritional intake, and several other reasons.

There is strong evidence that magnesium deficiency is much more prevalent in migraine sufferers than in healthy controls. Double-blind, placebo-controlled trials have produced mixed results, most likely because both magnesium deficient and non-deficient patients were included in these trials. This is akin to giving cyanocobalamine in a blinded fashion to a group of people with peripheral neuropathy without regard to their cyanocobalamine levels.

Both oral and intravenous magnesium are widely available, extremely safe, very inexpensive and for patients who are magnesium deficient can be highly effective. Considering these features of magnesium, the fact that magnesium deficiency may be present in up to half of migraine patients, and that routine blood tests are not indicative of magnesium status, empiric treatment with at least oral magnesium is warranted in all migraine sufferers.


Mauskop, A., et al., Why all migraine patients should be treated with magnesium. J Neural Transm, 2012. 119 (5): p. 575-9.

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