TOP TIP: If you have a patient who presents with an MSK issue thats been ongoing far beyond the normal expected timeframe… First ensure there is not a missed differential diagnosis, eg rheumatological, neurological, vascular etc! But then look for iatrogenic and socioecominal factors have may have prevented time helping, eg misinformation, negative narratives, lifestyle, self efficacy etc!

Prof. Maher he should be ASHAMED of himself for blocking half of this platform for calling his bogus trial and for this puny attempt to spin the onus of proof. Those authors bluntly ignored the rules of logical and scientific inference. Their trial is only “evidence” that one type of opioid not indicated for acute pain is ineffective for acute low back and neck pain. His attempt to shift the onus to the skeptics and critics is pathetic which had no hypothesis.

The Lancet is the no.1 medical journal in the world. So, when they published the flawed OPAL trial a year ago we felt we had to respond. The authors of the trial claimed their study showed “opioids are no better than placebo for acute low back and neck pain” and that “guidelines for opioid prescription should be changed due to their findings.” This couldn’t be further from the truth and a massive disservice to patients! Too bad one of the authors of the paper Prof. Chris Maher relentlessly blocked me and many other patient advocates here for merely mentioning the flaws. Special thanks to Dr. @jeubanksMD for his contribution.

#chronicpain For those of you with painful peripheral neuropathies including small fiber neuropathy what seems to work best. Please retweet