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john quintner

What do I do with my trigger points now, Dr Quintner?

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John Quintner, Professor Milton Cohen and Dr Geoffrey Bove recently published a very controversial review – A critical evaluation of the trigger point phenomenon. Their article aims to show the hypothesis – “Myofascial Pain arising from Trigger Points” – formulated in the 1980s by Travell and Simons, is ‘flawed both in reasoning and in science’.

Being closely aquainted to John (albeit via cyberspace), I sought a patient’s explanation. What does this mean for me and others with chronic pain erroneously attributed to myofascial trigger points?

How many years have you been practising and researching chronic pain?

I commenced my career in rheumatology in 1975. My interest in chronic pain dates from 1985, when I admitted to myself that I had no idea about what was then being called “RSI”. Without a research background I was left with no other option but to learn “on the job”. I remember that some of my rheumatology colleagues would laugh at those of us who were making a serious effort to understand these conditions. But these were extraordinary times when a fierce debate over the validity of “RSI” as a compensable condition was raging across Australia.

Do you believe pain will be explained one day?

The short answer is NO. Attempting to explain the experience of pain is inextricably linked to our inability to explain consciousness. You could ask if we will ever explain LOVE and I would give you the same answer.

What might your research mean for someone with chronic pain?

Along with those with whom I have collaborated, and the list includes Professor Milton Cohen, Mr Robert Elvey and Dr Geoffrey Bove, my research has been aimed at shining the torch of critical scientific inquiry upon a number of complex and poorly understood conditions. From our attempts to do so, I hope that in some small way we have helped people in chronic pain to avoid the stigma that is so often conferred upon them by members of our society, including their well-meaning medical and other health professionals. Continue Reading

Yet Another Comedy of Errors: Act III, the Outcome

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Those on long term benefits should be cut like 'low hanging fruit', Denis Cosgrove wearing my compensation.Scene I

The long-awaited meeting takes place, as scheduled, 11 months after my lodgement of a 93cd application.

Theo and I, together with my WorkCover Assist representative met with the Conciliator and K – a rather gruff and insensitive guy who is representing my VWA-appointed Agent. We have not met him before nor to our knowledge has he been involved in managing my claim. From the outset, it was obvious that he would fight against us every inch of the way. You can well imagine that the spirit of conciliation was lost upon him. He offered no apology for his rude behaviour.

If you do not know, conciliation is a voluntary, flexible, confidential and interest based process. The parties seek to reach an amicable settlement of disputes with the assistance of the conciliator, who acts as a neutral third-party (whilst still abiding by the system’s own legislation).

Just to recapitulate, we had raised three important disputed issues for conciliation:

(i) that part payments for my medical expenses were still outstanding;

(ii) that contrary to the “expert” opinion of my Agent, my working capacity was still limited to 15 hours a week and had not improved since the Medical Panel had examined me nor had I shown that I possess any new skills believed to be contributing to this added work capacity;

(iii) that my Agent was claiming that the date they are required to begin any payments is the date from when I “completed” the 93cd application (September 2013), and not the date on which I had actually lodged the application (June 2013). Until I had provided a current Tax return (which was a mandatory requirement and for the ATO is March of the following year), the application remained invalid; furthermore they consider my early June capacity date to be irrelevant. Continue Reading

I’ve been nominated for a WorkSafe Award

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VWAAwardWebsiteHeaderI’ve met some incredible people who have become my dear friends and my greatest supports during my pain journey. One of whom I often rave about is the wonderful John Quintner, Consultant Physician in Rheumatology and Pain Medicine. You’ve seen him battle beside me publicly on social media. Not only helping me with my comprehension and study of chronic pain, John has also helped me through the tangled forest of Workers Compensation. He now advocates to expose the many pitfalls for injured workers in the various Australian Worker’s Compensation systems.

In supporting my unequal struggle with the Victorian Workcover Authority (VWA) he has witnessed what it takes to survive being in the system. As if his support isn’t enough, he now honours me by nominating me for a VWA Heath and Safety Award.

Soula, with your permission I have just nominated you for a Victorian WorkCover Authority Award in recognition of your long and arduous struggle against all odds to return to work. Whether or not the nomination is successful, I want you to know that in my opinion and in that of the other referees, Professor Stephen Gibson & Rosemary McKenzie-Ferguson, you are most deserving of such recognition. In addition to your return to work, you have performed an important role in pain education as an advocate for sufferers of this distressing condition (pudendal neuralgia). Your ability to smile and to be creative in the face of adversity has been an inspiration to many pain sufferers around the world. I wish you the best of luck!

Basically, it’s about this:

Worker Return to Work Achievement. Tell us their story!
This category recognises a worker’s outstanding achievements in returning to work following a workplace injury.

Nominating a person, group or initiative is easy! All you need to do is tell us the nominee’s achievements by following the prompt questions – tell us what the person/business/group did, why they did it, and how it had a positive impact on their workplace.

I don’t mean to be pessimistic, but after experiencing the VWA culture for 7 years now, I’m pretty sure the nomination will be rejected for some paltry reason/s based on my pending application for part payments of compensation. It’s been over a year since I submitted that application, so they are obviously struggling to come to terms with the fact that I attempted a return to work. Accepting a nomination for someone they have not been supporting in their return to work would be hard to imagine. But I live in the hope that has sustained me so far – that of a successful outcome.

(Update July 22, 2014. Nomination accepted)

Nomination as submitted by John Quintner and supported by Professor Stephen Gibson and Rosemary McKenzie Ferguson:

Soula and her husband Theo run their own business in art and graphic design, providing creative solutions to their clients. Her injury has had a major impact upon their lives together, as well as upon their business. She has consulted many health professionals and has been given a large variety of opinions, investigations and treatment procedures.
Describe your job prior to your injury.

Prior to her injury she and her husband ran a highly successful business. Soula was also a prolific artist in her own right. She was very energetic and a great support to her family and friends.
How were you injured and what was your injury?

Soula fell onto her sacrum when a fit ball upon which she was seated burst. Her injury was extremely difficult to diagnose but after some considerable time her pelvic pain was ascribed to an injury to her pudendal nerve – pudendal neuralgia. The insertion of a pelvic nerve stimulator was a turning point in her rehabilitation. She is still quite disabled and requires regular medication for pain relief.
Describe the job they do now (including employer if different).

For the past 12 months Soula has been attempting a gradual return to work within her physical capacity and has reached 9 hours per week. She has had to overcome many physical difficulties in terms of her home and work environments. Soula is still engaged in art and design work. Since her injury she has taken on an important advocacy role for people suffering from pudendal neuralgia.
What were the hardest and best things about returning to work?

The hardest thing was the lack of support from her WorkCover-appointed Agent, who placed many obstacles in her path and has refused to pay her any compensation for the past 12 months. Soula has been examined by two medical assessment panels and has found the Conciliation process to be unhelpful. The Ombudsman has been approached for assistance. The best things have been her ability to retain a sense of humour, to remain creative and positive in the face of adversity and to provide inspiration to many pain sufferers around the world.
What do you think helped you most to return to work and get your life back?

The support of her husband and family, as well as her many friends in the art world and in the world of pain management. Last year, with the support of a pharmaceutical company and members of the Australian Pain Society, Soula addressed a meeting in Sydney of over 160 pain specialists. The text of her address to this meeting is posted on her website. She has also taken part in an advertisement to raise research funds for the Faculty of Pain Medicine, Australian and New Zealand College of Anaesthetists. Soula has become an advocate for sufferers of pelvic pain conditions.
What advice would you give other injured workers?

The many injured workers and fellow pain sufferers who follow her web-log have benefited from reading about her quite varied experiences whilst in the WorkCover system. She found the system to be decidedly unfriendly to women with undiagnosed persistent pain but she has counselled them not to lose hope. For those who are faced with her situation, her advice to other injured workers is not to declare a work capacity,

View my nomination at www.healthandsafetyawards.vwa.vic.gov.au/browse-entries/entries/the-hurting-strings

 

Arthritis & Osteoporosis WA, Making Sense of Pain, 7-8th March

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Update March 13, 2014

The Inter-disciplinary Workshop for Health Professionals, Making Sense of Pain, was organised by Dr John Quintner (Pain Medicine physician) and Melanie Galbraith (Physiotherapist).

The Workshop was sponsored by Arthritis and Osteoporosis WA and held at the Wyllie Arthritis Centre, 7th and 8th March 2014.

Key presenters were John, Melanie, Mary Roberts (Psychologist), Jane Muirhead (Occupational Therapist) and Vance Locke (Academic Psychologist) were key presenters.

Vanessa Watson and Eva Miller were our two Pain Champions who told their stories and engaged with the Health Professionals on the second day of the workshop.

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Event Description

The aim of this workshop is to provide physiotherapists and other health professionals with an opportunity to effectively translate their knowledge and skills into clinical practice. Of equal importance is that they become aware of their own beliefs and attitudes to people in pain and the potential for these attributes to colour therapeutic relationships and influence outcomes. Continue Reading

John Quintner

Author:

John QuintnerI’ve made some great friends in cyber space throughout this PN pain journey (and developed quite a library along the way!). One friend I consider a favorite is John Quintner. He’s one of my most reliable sources when I need an honest opinion. We bump into each other over two main mutual ‘interests’: the (primitive) WorkCover assessment methods, and pain definitions. John doesn’t just know what he’s talking about, he’s upfront, honest and calls it how he sees it. And when someone has these credentials, I’m all ears, not to mention I become much wiser!

John doesn’t have a website but he’s on facebook and you can find him around the social media pain traps. His publications and efforts within the pain world have been a plenty and although all of the following info isn’t specifically related to PN or PNE, I felt it was very relevant for readers. And yes, you do recall correctly that I had published, John Quintner’s Personal injury compensation: lessons from Talmudic law on my website a while back.

So without further ado, I present my friend, the great John Quintner and his incredible opinions:

John’s interest in pain was aroused in the mid-1980s when he had to try to make sense of what was then known as “RSI”. In collaboration with the late Robert Elvey, physiotherapist, he published an hypothesis, which has stood the test of time. He also published his work on “whiplash”. Since then, together with fellow rheumatologist Professor Milton Cohen, he has published extensively in the field of Pain Medicine. They have tackled such controversial topics as Fibromyalgia, Myofascial Pain Syndrome, as well as exploring the concepts of stigma, stereotyping and empathy in the context of chronic pain patients. Together with Dr Pamela Lyon, they have published a comprehensive hypothesis for Chronic Widespread Pain (Fibromyalgia). Their most recent paper addresses the question “Is Chronic Pain a Disease?”.

John’s publications:

An Evol Stress-Response Hypothesis for CWP. pdf
A book chapter from At the Edge of being: The Aporia of Pain. Published in 2012 by Interdisciplinary Press, Oxford. Editors: Heather McKenzie, John Quintner, Gillian Bendelow.pdf
Butler Medically Unexplained Symptoms pdf
Consumers in remote areas pdf
A critical evaluation of the trigger point phenomenon pdf
Drugs for Fibromyalgia: How Good Are They? National Pain Report website.
Evolution, Stress and Fibromyalgia pdf
Exploring the underpinnings of research pdf
Fibromyalgia falls foul of a fallacy pdf
Fibromyalgia Syndrome- a problem of tautology pdf
From Neuralgia to Peripheral Neuropathic Pain pdf
Is chronic pain a disease? pdf
journal.pone pdf
La Doulou Provencal Word For Pain by John Quintner & Melanie Galbraith
Maldynia as moral judgment pdf
Painful cervical radiculopathy pdf
Pain Med Models pdf
Preclinic group education pdf
Referred pain of peripheral nerve origin pdf
Signification & Pain pdf
Stretch-induced cervicobrachial pain syndrome pdf
System plasticity and integrated care pdf
The Australian RSI debate- stereotyping and medicine pdf
The Challenge of Validating the Experience of Chronic Pain pdf
The horse is dead pdf
The medically unexplained revisited pdf
The RSI syndrome in historical perspective pdf
This Train is Bound for… Wholeville: A Travel Guide for the Perplexed pdf
Whiplash study pdf

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Pain sucks for injured workers

Author:
Quintner-Dr-John Apr12

Surfing the many ‘pain’ forums you eventually get to ‘cyber’ know the regular contributors. One of my favorites to bump into is the highly accredited and regarded, John Quintner. I give full attention too John, he is a great support for me (and to the world of pain). Regular readers of my blog might remember his previously posted paper ‘John Qunitner’s point of view‘ and may have also seen some of John’s great comments, in particular where I vent my frustrations with WorkCover.

But this post isn’t about me, it certainly interests me as it refers to assessments within the WorkCover system. Although John speaks for WA this does also apply for Victorian injured workers. I’m happy to be able to post this on my blog, although flattened and left without acknowledgement with my personal WorkCover impairment. I still hold hope our out-of-date system will be updated someday and it will be opinions such as these that will instigate that change. Future injured workers should be grateful for them.

If you haven’t come across John Quintner then my advice would be to google his name, he has some great opinions to share about chronic pain.

Written by Dr John Quintner
Monday, 01 July 2013

Dr John Quintner. Consultant Physician in Rheumatology and Pain Medicine

Mr Chris White, CEO, WorkCover WA (WA compo compares favourably, June 2013) rightly calls for factual information to support any suggestions as to how the scheme he administers could be improved.

In so doing, he has sidestepped the call for reform of the system made by pain specialists Drs John Salmon and Stephanie Davies (Management of WA’s work injured needs reform, May 2013).

Does WorkCover have a case to answer or are these experienced pain specialists making a big fuss about nothing? Well, let’s look at some facts.

In the WorkCover WA Guides for the Evaluation of Permanent Impairment (3rd edition, 2010), we read that because there is currently no validated measurement tool for the assessment of pain, WA has followed the NSW WorkCover Guides by excluding Chapter 18 (The Assessment of Pain) of the AMA(US) Guides V.

Without providing any factual evidence to bolster its position, WorkCover WA claims that pain has already been factored into the impairment ratings for demonstrable work-related conditions.

If that were indeed the case, extrapolating from this administrative decision, one might reasonably expect to find that the Guides being used in WA (and NSW) rely upon the use of validated measuring tools to determine the extent of bodily impairment.

But that is not the case: there are hardly any studies that would validate the assessment of physical impairment currently being used by WorkCover. [Davies, 2008]

This is doubly detrimental to the injured worker with ongoing pain and apparently little or no assessable impairment. Contrast this to the attempt to resolve the vexed question of psychiatric impairment.

Here, not only does WorkCover WA use ‘impairment’ as a surrogate term for ‘disability,” but also Approved Medical Specialists (AMS) are mandated to use the Psychiatric Impairment Rating Scale (PIRS), which was constructed by an expert group of NSW psychiatrists.

The PIRS comprises six subscales, each of which is said to delineate and evaluate discrete areas of functional impairment: self-care and personal hygiene; social and recreational activities; travel; social functioning (relationships); concentration; and employability.

Data on the reliability and validity of the PIRS has yet to be published by NSW WorkCover, although it did fund such a study in 2003. [Davies, 2008] Could it be that the results were inconclusive (or even worse than that)?

Furthermore, the final calculation of impairment rating using the PIRS is skewed towards the lower scores, thus reducing the overall amount of compensation paid. [Davies, 2008]

But at least workers with psychiatric impairment/disability are afforded a mechanism of sorts for assessing their entitlements. Why are workers with chronic and disabling pain being denied the same opportunity? Continue Reading

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Definitions of pain

What is Pudendal Neuralgia (PN)?
Most simply put PN is Carpal Tunnel in the pelvis/buttocks. Compression of the Pudendal Nerve occurs after trauma to the pelvis and is aggravated with pressure. The pain is often described as a toothache like pain, with spasms, sensations of tingling, numbness, or burning. It can be very debilitating.

What is Neuropathic pain?
Neuropathic pain is the result of an injury or malfunction in the peripheral or central nervous system. The pain is often triggered by an injury, but this injury may or may not involve actual damage to the nervous system. More…

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