Although Dr Winer is not

officially representing the

Society or Faculty on this

run it would be hard to

separate him from the

two. Conrad is a past

president of the faculty

and has served on many

College, Faculty and AMA

committees since 1969.

He was awarded a Medal

in 2004 for services to

Medicine by the RACP.

His contribution contains

some great history

directly relevant to the

society. Certainly a true

stalwart of rehabilitation

medicine in Australia, I

wish him well on his run

and with his fundraising.

Editorial Damien Daniel

It’s a pleasure to be able to introduce the

new RMSANZ newsletter by name,

Rehab Matters. Well done to Clive Sun

who combined taxonomic wit with medical

fact to christen this mini-tome. It feels that

we now have some editorial standard by

which we shall be judged! I hope we have

reached these heights in our second

publication.

Michael Vagg has provided a great article

commenting on the use (or otherwise) of

medicinal cannabis in chronic non-cancer

pain (Ed. This does not include the

purported 20% of CNCP patients who

smoke it already for “analgesia”). Most

importantly is the current position of the

Faculty of Pain Medicine, which can act

as guide for those of us who are likely to

deal with this issue clinically. From 1

August, NSW became the first state to

allow the prescription of some

unregistered (with the TGA) cannabis

products, by approved prescribers, in

special circumstances only. The trials to

date have focussed on uncontrolled

seizures in children, uncontrolled

chemotherapy-induced nausea and

vomiting, and spasticity in MS. However

the public focus is on chronic pain,

especially after politicians discovered this

hot topic prior to the recent election and

started making promises the science

cannot currently match. Doctors and

scientists are calling for restraint.

(www.mja.com.au/journal/2016/204/10/m

edicinal-cannabis-australia-missing-links)

The list of conditions that can be treated

by medicinal cannabis, when provided by

advocacy groups, tend to be extensive to

say the least (eg.

www.unitedpatientsgroup.com/resources/i

llnesses-treatable).

It is not only those of us treating chronic

pain that will face this issue. A series of

articles addressing each condition, such

as MS, Parkinson’s Disease or

Rheumatoid Arthritis provided by

members working in those fields would be

a useful resource for us all. Hopefully we

will have more to come on this topic.

We also have a report on the ever-

popular annual MSK workshop in Orange,

NSW. I have heard excellent feedback on

this clinical weekend for registrars for a

number of years now, and it is a

wonderful resource for trainees.

Unfortunately I never made it myself but

perhaps I will one day as a trainer (hint,

hint...).

Nathan Johns has provided a spectacular

AROC infographic that is going to be hard

to beat in future editions. Unlike some,

this one is as informative as it is eye

catching. We also have a very interesting

perspective on the movie “Concussion” by

Maria Paul.

And we have our first submission to the

Community Bulletin Board, and a great

one at that. Dr Conrad Winer, at 80 plus

years, is running the 14km City2Surf in

Sydney this weekend. Conrad is not only

raising money for World Animal

Protection, he is also seeking to promote

Lifestyle Medicine.

12 August 2016 Volume 1, Issue 2

Rehab Matters

The Rehabilitation Medicine Society of Australia and New Zealand Ltd.

In this issue:

Editorial 1

MSK Workshop in Orange 2

Movie Review: Concussion 3

Life Style Profile 4

Community Notice Board 5

AROC Update 6

Chronic Noncancer Pain 7 From 1 August, NSW became the first

state to allow the prescription of some

unregistered (with the TGA) cannabis

products….

To donate please go to https://city2surf2016.everydayhero.com/au/conrad.

In April 2016 we again had the

pleasure of organising the

Musculoskeletal (MSK) workshop in

Orange in rural NSW.

This was an initiative of two

dedicated Rehabilitation

Consultants who are committed to

providing trainees with

rehabilitation focused MSK

education. It ran over two days to

provide an intensive “hands-on”

MSK examination workshop for

AFRM trainees, particularly those

preparing for Module Two and

Fellowship exams. This workshop

has been held in 2010, 2011, 2014

and 2015 with overwhelming

success.

The places for the workshop were

initially limited to 25 candidates but

due to popularity we had to

increase this to 30. Trainees

attended from most states in

Australia, as well as from New

Zealand.

The workshop’s objectives

included: Comprehensive

understanding of MSK examination,

review of MSK injection techniques,

and improved clinical skills

specifically for OSCE examinations.

Musculoskeletal Workshop in Country NSW Sumitha Gounden

With such great success we are

planning to run the workshop again

in Orange next year.

2

Feedback from attendees was

positive and the majority felt their

objectives were met. Trainees

were, however, generally surprised

that such a well-structured, high

quality teaching workshop could be

offered in such a small city such as

Orange!

Colourful Orange has plenty to offer

for everybody. Only three and a

half hours from the hustle and

bustle of Sydney, you will find a

welcoming city full of life, elegant

streetscapes and buildings,

beautiful parks and gardens and

some of the best regional food and

wine in Australia. Orange, is one of

the gourmet capitals of Australia,

with world famous cold climate

wines and tasty morsels to suit

everyone’s palate.

A Trainee’s Perspective

Trudi Richmond

I would like to thank Dr Alex

Ganora and Dr Sumitha Gounden

and her team for organising a

brilliant musculoskeletal workshop

in Orange this year. It was my third

attempt at trying to get there for the

weekend and definitely worth going

to. A lot was packed into two days

and although a lot was covered I

think everyone who attended found

it a lot of fun as well. I certainly feel

a lot more confident with my

examination techniques especially

those ones that we rarely do (ankle

and feet).

It was great to have the

examinations shown to us step by

step, then a chance to practice

them on each other and get

feedback on our technique. Also

having musculoskeletal injection

techniques explained to us step-by-

step was helpful (and highly

relevant to exams). I’m sure

everyone who attended learnt

something from the weekend. It is

a must-do for all rehab trainees

regardless of their year of training. I

enjoyed the weekend so much I’ll

be attending again next year for a

refresher before I sit my Fellowship

exam.

Adam Cho demonstrating what he has learnt

With such great success we are

planning to run the workshop again

in Orange next year.

Thanks must be extended to the

esteemed guest speaker, Dr Alex

Ganora. I would also like to thank

our senior physiotherapist Jon

Garner, Dr Claire Sui and all the

other lovely volunteers who

assisted in enabling this workshop

to be such a great success. Our

sponsors and the Orange Health

Service enabled us to host this

workshop. We look forward to the

opportunity of showcasing our

wonderful facility, beautiful city and

providing top class education to

future trainees.

Alex Ganora explaining the knee examination

Workshop participants

The film has a very serious tone

throughout and at times appears to

move at snail’s pace. Will Smith

gives a reasonable performance

with an acceptable imitation of an

Nigerian accent. He plays an

outsider in football-mad

Pennsylvania, trying his best to

integrate into American life and

culture – something the immigrants

amongst us can relate to – whilst

simultaneously challenging the local

culture.

I liked the fact that the film

highlighted the hidden

consequences of brain injury, sadly

a daily battle for the person

suffering the injury and their

families. Rehabilitation

professionals are all too

frustratingly familiar with

encountering employers, lawyers

and also other health professionals

who refuse to acknowledge

someone has had a brain injury

just because they look ‘normal’ and

have a normal brain scan!

The film received mixed reviews

with ‘The Guardian’ giving it only

one star! I don’t think it’s that bad. I

would certainly encourage those in

the rehabilitation field to watch it, if

only for professional reasons. Even

better, consider showing it at an

ABI movie night fundraiser!

Movie Review: Concussion Maria Paul Families4Families (an acquired

brain injury support network in SA)

recently organised a movie night

fundraiser. Myself, and a number of

rehab colleagues, attended. After a

great opportunity to socialise and

network with patients past and

present, their families and other

stakeholders, we settled to watch

the film. The film was ‘Concussion’.

The film is set in U.S.A in 2002 and

based on the true story of Dr.

Bennet Omalu, a Nigerian forensic

pathologist living in Pennsylvania.

When former NFL football player

and local hero Mike Webster (actor

David Morse) suffers memory loss,

depression, severe mood swings,

homelessness and eventually

premature death, Dr Omalu (actor

Will Smith) is puzzled by how an

otherwise healthy athlete could

suffer such a dramatic psychological

breakdown. While conducting an

autopsy on Webster, Dr. Omalu

discovers neurological deterioration

that is similar to Alzheimer's

disease. He names the disorder

Chronic Traumatic Encephalopathy

(CTE) and publishes his findings in

a medical journal. When other

athletes face the same diagnosis,

he embarks on a mission to raise

public awareness about the dangers

of football-related head trauma (American football, not soccer, for all the

true sports tragics – Ed.). Dr Omalu

soon finds himself fighting against

efforts by the sports ruling body, the

National Football League, to

suppress his research on CTE.

3

Maria Paul

The film highlighted the hidden

consequences of brain injury

NEW Social Events have been recently added. You can have dinner on Sunday night (16 October) with others

interested in Musculoskeletal Medicine and Pain Medicine or with those working in Private Practice or with

others interested in Rural and Remote Rehabilitation Medicine. On Monday night (17 October) why not have

dinner with those interested in Neurorehabilitation Medicine and listen to a dinner talk by D J Kennedy?

For more information see: http://www.dcconferences.com.au/rmsanz2016/social_program

Lifestyle Profile: Greg Dower Interviewed by Damien Daniel

How do you think podiatry fits into a

multidisciplinary rehabilitation

model?

Podiatry is a fundamental part of the

multidisciplinary rehabilitation model.

We have a visiting Rehabilitation

Physician in our Centre of Excellence

(COE) in Brisbane and plan to work

collaboratively with rehab doctors in

our other state COEs. We can also

assist in chronic lower limb or low back

pain, not just when all else fails, but

also earlier, before interventional or

pharmacological strategies need be

employed.

What does a typical workday look

like for you?

Monday’s are crazy and jam packed

with the most challenging diabetic,

sports medicine and rehabilitation

cases at our COE in Camp Hill,

Brisbane. The rest of the week is less

interesting and spent traveling and

attending meetings in the boardroom.

What is your best memory working

as a podiatrist?

Working with the world’s best

cricketers is fun but saving limbs is

hard to beat. I enjoy designing

complex, custom footwear for

Charcot’s feet with our 3D CADCAM

system.

What are you passionate about,

both inside, and outside work?

I’m passionate about innovating

podiatry, limb salvage and establishing

a nationwide group of foot hospitals

and clinics with a multidisciplinary

focus.

Greg Dower is one of Australia’s most

successful podiatrists. With Darren

Stewart he established MyFootDr,

which now has over 20 clinics across

both Australia and Asia. At his Camp

Hill Centre of Excellence in East

Brisbane he has established quite

likely the most technologically

advanced multidisciplinary lower limb

practice in the world. He is incredibly

skilled in, and passionate, about his

work and also his hobbies – Elvis,

Cadillacs, cricket and rockabilly blues.

He is a fantastically memorable pubic

speaker and has delivered brilliant

lectures to Queensland AFRM trainees

for many years, and at the 2014 AFRM

Trainee Meeting on the Gold Coast.

What is your job and what are your

qualifications?

I began my career as a sole

practitioner after obtaining my bachelor

degree in podiatry in 1992 and recently

as a certified pedorthist (Custom Boot

Maker). These days however I spend

more time innovating foot care and

developing MyFootDr across Australia

and Asia.

Why podiatry?

I feel I can make a positive impact in

someone’s life and enjoy challenging

cases such as cerebral palsy, diabetic

feet and orthopaedic trauma.

Tell us about the company you work

for.

I am a cofounder, with Darren Stewart,

of Australia’s largest podiatry group,

MyFootDr. We incorporate podiatry,

orthotics and prosthetics and

pedorthics within the same business.

We are the naming rights sponsor of

the legendary Queensland Bulls

cricket team. We were also the

podiatrists for the last ICC One Day

Cricket World Cup.

After work I love chilling at

Graceland and performing with my

rockabilly band The Blue Cats.

(Greg is being humble here – In

addition to being one of the world’s

best podiatrists, he is also one of the

world’s great Elvis impersonators

and owns 13 Cadillacs. His house

really is called “Graceland” - Ed).

Where do you see yourself in 10-

15 years, both professionally and

personally?

Hopefully as a mentor for aspiring

young practitioners and personally I

would love to hear the pitter-patter of

little feet around the house again as

Australia’s coolest grandfather.

Where do you see the specialty of

podiatry in 10-15 years?

Hopefully more integrated with other

allied health and medical

practitioners and more corporatized.

We are presently doing a rollup

across Australia with entrepreneur

and Shark Tank judge Dr Glen

Richards.

If you were published in a

Rehabilitation Medicine

Newsletter, what would you say to

Rehabilitation Physicians?

If you want to work collaboratively

with an innovative group of

podiatrists, pedorthists and O&P

practitioners anywhere in Australia

or Singapore please give me a call

on +61 418 178 528 or drop me a

note at:

greg.dower@myfootdr.com.au

4

Greg Dower, Nathan Lyons and

Darren Stewart (co-founder of

MyFootDr)

5 Community Noticeboard

SYDNEY CITY2SURF: Please support a colleague

In our last Newsletter we were reminded that our first ASM of the RMSANZ in October “is the equivalent of the 24th ASM of AFRM and it will be the 35th year of uninterrupted ASMs held by the profession of Rehabilitation Medicine in Australia and New Zealand”. Thirty-five years takes us back to 1981. This, in turn, takes me back to 1967 when I was invited by Dr Adrian Paul to join his team, as a Specialist VMO in the Department of Physical Medicine and Rehabilitation at Royal Prince Alfred Hospital, Sydney. Such departments were comparatively rare at that time. The pioneers in this field were represented by the Australian Association of Physical Medicine and Rehabilitation, formed only 7 years previously.

When this later evolved into the Australian College of Rehabilitation Medicine, I was the Representative of the College on various AMA committees. Younger members of our Faculty, who take the Workers Compensation system for granted, may be interested to hear that one of the AMA submissions which we prepared for me to give evidence to a NSW State Commission, before Judge A.T. Conybeare, was to The Commission of Inquiry into the feasibility of establishing a system for the rehabilitation of injured workers under the N.S.W. Workers' Compensation Act.

What has this got to do with the City2Surf Run? Partly it was to make the point that I have been around for some time, and that therefore running 14km non-stop could be seen as a challenge!

However, I consider that I enjoy this as a result of a healthy lifestyle, and that if I ran for charity this year it could help to bring the “lifestyle” message to the general public. My page on the public fundraising website carries this message. (Ed: https://city2surf2016.everydayhero.com/au/conrad). Instructing our patients in lifestyle medicine is an integral part of rehabilitation, and I believe we should all “practice what we preach”. I believe I do.

I write to request a 50 cent donation (or more) for each of the 14 km achieved. I promise to refund for each km not completed. (Ed: Don’t provide bank details for refunds just yet – Conrad completed his first half-marathon just last year!). Any such donations serve to help the work of my nominated charity, but also to respect the pioneers whose efforts led to the acceptance of Rehabilitation Medicine as a Specialty. It was extremely difficult to choose from amongst the many and various medical charities I support. I eventually opted instead, for World Animal Protection.

The animals and I would be most grateful for your support.

The Run is on Sunday 14th of August, though any later donations will continue to be forwarded to the charity during the following four weeks.

With Warm Regards, Conrad Winer

RMSANZ ASM 2016

REGISTER NOW!

Early bird discounts end on 9 September

Go to: www.dcconferences.com.au/rmsanz2016

6 AROC Update

Nathan Johns

The team at AROC have been working hard to develop a new graphical method to display your hospital’s rehabilitation data. The AROC dashboard allows you to see your demographics instantly to compare age, complication rate and impairment mix. It graphically plots your hospital’s rehabilitation service against all other Australian sites with regards to functional gain and length of stay to allow for quick comparisons of these quality measures, ready for further analysis and interpretation. Ask your Medical Director today to see how your facility data compares so that you can participate in the quality management at your facility.

7

Therapeutic Cannabinoids and the Rehabilitation Physician

Part 1 -Chronic Noncancer Pain Michael Vagg

Psychoactive and motivational side

effects are believed to be less

common with low THC products, but

the implication is that this will also

substantially reduce even the

modest efficacy that has been

proposed for cannabinoid products

in therapeutic use. Availability of

high THC therapeutic cannabinoid

products is likely to reduce

motivation and cause a higher rate

of psychoactive side effects. Effects

on perception, cognition and

motivation are foreseeably

detrimental to rehabilitation efforts.

Combining analgesic cannabinoids

with opioids or anticonvulsants is

likely to yield substantial cognitive

impairments in rehabilitation

patients, and would be of particular

concern in the ABI population where

heavy recreational use is already

known to be associated with poorer

long-term outcomes.

Despite the often moving anecdotal

data presented by pro-cannabis

lobby groups, there remains such a

lack of plausible benefit and risk of

foreseeable harm. It is unsurprising

then that pain management

clinicians have been unenthusiastic

about future ‘medicinal’ cannabis

trials. Much of the preliminary

research concerning analgesic

cannabinoids that has been done is

not promising. Better results for the

Australian community with

persistent pain could be achieved

by other, better-evidenced

approaches.

While the current political and

legislative momentum behind the

push for ‘medicinal’ cannabis has

reached the point of

implementation, the indications and

in fact the form of cannabinoids

approved for use remain open for

debate.

One of the major myths driving

community activism in support of

these changes is the claimed

efficacy of cannabinoids in chronic

noncancer pain. There have been a

number of small-scale studies of

whole plant derivatives in various

chronic pain states including HIV

neuropathy pain, persistent low

back pain, and diabetic peripheral

neuropathy. The results have been

mixed and are generally

unconvincing in supporting the case

for larger studies. The heterogeneity

of design and outcome measures

chosen has meant that meta-

analysis is not feasible. Synthetic

derivatives such as nabilone have

been similarly disappointing. From

the available studies, one concludes

that as an analgesic, the effect size

is comparable to a weak opioid such

as codeine or tramadol. A 2009

systematic review of 18 RCTs

looking at cannabinoids in chronic

non-malignant pain concluded that

the modest beneficial effects may

be entirely offset by potential for

serious harm. A review of

neuropathic pain treatment to

coincide with the IASP Global Year

Against Neuropathic Pain

recommended against therapeutic

cannabinoids based on the current

assessment of risk versus benefit.

The Faculty of Pain Medicine has

produced a position statement

which summarises the consensus of

Specialist Pain Medicine Physicians

in the Australian setting. In

particular, is a significant concern

that the pattern of well-intentioned

iatrogenic harm that has occurred

with sustained-release opioid

prescribing may be about to be

repeated with a class of drugs about

which far less is known of the

potential benefits and harms. What

we know of the benefits is

unimpressive. What is known about

the potential harms is very

concerning.

A particular concern for

rehabilitation physicians is the

impact of analgesic cannabinoids on

motivation and cognition. Studies

which have demonstrated some

degree of analgesia have involved

products which are high in

tetrahydrocannabinol (THC).

References:

Murnion https://www.nps.org.au/australian-prescriber/articles/medicinal-cannabis

Finnerup et al http://www.thelancet.com/journals/laneur/article/PIIS1474-4422(14)70251-0/fulltext

Martin-Sanchez et al http://www.ncbi.nlm.nih.gov/pubmed/19732371

Faculty of Pain Medicine PM10 http://fpm.anzca.edu.au/documents/pm10-april-2015.pdf

You too can advertise HERE

RMSANZ was established by Rehabilitation Physicians in Australia

and New Zealand in February 2015 to function as a membership

driven independent society dedicated to promote the specialty of

Rehabilitation Medicine and to advocate on behalf of the

professionals and recipients of disability services in Australia and

New Zealand. A major objective of the Society is to provide a forum

for members to engage in the pursuit of Rehabilitation Medicine and

its special interests and related interests amongst Medical, Nursing

and Allied Health professions.

Publication and distribution of an electronic newsletter is designed

to facilitate communication amongst members and other interested

parties by presenting informative and entertaining articles that

might provoke thought, and possibly stir controversy.

Feedback, contributions and suggestions are all welcomed.

Please address all correspondence to the Editorial Committee via

email to: admin@rmsanz.net or contact Sybil Cumming, the

RMSANZ’s Administrative Officer directly via email to:

rmsanz15@gmail.com

PO Box 777 Cairns, Qld 4870

Phone: 0414 992 324 E-mail: admin@rmsanz.net

RMSANZ Ltd.

Disclaimer

The opinions expressed in this

publication are those of the authors.

They do not purport to reflect the

opinions or views of the RMSANZ

Ltd or its members.

© Copyright 2016 RMSANZ Ltd

Reproduction of the material contained in this publication may be made only with the written permission of the RMSANZ Editorial Committee.

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8

For event details and for registration visit the website: http://www.aopa.org.au/events/event/aopa-congress-2016

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