Big questions in pain rehabilitation

The last 30 years or more of pain research and management have been exciting for us pain nerds. We’ve learned so much about processes involved in nociception, about the psychology of our responses to nociceptive input, about treatments (that often don’t work terribly well), and we’ve discovered that we (mainly) don’t know what we don’t know. There are some big questions though, that have yet to be answered – and don’t yet share the limelight that neurobiological processes seem to hog. Here are a few of my big questions. How do we alter public health policy to move from an acute biomedical model to the broader and more adequate biopsychosocial understanding of illness, as opposed to disease? To expand on this – our current healthcare funding targets procedures, actions taken against “diseases” like an osteoarthritic knee that can be whipped out and replaced with a shiny new one. The person living with that knee doesn’t really feature because what matters is getting rid of a waiting list of people who want new knees. Government funding is allocated to ensure X number of knees are replaced with the unquestioned belief that this is the best way to deal with osteoarthritic knees. Rehabilitation, or the process of helping a person deal with the effect of a disease on their experience (ie illness), is, by comparison, poorly funded, and the outcomes rather more uncertain and complex. It’s hard to count outcome...
Source: HealthSkills Weblog - Category: Anesthesiology Authors: Tags: Motivation Pain conditions Professional topics Science in practice questions Source Type: blogs

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Once you begin to dip your toes into psychological therapies, it doesn’t take long before you begin to see TLAs all over the place. So today I’m going to post on two things: some of the TLAs, and why or how we might consider using these approaches in pain rehabilitation. The first one is CBT, or cognitive behavioural therapy. CBT grew out of two movements: behaviour therapy (Skinner and the pigeons, rats and all that behaviour modification stuff), and cognitive therapy (Ellis and Beck and the “cognitive triad” – more on this later). When the two approaches to therapy are combined, we have c...
Source: HealthSkills Weblog - Category: Anesthesiology Authors: Tags: ACT - Acceptance & Commitment Therapy Clinical reasoning Cognitive behavioral therapy Coping strategies Interdisciplinary teams Occupational therapy Physiotherapy Professional topics Psychology Research Science in practice Source Type: blogs
Today’s post is another one where there’s very little to guide my thinking… Have you ever wondered why we read so much research looking at the characteristics of the people who look for help with their pain – yet not nearly as much about us, the people who do the helping? There are studies about us – thanks Ben – and others! (Darlow, Dowell, Baxter, Mathieson, Perr &Dean, 2013; Farin, Gramm &Schmidt, 2013; Parsons, Harding, Breen, Foster, Pincus, Vogel &Underwood, 2007). We know some things are helpful for people with pain: things like listening capabilities (Matthias, Ba...
Source: HealthSkills Weblog - Category: Anesthesiology Authors: Tags: Chronic pain Coping strategies Pain conditions Professional topics Research Science in practice attitudes beliefs communication nocebo Source Type: blogs
Conclusion. Our study identifies the various factors associated with a lower likelihood of RTW at 3 months after cervical spine surgery in the non-worker's compensation setting. This information provides expectations for the patient and employer when undergoing cervical spine surgery. Level of Evidence: 3
Source: Spine - Category: Orthopaedics Tags: CERVICAL SPINE Source Type: research
Conclusion: These findings support the hypothesis that in FM a deteriorated function of cortical inhibition, indexed by a higher SICI parameter, a lower function of the DPMS, together with a higher level of BDNF indicate that FM has different pathological substrates from depression. They suggest that an up-regulation phenomenon of intracortical inhibitory networks associated with a disruption of the DPMS function occurs in FM. Introduction Major depressive disorder (MDD) and fibromyalgia (FM) present overlapped symptoms. Although the connection between these two disorders has not been elucidated yet, the disruption...
Source: Frontiers in Human Neuroscience - Category: Neuroscience Source Type: research
This study aims to validate an ambulatory circadian monitoring (ACM) device for the detection of sleep and wake states and apply it to the evaluation of sleep quality in patients with Parkinson disease (PD). A polysomnographic validation study was conducted on a group of patients with different sleep disorders in a preliminary phase, followed by a pilot study to apply this methodology to PD patients. The ACM device makes it possible to estimate the main sleep parameters very accurately, as demonstrated by: (a) the lack of significant differences between the mean values detected by PSG and ACM in time in bed (TIB), total sl...
Source: Frontiers in Neurology - Category: Neurology Source Type: research
Abstract Among chronic low back pain (CLBP) patients, workers' compensation is associated with longer term prescription opioid analgesic use (OAU). The aim was to study the association between receiving Social Security Disability Insurance (SSDI) benefits and course of OAU. This prospective cohort study utilized data from primary care patients diagnosed with non-cancer CLBP. The outcomes were morphine equivalent dose (MED) - categorized as no OAU, 1-50mg MED, or>50mg MED - and change in MED over time using mixed multinomial logistic regression models. Covariates included sociodemographics, pain severity, pain m...
Source: Pain Physician - Category: Anesthesiology Authors: Tags: Popul Health Manag Source Type: research
The objectives of this study were to define the role for surgery in the treatment of chronic low back pain (cLBP) and to develop a new classification of cLBP based on the pattern of injury.HypothesisSurgery may benefit patients with cLBP, and a new classification based on the injury pattern may be of interest.MethodA systematic literature review was performed by searching Medline, the Cochrane Library, the French public health database (Banque de Données en Santé Publique), Science Direct, and the National Guideline Clearinghouse. The main search terms were “back pain” OR “lumbar” OR &...
Source: Orthopaedics and Traumatology: Surgery and Research - Category: Orthopaedics Source Type: research
NEW YORK (New York)—Patients with anxiety and depression may be less satisfied than other patients with their chronic low back pain (CLBP) treatments, new research suggests. “Patients with anxiety/depression symptoms experienced more pain severity and more pain-related functional, social, and emotional disability, and they were less satisfied with care, compared with the other groups,” the... [Read More]
Source: The Rheumatologist - Category: Rheumatology Authors: Tags: Conditions anxiety Back pain Chronic pain Depression low back pain Pain Management Source Type: research
Conclusions: This study revealed that stabilization exercise is very useful in the management of sleep disturbance, pain-related disability, depression, and anxiety in NSCLBP patients. PMID: 30013734 [PubMed]
Source: Korean Journal of Pain - Category: Anesthesiology Tags: Korean J Pain Source Type: research
Last week I wrote about my approach to assessing sleep problems in those with persistent pain. As an ex-insomniac I’ve spent a while learning about sleep so I can understand what’s going on, and why sleep can be such a problem. In this week’s post I want to dig a little deeper into what’s going on with poor sleep, as well as some of the unique features of sleep in people experiencing persistent pain. Having reviewed the five main areas that are fundamental (and can/should be assessed by anyone working with people who experience persistent pain), the next area I want to look at with people is mood. T...
Source: HealthSkills Weblog - Category: Anesthesiology Authors: Tags: Assessment Chronic pain Clinical reasoning Health Pain conditions Research biopsychosocial coping disability function pain management treatment Source Type: blogs
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