What do occupational therapists add to pain management?
I’ve struggled with professional identity from time to time, but after completing my PhD thesis looking at how people live well with pain, I’ve developed a new understanding of how occupational therapists add value in this area of practice. Occupational therapists joke that “no-one knows what an occupational therapist does” – and sadly, that’s true. It’s not because what we do isn’t important, it’s because our view of people and the way we work with people differs from most health professions. Occupational therapists don’t treat disease per se, we work with peo...
Source: HealthSkills Weblog - September 27, 2020 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Chronic pain Occupational therapy Professional topics Resilience Science in practice Source Type: blogs

On values, culture and health
This week is Te Wiki o te Maori – and the theme is Kia Kaha te Reo Maori. For those readers not familiar with te reo, kia kaha translates to “be strong.” It’s a word people from Otautahi (Christchurch) have used a lot since 2010 and the first of the many events that have shaken (literally) our world since then. Te Wiki o te Maori is a week dedicated to celebrating and strengthening the use of Maori language in New Zealand. While the week celebrates the language of Aotearoa, it also helps us tangata tiriti, or people of the Treaty of Waitangi, remember that we have a place in this whenua (land). ...
Source: HealthSkills Weblog - September 13, 2020 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Chronic pain Pain conditions Professional topics Research Resilience/Health Science in practice respect values Source Type: blogs

What to do when one size does not fit all
Alert: rant ahead. Early in my career working in persistent pain management, it was thought that “chronic pain is chronic pain is chronic pain” and pretty much anything that helped one person would help the next. Over time we’ve learned a lot more about persistent pain: the mechanisms differ a lot between neuropathic mechanisms and nociplastic mechanisms. Even within these groups, the mechanisms are very different. We’ve also learned a lot more about the psychosocial variables that are associated with prolonged disability and distress when pain persists. Some of the earliest work by Turk and coll...
Source: HealthSkills Weblog - September 6, 2020 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Chronic pain Groupwork Interdisciplinary teams Pain conditions Research Science in practice Source Type: blogs

The hardly hidden costs
Chronic/persistent pain management is not sexy. No-one gets a magic cure. Lives are not saved – at least not in a way that mortality statistics show. Chronic pain management is under-funded. And now: buried in a list of other proposed service cuts in the local health board’s plan to save millions of dollars, is a proposal to “save” $650,000 from the pain clinic. You’ll note also reductions in community services, GP support for vulnerable, and healthy lifestyles programmes. https://www.stuff.co.nz/national/health/122558278/hundreds-of-staff-nurses-and-services-may-be-axed-at-canterbury-d...
Source: HealthSkills Weblog - August 30, 2020 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Chronic pain Interdisciplinary teams News Pain conditions Research Science in practice Uncategorized Source Type: blogs

Whose life is it anyway?
A couple of weeks back I posted about my concerns that exercise is often over-hyped, has limited effects on pain and disability, and therefore people going through a rehabilitation programme will likely dump doing the exercises as soon as the programme ends. Well, that was an interesting conversation starter! TBH I expected the response. On the one hand we have avid strength and conditioning people (including a whole bunch of physiotherapists) saying it’s crucial to get strong and fit because it’s good for health and longevity, while on the other hand we have a large group of “others” who think life...
Source: HealthSkills Weblog - August 23, 2020 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Chronic pain Clinical reasoning Pain conditions Professional topics Research Science in practice goal setting Source Type: blogs

A lot can happen in a week …
This time last week I had this mad idea to share some of my thoughts about “exercise” – not thinking that post would create such a stir! Is it really so radical to recognise that not everyone likes That Word? And that for some, the benefits of exercise aren’t as valued as other important parts of life? And that movements, like people, come in all shapes and sizes so what YOU like might not be something I like? In New Zealand we’ve also had a new emergence of Covid19 in the community, after 102 days without any community-based cases. This has been very scary for some of us, a real frustratio...
Source: HealthSkills Weblog - August 16, 2020 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Off topic diversity feminism professional behaviour Source Type: blogs

Is exercise the new snake oil? or just a dirty word?
If you haven’t heard about the health benefits of exercise in the last 10 years or longer, then you’ve probably been a hermit! Exercise can do all these wonderful things – help you lose weight, reduce heart disease, moderate insulin and blood glucose levels, improve your mental health, and yes! reduce pain and disability when you’re sore. (check this list out) The claims sound suspiciously similar to the claims made by old snake oil merchants – or the amazing White Cross Electric Vibrator! Well perhaps there’s a little more research supporting claims for exercise… but a...
Source: HealthSkills Weblog - August 9, 2020 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Chronic pain Coping strategies Motivation Professional topics Resilience/Health Science in practice exercise movement persistent pain Source Type: blogs

Pain may not be what a person fears most
We all have typical ways of going about our daily routines and solving problems. Mostly these work – until we encounter a situation where they don’t. If we’re flexible enough, we’ll figure out a way to change what we do in that instance, and this will become another strategy to draw on, and might even become another habit that works – until it doesn’t. In pain rehabilitation, there are certain patterns of activity that have received a lot of research attention. Activity avoidance is one of them, while task persistence is given rather less air time (though it’s emerging as an int...
Source: HealthSkills Weblog - July 26, 2020 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: ACT - Acceptance & Commitment Therapy Chronic pain Coping Skills Coping strategies Occupational therapy Pain conditions living well persistent pain Source Type: blogs

That elephant in the room thing
This weekend I was incredibly fortunate to speak at Le Pub Scientifique (the next one is the super intelligent Tasha Stanton!) about one part of our pain conversation that’s absent: how do we have a conversation about when pain persists and doesn’t respond to any treatments? I still don’t have any research to show how we might broach this topic in a way that respects the person with pain, acknowledges just how poorly our treatments do, and provides a framework for us to collaborate. It’s like this big bogey sitting in our clinics that we pretend isn’t there. Why do we need to have this c...
Source: HealthSkills Weblog - July 19, 2020 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: ACT - Acceptance & Commitment Therapy Chronic pain Coping strategies Pain conditions Science in practice Therapeutic approaches Clinical reasoning empathy persistent pain self-compassion Source Type: blogs

Le Pub Home Brew
Now I’m the kinda woman who enjoys a bevvie or two – and I do love to talk! Combine them both with my favourite topic of pain, and you end up with Le Pub Home brew…and I’m speaking THIS SATURDAY!! My topic? Let’s stop focusing on pain, because we have a few elephants in the room we need to discuss. Come and join me as I poke and prod at assumptions made about why people come asking for help with their pain, why clinicians often focus on the wrong thing, why we need to listen to the messages buried beneath the “take my pain away” call – and why the skills clinicians ha...
Source: HealthSkills Weblog - July 15, 2020 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Uncategorized Source Type: blogs

Secondary gain: really?
One of my most popular posts ever is one I wrote many years ago on malingering. Secondary gain, like malingering or symptom magnification is one of those terms used by people who don’t live with persistent pain, and commonly used when a person with pain doesn’t seem to be progressing “as expected”. The term is an old one, originating in the psychoanalytic literature, brought into compensation and insurance environments but never really examined (Fishbain, Rosomoff, Cutler & Rosomoff, 1995) until well after it had become a popular label. Freud first identified the potential for gains from bei...
Source: HealthSkills Weblog - July 12, 2020 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Assessment Chronic pain Professional topics Research malingering secondary gain stigma Source Type: blogs

International Chronic Pain Virtual Summit 2020
I am so happy to be part of this virtual summit especially under our current COVID19 disruptions! It’s FREE and more than 20 speakers from around the world are talking about the things that matter in pain rehabilitation and management. I might even drop in a word or two about occupational therapy….!Click the link and find out more! – click Just to give you an idea of the speakers involved, you’ll get to hear from: Professor Peter O’Sullivan Professor Tasha Stanton Lissanthea Taylor Vidyamala Burch Dr Stephen Grinstead Kathy Hubble Pete Moore Prof Kim Burton Prof ...
Source: HealthSkills Weblog - June 14, 2020 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Uncategorized Source Type: blogs

Knowledge translation: beyond the peer reviewed papers
Oh the risks and pitfalls of trying to get research into clinical practice! There’s an often-cited figure estimating it takes around 17 years for a new practice to enter routine clinical care (Dilling, Swensen, Hoover, Dankbar, Donahoe-Anshus, Murad & Mueller, 2013) – that’s a long time! There are many reasons for this delay: Inertia – change is hard!Systems – often support the status quo, may not fund new or innovative practicePeer pressure – to keep on doing the same as everyone elseQuestioning whether the benefits are truly thereBusy clinical practice making it difficult to...
Source: HealthSkills Weblog - May 24, 2020 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Professional topics knowledge translation musing research into practice Source Type: blogs

5 Things I Learned from Lock-down
As New Zealand emerges from the most severe lock-down levels to greater freedom (but still not back to life as usual) I’ve been reflecting on what I’ve learned – no, not a new language, new baking skills, or sudden competence in using R (see here for a great tutorial), but things about myself. Odd though it may seem, I’m leaving lock-down with a sense of wistfulness. You see, the time from the end of March to end of April has been a lovely time for me. I’m lucky, I have a good job, my work hasn’t changed much (well, a bit), my family are safe, I live close to the beach and a park, an...
Source: HealthSkills Weblog - May 17, 2020 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Pain conditions Professional topics Resilience/Health Uncategorized COVID19 Source Type: blogs

On labels and boundaries
What we call a disease matters. It matters to the person because a diagnosis is a marker: this problem is known, it’s recognised, it’s real (Mengshoel, Sim, Ahlsen & Madden, 2017). It matters to the clinician, particularly medical practitioners, but also those clinicians working within a largely “disease-oriented” framework (for example, physiotherapists, osteopaths) (Haskins, Osmotherly, Rivett, 2015; Kennedy, 2017). It matters also to insurance companies, or funding providers – who is in, and who is out. The diagnostic label itself hides a great many assumptions. The ways in which dia...
Source: HealthSkills Weblog - April 6, 2020 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Assessment Chronic pain Clinical reasoning Coping strategies Pain conditions Professional topics Uncategorized Source Type: blogs

When life is topsy turvy
I had intended to write about a piece of research today, but as I read all the news reports about how much life has changed and needs to change more, I’ve decided it’s time to address important issues facing health professionals working in pain management and rehabilitation. In New Zealand the alert level is at 2 out of 4. I suspect this has been instituted to soften the shock later in the week when we’re asked to completely lock down. We are currently being asked to maintain physical distancing, older folks are asked to self isolate as much as possible, GPs and nurses are being asked to move to virtua...
Source: HealthSkills Weblog - March 22, 2020 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Coping strategies COVID19 Source Type: blogs

Coronavirus (COVID19), catastrophising – and caution
I don’t often leap aboard a popular topic and blog about it, but I’m making an exception right now because, although COVID19 is new – catastrophising is not. There are a number of people who really do not like the term “catastrophising”. There are comments that this is a pejorative term, used to deny the validity of a person’s experience. That it means the person is exaggerating or being melodramatic or in some way not believable. But as I read the many, many headlines about COVID19, including the international toilet paper frenzy, reading about Vitamin C or “anti-inflammator...
Source: HealthSkills Weblog - March 15, 2020 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Chronic pain Clinical reasoning Resilience/Health Science in practice catastrophising COVID19 Source Type: blogs

“ Intuition ” – and clinical reasoning
Intuition is one of two main modes of thinking, according to Daniel Kahneman. Intuition is fast, considers the whole rather than components of the whole, and intuition feels effortless. Intuition can also be wrong – but often isn’t (Gruppen, Woolliscroft & Wolf, 1988). We use intuition well when we’ve been exposed to many examples of the phenomenon under consideration – for example, if we’ve seen a lot of patients with similar health problems. We don’t use intuition well when we buy into biases or stereotypes. The alternative to intuition is slower thinking, that typically brea...
Source: HealthSkills Weblog - March 8, 2020 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Assessment Chronic pain Clinical reasoning Occupational therapy Pain conditions Physiotherapy Professional topics Psychology intution Source Type: blogs

" Intuition " – and clinical reasoning
Intuition is one of two main modes of thinking, according to Daniel Kahneman. Intuition is fast, considers the whole rather than components of the whole, and intuition feels effortless. Intuition can also be wrong – but often isn’t (Gruppen, Woolliscroft & Wolf, 1988). We use intuition well when we’ve been exposed to many examples of the phenomenon under consideration – for example, if we’ve seen a lot of patients with similar health problems. We don’t use intuition well when we buy into biases or stereotypes. The alternative to intuition is slower thinking, that typically brea...
Source: HealthSkills Weblog - March 8, 2020 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Assessment Chronic pain Clinical reasoning Occupational therapy Pain conditions Physiotherapy Professional topics Psychology intution Source Type: blogs

Undergraduate pain curriculum: What needs to be included and what doesn ’ t?
One of the prominent themes in social media discussions about pain is that the subjects are not given sufficient attention at undergraduate level. The results of this omission are that many entry-level clinicians don’t have the necessary knowledge, skills or attitudes for working with people who experience pain. (As an aside, it also makes my job as a postgraduate Academic Leader much more difficult: where do I start when developing a programme?!) Luckily there is an IASP Pain Curriculum. Actually there are many of them, for many disciplines, and they provide educators with great guidance. The problem is, however,...
Source: HealthSkills Weblog - March 1, 2020 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Education/CME Pain conditions Professional topics Research Science in practice Source Type: blogs

Undergraduate pain curriculum: What needs to be included and what doesn't?
One of the prominent themes in social media discussions about pain is that the subjects are not given sufficient attention at undergraduate level. The results of this omission are that many entry-level clinicians don’t have the necessary knowledge, skills or attitudes for working with people who experience pain. (As an aside, it also makes my job as a postgraduate Academic Leader much more difficult: where do I start when developing a programme?!) Luckily there is an IASP Pain Curriculum. Actually there are many of them, for many disciplines, and they provide educators with great guidance. The problem is, however,...
Source: HealthSkills Weblog - March 1, 2020 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Education/CME Pain conditions Professional topics Research Science in practice Source Type: blogs

Did you miss me?
It’s been a while since I last posted on my blog, as I’ve had other projects on the go this summer. Over this time I’ve been pondering, as I usually do, why pain management/rehabilitation has so many problems. Conceptually, I can understand that pain is a complex experience that we’re a long way from understanding. I get that it’s a philosophically challenging subject. That because it’s subjective (like love, disgust, fatigue or hunger) it’s difficult to examine dispassionately. I also get that it’s big business. Pain is one aspect of being human that captures the entrepr...
Source: HealthSkills Weblog - February 23, 2020 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Low back pain Pain conditions Professional topics Science in practice Source Type: blogs

Cannabis questions … so many questions!
Recently I wrote a summary of my readings around cannabis for pain. It’s a hot topic in New Zealand because we’re holding a referendum on cannabis law reform next year, and as expected, all the lobby groups are out in force! My interest is sparked because so many of the people I work with as patients also use cannabis – and the evidence from RCTs is pretty poor. And YET as a recent study colleagues and I carried out with people who have spinal cord injury and neuropathic pain, cannabis is something that holds appeal, and interestingly, seems to provide some useful effects. The study we conducted (see i...
Source: HealthSkills Weblog - October 28, 2019 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Coping strategies Pain Pain conditions Research cannabis medicinal cannabis qualitative Source Type: blogs

Podcast with Matt Wallden!
I had the pleasure of chatting to Matt Wallden from FC20 recently – and here’s the evidence:
Source: HealthSkills Weblog - October 28, 2019 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Uncategorized Source Type: blogs

Why are there not more occupational therapists in pain rehabilitation?
A question I’ve asked myself many times! As a small profession with a long history (as long as physiotherapy, TBH), it does seem odd that there are many, many pain rehabilitation services where never an occupational therapist has darkened the door. Some of the reasons lie within the profession: in general, occupational therapists are busy being clinicians and have little time for research. In New Zealand, few occupational therapists pursue higher degrees, and many avoid statistical analyses, experimental design, randomised controlled studies. In fact, some occupational therapists have argued that the tailored appr...
Source: HealthSkills Weblog - October 13, 2019 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: ACT - Acceptance & Commitment Therapy Clinical reasoning Cognitive behavioral therapy Coping strategies Occupational therapy Pain conditions Resilience/Health interprofessional teams pain rehabilitation persistent pain Source Type: blogs

Three letter acronyms and what they mean – CBT, DBT, CFT, ACT – not alphabet soup!
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 - October 6, 2019 Category: Anesthesiology Authors: BronnieLennoxThompson 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

Flare-ups and how to handle them
If you live with persistent pain of any kind, you’ll know what a flare-up is. Periods of time when pain is exacerbated and sustained at a higher than average level over at least a few days, often longer. Flare-ups always settle down – but oh my, it can feel like they’re going on forever! Handling a flare-up is not quite the same as handling everyday pain. Everyday pain, for those of us who manage it independently of healthcare professionals, usually needs a generally steady routine, not too many surprises. A regimen of movement, relaxation, fun, mindfulness, plodding on and managing stress. A little bo...
Source: HealthSkills Weblog - September 29, 2019 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Chronic pain Coping Skills Coping strategies Pain conditions Professional topics Resilience/Health exacerbation flare-up management flare-ups Source Type: blogs

Who am I? The sense of self in chronic/persistent pain
One of the most pervasive descriptions of what it is like to live with persistent pain is the loss of sense of self. Time after time in qualitative research we read about people feeling they’re in “limbo land”, losing confidence that they can do what matters in their lives, feeling stigmatised and isolated – not themselves any more. An in-depth meta-ethnography of qualitative research showed that pain undermined participation, ability to carry out daily activities, stymied a sense of the future, and intruded on the sense of self (MacNeela, Doyle, O’Gorman, Ruane & McGuire, 2015). To und...
Source: HealthSkills Weblog - September 22, 2019 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Uncategorized Source Type: blogs

Having The Conversation …
Over the past few weeks I’ve been posing some of the curly questions that I don’t think have yet been answered in pain rehabilitation. In fact, some of them have yet to be investigated in any depth. Today I’m stepping out into the abyss to offer my current thoughts on one question that has been rattling around for some time: how do we have a conversation about pain and its persistence? I want to begin by stating very emphatically, that I do believe pain can change. And that the way a person views or interprets their experience can change, and there is reversibility in pain intensity and quality. Having a ...
Source: HealthSkills Weblog - September 8, 2019 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Chronic pain Coping strategies Pain conditions Professional topics Research Resilience/Health Science in practice acceptance rehabilitation willingness Source Type: blogs

There are two of us in this …
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,...
Source: HealthSkills Weblog - September 1, 2019 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Chronic pain Coping strategies Pain conditions Professional topics Research Science in practice attitudes beliefs communication nocebo Source Type: blogs

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 ...
Source: HealthSkills Weblog - August 25, 2019 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Motivation Pain conditions Professional topics Science in practice questions Source Type: blogs

Uncertainty: perennial controversies in pain understanding
As I write this post today, yet again there are new theories being proposed for that most common of experiences: pain. Not only theoretical controversies, but even the definition of pain is being debated – is pain an “aversive” experience? An aversive sensory and emotional experience typically caused by, or resembling that caused by, actual or potential tissue injury. Some researchers have recently “found” a new nociceptive fibre (though they persist in calling it a “pain fibre” – once again perpetuating the idea that pain is one and the same with nociception). One of the ...
Source: HealthSkills Weblog - August 18, 2019 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Chronic pain Pain conditions Research Resilience/Health Science in practice definition disability living well persistent pain Source Type: blogs

The know-do gap: does social media help change things?
This post is prompted by a Facebook post from Connor Gleadhill asking “in what way is SoMe contributing to knowledge translation (KT)? I’m interested in the experience of those tagged and if anyone is aware if it has been rigorously tested. As far as I’m aware it hasn’t. Is it simply a confirmation bias arena? We are humans after all, and we curate our experience on SoMe.” Oh such a great question and one reason I still hang out on social media! I’ve been blogging since 2007, two years before the famous Body in Mind (who have just announced they won’t post any more content)....
Source: HealthSkills Weblog - August 4, 2019 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Clinical reasoning Education Education/CME Professional topics Research blogging community of practice conversations knowledge translation research translation social media Source Type: blogs

Cannabis and cannabinoids for persistent pain?
Over the last 12 months New Zealanders have entered into the debate about cannabis and cannabinoids for medical use. In the coming year we’ll hear even more about cannabis as we consider legalising cannabis for recreational use. There is so much rhetoric around the issue, and so much misinformation I thought it high time (see what I did there?!) to write about where I see the research is at for cannabis and cannabinoids for persistent pain. For the purposes of this blog, I’m going to use the following definitions: Cannabis = the plant; cannabis-based medication = registered extracts (either synthetic or from...
Source: HealthSkills Weblog - July 21, 2019 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Chronic pain Coping strategies Research Science in practice cannabinoids cannabis medicinal cannabis neuropathic pain persistent pain recreational cannabis Source Type: blogs

Informing — and knowing
Learning is perceived as a process of personal and social construction where people are actively involved in making sense of information they interact with, rather than passively receiving it (Kuhthau 2004). This cumulative and developmental process involves the whole person in thinking, acting, reflecting, discovering ideas, making connections, and transforming prior knowledge, skills, attitudes, and values into new knowledge (Dewey 1933). I’m an educator for much of my time. When I think about it, I’ve been an educator for most of my clinical career – after all, when I helped people learn how to show...
Source: HealthSkills Weblog - June 16, 2019 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Chronic pain Coping strategies Education Education/CME Professional topics data information knowledge meaning Source Type: blogs

Barriers to good pain rehabilitation
This is a long…… readooops, sorry, not. Low back pain is, we know, the greatest contributor to days lived with disability (Rice, Smith & Blyth, 2016). And no-one anywhere in the world has found a good mix of services to reduce the number of days lived with disability as a result of this problem. And yet billions of dollars are used to fund research into the many contributors to a shift from acute low back pain to ongoing disability associated with low back pain. At the same time, treatments that directly target disability, rather than pain (a target considered the most important outcome by Sullivan ...
Source: HealthSkills Weblog - June 9, 2019 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Chronic pain Low back pain Pain conditions Research Science in practice health funding health systems models of care Source Type: blogs

Clinical reasoning models: what ’ s wrong with them?
I’ve been interested in clinical reasoning and models used in clinical reasoning for quite some time. Occupational therapy has several models, including the “occupational therapy problem solving process” by Lela Llorens, the Model of Human Occupation by Gary Kielhofner, and the Canadian Model of Occupational Performance by Polatajko, Townsend and Craik in 2007. All of these models were designed to support occupational therapy clinical reasoning processes, and to capture the essence of what occupational therapy is about. When it comes to pain rehabilitation, I’ve found the occupational therapy mo...
Source: HealthSkills Weblog - May 26, 2019 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Assessment Clinical reasoning Occupational therapy Pain Pain conditions Physiotherapy Professional topics Psychology Research Science in practice hypotheses models theory Source Type: blogs

Self-management: What do we think about it?
Self-management is all about the person living with their chronic health problem, learning how to maximise their wellbeing and limit the impact of their health problem on their life. The words might be well-known – but how self-management is best carried out, by whom, and when is a vexed question. I stumbled upon a study carried out by Van Wely, Boiten, Verhoef, Eijckelhof, Van Hooft, Van Staa et al (2019) where, using Q-methodology (more about this shortly), they examined the beliefs about self-management of a group of Dutch physiotherapists. First of all, why is this something to blog about on a blog about p...
Source: HealthSkills Weblog - May 19, 2019 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Chronic pain Coping Skills Coping strategies Professional topics Research Science in practice independence living well persistent pain Resilience self management Source Type: blogs

Clinical reasoning & meaning-making (a long post)
Clinical reasoning is a cornerstone of evidence-based healthcare, in fact some would argue it’s the cornerstone of all healthcare. While there are many different processes, the ultimate purpose of clinical reasoning is to ensure the person seeking help has their needs identified then met, and the clinician has a basis upon which to decide which treatment they should offer. The approach we use in clinical reasoning, including the information we prioritise and search for, and the way we synthesise the information to make sense of it will depend on the model we have to explain our treatment approach. For example, if...
Source: HealthSkills Weblog - May 12, 2019 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Chronic pain Clinical reasoning Occupational therapy Pain conditions Physiotherapy Professional topics Psychology Research Science in practice embodiment intersubjectivity making sense persistent pain Source Type: blogs

An experimental study of pharmaceutical cannabis in fibromyalgia
This study is one of the growing number of studies beginning to examine the effects of cannabinoids on pain, and offers a tiny window into what might be happening. Note: the study was performed in collaboration with the cannabis producer, and one of the authors is an employee of this company. Although his role was only to comment on the protocol and final version of the paper, it’s worth noting this relationship. The study question In this study, the researchers were looking to understand the analgesic effect of inhaled pharmaceutical-grade cannabis as a plant rather than an extract, using four different variet...
Source: HealthSkills Weblog - May 5, 2019 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Chronic pain Coping strategies News Pain conditions Research cannabis experiment fibromyalgia Source Type: blogs

Pacing, pacing, pacing …
If there’s one pain management and rehabilitation strategy that keeps me awake at night, it’s pacing. Living with persistent pain, I loathe the idea of pacing because I know everyone “booms and busts” from time to time, and few people like the idea of planning every single aspect of every single day as they come to grips with modifying their daily routines. BUT it’s one of the most popular strategies in textbooks, self-help books, and in treatment so there must be something in it, right? Vexed definitions One of the problems with the whole pacing concept is defining what we mean by it. I...
Source: HealthSkills Weblog - April 28, 2019 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: 'Pacing' or Quota Chronic pain Clinical reasoning Coping Skills Coping strategies Occupational therapy Pain conditions Physiotherapy Research Science in practice activity management activity pacing pain management pain rehabilita Source Type: blogs

Do you trust me?
Trust – something that needs to be earned, or something that is present at first… and then erodes? Or perhaps, it’s a snap judgement we make on the fly – and judge everything else about a person on that basis? Firstly, why even discuss trustworthiness in pain rehabilitation? Well, the answer is quite clear: I don’t know how many times I’ve been asked if I can tell whether someone is faking their pain. I’ve read numerous articles on functional capacity testing – and its poor predictive validity (or completely absent investigation of such properties). I’ve had case ma...
Source: HealthSkills Weblog - April 14, 2019 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Chronic pain Clinical reasoning Coping strategies Pain conditions Professional topics Science in practice empathy malingering stereotypes stigma trust trustworthiness Source Type: blogs

The next new thing
Each week as I sit to write a blog post, I think about what’s been happening in my world and in the world of pain rehabilitation. It struck me this morning that we’re often a bit like “Ooooh! Shiny!” with new toys and techniques and research to read… yet as so many people point out, the old biopsychosocial (sociopsychobiological) framework doesn’t seem to have seeped down very far, particularly when we look at undergraduate training about pain. It’s like an abstract concept until we meet face-to-face with how poorly our original training sets us up for complexity and messiness. ...
Source: HealthSkills Weblog - April 7, 2019 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Clinical reasoning Education/CME Pain Professional topics Science in practice biopsychosocial CPD sociopsychobiological Source Type: blogs

Why focus on pain management (rehabilitation)? Response to comments
My response to comments is that at this time self-efficacy (confidence you can do things despite your pain) is really low. Self-efficacy, like love, isn’t a finite resource though, although the energy required to keep on coping (balancing all the multiple demands that persistent pain has on you) can exceed current capacity. Both self-efficacy and energy are renewable resources and change over time. Love expands as we add to it. Self-efficacy increases as we have more successes. Energy renews as we find ways to fill our buckets up faster than the holes leak it out. This post was written for health professionals, he...
Source: HealthSkills Weblog - April 2, 2019 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Uncategorized Source Type: blogs

Always look on the bright side of life!
This study was carried out in mainland China, and is for this reason alone, is an interesting study (most of our understanding about pain comes from the US, Canada, Australia and the UK). China also faces an enormous burden from people being disabled by chronic pain, so this is a good step forward to understanding what might support living well with pain in this highly populated country. The study is by Shuanghong Chen and Todd Jackson, and published last year in the journal Rehabilitation Psychology. The authors recruited 307 Chinese adults with chronic back pain (189 women, 118 men), and asked them to complete a batch...
Source: HealthSkills Weblog - March 31, 2019 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Chronic pain Clinical reasoning Coping Skills Coping strategies Research Resilience/Health Science in practice Low back pain positive psychology self efficacy Source Type: blogs

Knowledge translation: A home for occupational therapy?
Modern occupational therapy is involved with helping people participate in daily life in the real world. Indeed, occupational therapy has always been about “doing” – see here for a brief history of occupational therapy – but it has been difficult, in a strongly reductionist and biomedical context, to articulate the unique and particular contribution occupational therapy makes within healthcare. In a conversation last week with Dr Mary Butler from Otago Polytechnic, we were discussing our areas of research. I mentioned that knowledge translation, or helping clinicians use research that is often l...
Source: HealthSkills Weblog - March 24, 2019 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Chronic pain Clinical reasoning Coping strategies Occupational therapy Pain conditions Professional topics knowledge translation treatment Source Type: blogs

The “ onion ring ” model of pain
Clinicians constantly search for a better way to describe the tangled mess that constitutes ways to explore pain. Today I’m hoping to add another way, but hopefully one that might help disentangle certain aspects of pain for ease of learning. And as usual, it’s largely not my own model, but one first developed by Professor John Loeser, eminent neurologist and neurosurgeon and Director of the Multidisciplinary Pain Center from 1982-1997 at the University of Washington. There are many different versions of the ‘Onion ring’ model – Gordon Waddell, orthopaedic surgeon and contemporary of Loese...
Source: HealthSkills Weblog - March 10, 2019 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Assessment Chronic pain Coping strategies Pain conditions Professional topics explanations model of pain Source Type: blogs

Why reducing pain intensity doesn ’ t always mean a better outcome
This article challenges clinicians to rethink pain reduction as the primary outcome measure for persistent pain in the face of increasing opioid use (now reducing but often without subtlety or support) because of the very issues I’ve outlined above. They state the following: Suffering may be related as much to the meaning of pain as to its intensity. Persistent helplessness and hopelessness may be the root causes of suffering for patients with chronic pain yet be reflected in a report of high pain intensity. And conclude their article with this: When pain is chronic, its intensity isn’t a simple measur...
Source: HealthSkills Weblog - March 4, 2019 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Chronic pain Coping strategies Pain conditions Professional topics Resilience/Health Science in practice complexity disability pain intensity persistent pain Source Type: blogs

San Diego Pain Summit – only a few days to go, but you ’ re not too late!
Live Stream package details: Watch the conference on Feb. 23-24 in real time. Note that the conference occurs in Pacific Standard Time. Participate in Q&A and prize drawings. Package includes 1 year membership to Pain Summit Online, beg. March 1, 2019. Membership includes access to all presentations from 2015 to present. The 2019 presentations will be uploaded sometime in the first few weeks of March. Live Stream video contains a lag, so you can rewind hours later to watch something you missed. Approved by the California Physical Therapy Association for 1.15 CEUs or 11.5 hours. Link to register: https...
Source: HealthSkills Weblog - February 17, 2019 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Uncategorized Source Type: blogs

Reconciling uncertainty and the drive to diagnose
Recently it was suggested to me that even though I’m an occupational therapist, I might “diagnose”. Not so much diagnose disease, but “determine if a patient is depressed, anxious, catastrophising, fear avoidant etc?” The author goes on to say “isn’t that diagnosis too?” The comment was made in the context of a lengthy Twitter discussion about so-called “non-specific” low back pain. Over the course of I think about five weeks now, a large number of highly educated, erudite and passionate clinicians have argued the toss about whether it’s possible to identify...
Source: HealthSkills Weblog - February 17, 2019 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Back pain Clinical reasoning Interdisciplinary teams Low back pain Pain conditions Resilience Science in practice certainty collaboration diagnosis NSLBP uncertainty Source Type: blogs