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 13, 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 6, 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 29, 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

Why do clinicians fear telling people their pain may persist?
There is a big void in our understanding of interactions between clinicians and people who live with persistent pain, and that vacuum is about how people learn that their pain is not going anywhere soon. Recently I searched for qualitative research examining the conversations between clinicians and patients at the moment of diagnosis: that moment when a clinician says “I’m sorry, but you’ve tried all there is to try, and it looks like your pain might not respond”. Or it might be “We’ve found out what your problem is, but we know that right now, there aren’t any very effective treat...
Source: HealthSkills Weblog - February 10, 2019 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Chronic pain Coping strategies Health Pain conditions Professional topics Research Science in practice diagnosis living well persistent pain Source Type: blogs

Tough Topics to Talk about
A series of short videos on communicating in the clinic. Tough topic one – setting the scene Course details: https://www.trybooking.com/book/event?eid=460122&fbclid=IwAR2Vz32dzfBJ1w4CkUaqcRwZWFJJy3EJ2-mubuWlH–ZAsA_hZQ2l3U6PRs (Source: HealthSkills Weblog)
Source: HealthSkills Weblog - February 3, 2019 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Uncategorized Source Type: blogs

Tough topics to talk about
I was involved in a Facebook discussion about intimacy and sexuality and pain, and I was struck at how tough people find it to raise this kind of topic with a new person seeking help. So… I thought I’d do a series of very brief, very introductory talks on ways I’ve used to broach tough topics. Before I begin, though, I’d like to frame my discussion by sharing my “therapy viewpoint” or the values I try to integrate in my work. People are people, so it’s OK to be a person too. What I mean by this is that therapists can sometimes feel they have to be “perfect” and ...
Source: HealthSkills Weblog - February 3, 2019 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Clinical reasoning Coping strategies Pain conditions Professional topics Therapeutic approaches clinical communication interviewing tough topics Source Type: blogs

Ways to avoid “ othering ”
This study provides an insight into the norms expected as part of “being a proper patient – ready for change”. Norms are a part of culture, assumptions about what “is done” in a particular context. Just as health professionals learn to “be professionals”, people seeking help for their health are also expected to behave in certain ways. Othering is, as I’ve indicated above, a normal or common part of interactions – some authors suggest we need an “other” in order to for our self to “know itself and define its boundaries” (Krumer-Nevo, 2012). At...
Source: HealthSkills Weblog - January 27, 2019 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Assessment Clinical reasoning Coping strategies Pain conditions Professional topics Resilience/Health charity Chronic pain othering persistent pain reasonableness understanding Source Type: blogs

Othering
When we look at someone else, we first start by identifying the differences between that person and ourselves. It’s only later that we spend some time identifying the similarities between ourselves and that “other”. There’s a problem in pain management today. It’s this: too few of “us” are “them” – by which I mean, there are too few people who identify as living with persistent pain working with people who are seeking help for their pain. “Why is this a problem?” you ask… Well, it’s because it’s far too easy for “us&rdqu...
Source: HealthSkills Weblog - January 20, 2019 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Chronic pain Clinical reasoning Coping strategies Professional topics Resilience/Health interactions othering persistent pain Source Type: blogs

How are you going with your resolutions?
It’s seven days into the new year, and if you’ve made New Year’s resolutions I’d like to bet that it’s around now that your resolve is starting to fade… Don’t worry, I’m not going to nag! I am going to point out just how difficult it is to stick with a resolution, goal, action, new habit – whatever you call it. And take a moment, if you’re a health professional. Just stop for a moment and think about the resolution, goal, action, new habit you’ve just set with your last patient. What are the chances that person will stick with that goal for the week? ...
Source: HealthSkills Weblog - January 6, 2019 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Chronic pain Clinical reasoning Coping Skills Coping strategies Pain conditions Professional topics them and us goal-setting Motivation resolutions Source Type: blogs

Season ’ s Greetings
(Source: HealthSkills Weblog)
Source: HealthSkills Weblog - December 24, 2018 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Uncategorized Source Type: blogs

Five things I learned about pain this year
Our definitions of pain matter more to researchers and people who like to philosophise about pain than to people experiencing pain. At the same time, definitions do matter because when the IASP definition of pain was first established, the distinction between the neurobiological underpinnings of pain – and the experience – was clear. And this matters because neurobiology is only part of the picture. (Chekka & Benzon, 2018; Cohen, Quintner & van Rysewyk, 2018; Reuter, Sienhold & Sytsma, 2018; Tesarz & Eich, 2017; Williams & Craig, 2016)The idea of “tribes” in pain and pain managem...
Source: HealthSkills Weblog - December 23, 2018 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Pain conditions Professional topics diagnosis Education interprofessional lived experience silos social sociology tribes Source Type: blogs

Mind your language!
“Words are pale shadows of forgotten names. As names have power, words have power. Words can light fires in the minds of men. Words can wring tears from the hardest hearts.” ― Patrick Rothfuss, The Name of the Wind So much has been written about language, and I am not a linguist. I am, however, often accused of being pedantic because I like to use words with precision. In the world of pain rehabilitation/management/treatment/care (see what I did there?!) certain words seem to spark a huge debate. Words like “pain”, “nociception”, “suffering”, “harm”, &l...
Source: HealthSkills Weblog - December 16, 2018 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Off topic Pain conditions Professional topics Education ego gurusim meanings Source Type: blogs

Expectations – and communicating
There are times when I look at the research on persistent pain and treatment, and I begin to wonder why I’m still so positive about this field! After all, it seems that although a biopsychosocial or multidimensional framework for pain has been around since the 1970’s, I’m still encountering reasonably recently-graduated clinicians who sincerely believe that whatever treatment they’ve learned is the Bee’s Knees, and Will Truly Fix All Pain. And people who firmly believe that All Pain Is X. Or Y. Or Z. And surely we should do what they say (pay the fee, get the certificate, perhaps even levels 3...
Source: HealthSkills Weblog - December 9, 2018 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Back pain Pain conditions Professional topics Research Resilience/Health beliefs communication expectations goals listening Source Type: blogs

On the problem of coping
Coping. Lots of meanings, lots of negative connotations, used widely by health professionals, rejected by others (why would you need coping skills if you can get rid of your pain?). I’ll bet one of the problems with coping is that we don’t really know what we’re defining. Is coping the result of dealing with something? Or is it the process of dealing with something? Or is it the range of strategies used when dealing with something? What if, after having dealt with the ‘something’ that shook our world, the world doesn’t go back to the way it was? What if ‘coping’ becomes a...
Source: HealthSkills Weblog - December 2, 2018 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: 'Pacing' or Quota Assessment Chronic pain Clinical reasoning Coping Skills Coping strategies Motivation Research Science in practice activity patterns flexibility Occupational therapy physiotherapy values Source Type: blogs

Tribalism in pain rehabilitation
In this study, female patients and those without prior spine surgery appear to be most likely to benefit from fusion surgery for DDD.” The PCT is essentially a cast around the hips from waist to the top of the leg with a longer leg cast on the side that hurts. We can see similar appeals to single-factor causal models in studies of core stability – De Blaiser, Roosen, Willems, Danneels, Bossche, & De Ridder (2018) investigating whether this is a risk factor for lower extremity injuries in athletes, while Tayashiki, Mizuno, Kanehisa, & Miyamoto, (2018) investigated the causal effect of intra-abdominal...
Source: HealthSkills Weblog - November 25, 2018 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Clinical reasoning Pain conditions Professional topics Research Science in practice biopsychosocial clinical framework ideology Source Type: blogs

Pain science is not a thing
Today’s post is occasioned by reading several discussions on various forums where the term “pain science” and various adjectives to describe this kind of practice. For those who don’t want to read the rest of my ramblings: no, it’s not a thing, science is an approach to understanding phenomena, and I would have thought all health professionals would use a science-based approach to treatment. I went on to Google, as you do, to find out when this term began its rise in popularity. Google wasn’t particularly helpful but did show that it’s been around since 2004 at least, and seems to...
Source: HealthSkills Weblog - November 4, 2018 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Assessment Chronic pain Clinical reasoning Education Low back pain Pain conditions Professional topics Research Science in practice biopsychosocial interprofessional multidimensional pain management pain science Source Type: blogs

Wait and see … when do we “ escalate ” care for low back pain?
Prompted by reading a paper by Linton, Nicholas and Shaw (in press), today’s post is about various service delivery models for low back pain and not the content of back pain treatment. Service delivery in New Zealand is assumed to be based on getting most bang for the buck: we have a mainly socialised healthcare system, along with a unique “no fault, 24 hour” insurance model for accidents whether at work or elsewhere, which means market forces existing in other countries are less dominant. There are, however, many other influences on what gets delivered and to whom. Back to most bang for buck. With a l...
Source: HealthSkills Weblog - October 28, 2018 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Back pain Interdisciplinary teams Low back pain Professional topics Research Science in practice health systems treatment Source Type: blogs

On “ us ” and “ them ” : what if we ’ re one of “ them ” ?
Over the past few years I’ve been pondering the presumed gap between people living with pain and the people who “treat” or work with them.  Most of my readers will know that I live with widespread pain (aka fibromyalgia) or pain that is present in many parts of my body, and the associated other symptoms like DOMS that last for weeks not a day or two, and increased sensitivity to heat, cold, pressure, chilli, sound and so on. I first “came out” with my pain about 15 years ago: that is, I first disclosed to people I worked with that I had this weird ongoing pain – and finally joined...
Source: HealthSkills Weblog - October 7, 2018 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Chronic pain Professional topics Research Therapeutic approaches inclusion inequality Source Type: blogs

From the particular to the general – Clinical reasoning in the real world
From the particular to the general –Clinical reasoning in the real world I make no secret of my adherence to evidence-based healthcare. I think using research-based treatments, choosing from those known to be effective in a particular group of people in a specific context helps provide better healthcare. But I also recognise problems with this approach: people in clinical practice do not look like the “average” patient. That means using a cookie cutter, or algorithm as a way to reduce uncertainty in practice doesn’t, in my humble opinion, do much for the unique person in front of me. I&rsquo...
Source: HealthSkills Weblog - September 30, 2018 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Assessment Clinical reasoning Pain Pain conditions Science in practice biopsychosocial goal-setting healthcare rehabilitation Therapeutic approaches treatment Source Type: blogs

Wandering back from the IASP World Congress
Meetings, meanderings, mind-expansions I’ve been away for abut 10 days, attending the World Congress of the International Association for the Study of Pain. It was a time of meetings with wonderful people I’ve met via the interwebs, with researchers and clinicians, and most importantly, with people living with pain. It was also a time for meanderings – around the very walkable city of Boston, embracing history and looking towards the future, and mind meanderings as well. And because it was a conference, it was also mind-expanding. New ideas, new ways of investigating this human experience of pain, ne...
Source: HealthSkills Weblog - September 23, 2018 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Low back pain Chronic pain Research Occupational therapy Pain conditions Coping strategies Professional topics biopsychosocial pain management conference pain research Source Type: blogs

Six old papers for pain clinicians
We’re rather flighty beasts, us clinicians. From looking at the various ads for courses on the interwebs, it seems we’re all ready to jump on to the next newest thing. This same “what’s new” attitude is present in journals as well –  “these references are very old, are there newer ones you can use?” Here’s a question: what happens to the old stuff? Is it outdated and useless? Do really well-conducted studies have a “use-by” date? Are older therapies always less effective than the new ones? What if this urge to “refresh” means we do actually ...
Source: HealthSkills Weblog - August 27, 2018 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Pain conditions Professional topics Research Cognitive Behavioural Therapy function Health pain research rehabilitation Therapeutic approaches Source Type: blogs

Myths about exposure therapy
Exposure therapy is an effective approach for pain-related anxiety, fear and avoidance, but exposure therapy is used less often than other evidence-based treatments, there is a great deal of confusion about graded exposure, and when it is used, it is not always well-conducted. It’s not a treatment to be used by every therapist – some of us need to challenge our own beliefs about pain, and whether it’s OK to go “into” the pain a little, or even slightly increase pain temporarily! Below are some common misconceptions and suggestions for how to overcome them: Misconception: Exposure therapy cause...
Source: HealthSkills Weblog - August 19, 2018 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Assessment Chronic pain Clinical reasoning Pain conditions Professional topics Research Science in practice acceptance biopsychosocial function graded exposure Occupational therapy pain management rehabilitation Therapeutic app Source Type: blogs

What it means to be a therapist
I wrote the following response to a discussion held recently on a Facebook group Exploring Pain Science – about the term “catastrophising”. It’s a term that elicits great anger and frustration from people living with persistent pain, and I see the term used poorly by clinicians as a judgement about another’s experience. There’s certainly plenty of research showing relationships between high levels of “thinking the worst” about pain, and poorer outcomes – but HOW we as clinicians respond to someone in distress may be more of a problem than the act of a person describing ...
Source: HealthSkills Weblog - July 31, 2018 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: ACT - Acceptance & Commitment Therapy Chronic pain Clinical reasoning Coping strategies Resilience/Health catastrophising distress empathy mindfulness Source Type: blogs

The dynasty of the disc! More history in pain management
Low back pain, despite the multitude of explanations and increasing disability associated with it, has been with humans since forever. Who knows why and I’m not about to conjecture. What’s interesting is that despite ergonomic solutions (fail), increased fitness amongst many people (also a fail), surgical solutions (fail), hands on solutions (fail, fail), and a whole bunch of “special” exercises (fail, fail, fail) we still don’t have a handle on how to reduce disability from it. I don’t think there will be many people who haven’t seen this: I’ve never quite worked out why, w...
Source: HealthSkills Weblog - July 29, 2018 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Back pain Low back pain Pain conditions Research biopsychosocial Chronic pain Clinical reasoning disability pain management Therapeutic approaches Source Type: blogs

Learning from old research (digging into history)
I recently submitted a manuscript to a journal. After the usual delay as the reviewers commented on my draft, I received the feedback – one comment stood out to me: “the references are quite old”. I scurried around to find some more recent references and resubmitted, but as I did, I started pondering this drive to continually draw on recent research even if the findings of the older references had not been superseded. There is a sense that maybe journal editors and perhaps people reading the journals think that old research has no merit. As someone who relishes reading about the history of pain and pain m...
Source: HealthSkills Weblog - July 22, 2018 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Back pain Low back pain Professional topics history Source Type: blogs

Each time we face our fear, we gain strength, courage, and confidence in the doing – Theodore Roosevelt
I’m not certain Theodore Roosevelt actually said that – but who cares?! It’s a great statement. For the person living with persistent pain, though, it can be the last thing you want to hear. After all, it’s tough enough getting up and just doing the normal things let alone challenge yourself! So… how can a health professional help? Let’s briefly recap. Self efficacy is the confidence I can do something successfully if I wanted to. It’s a robust predictor of many health behaviours including exercise, stopping smoking, eating healthily and coping well with persistent pain (Jackson, ...
Source: HealthSkills Weblog - July 15, 2018 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Back pain Chronic pain Clinical reasoning Coping Skills Coping strategies Professional topics Research Resilience Science in practice biopsychosocial function healthcare pain management physiotherapy rehabilitation self effic Source Type: blogs

The confidence that you ’ ll succeed if you try …
Self efficacy. It’s a word bandied about a lot in pain management, and for a group of clinicians in NZ, it’s been a shock to find out that – oh no! They’re not supporting self efficacy with their patients very much! It means “confidence that if I do this under these conditions, I’ll be successful”. Self efficacy is part of Bandura’s social learning theory (click here for the Wikipedia entry) where he proposed that much of psychological treatment is driven by a common underlying mechanism: to create and strengthen expectations of personal effectiveness. Bandura recognised that...
Source: HealthSkills Weblog - July 8, 2018 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Clinical reasoning Coping Skills Coping strategies Motivation Pain Pain conditions Professional topics Research Resilience Science in practice biopsychosocial Chronic pain function healthcare pain management rehabilitation Source Type: blogs

Managing sleep problems – a medication-free approach (iv)
The fourth step in learning to sleep well within an ACT framework, is build. My previous posts were: Discover and Accept and Welcome. In build, we’re beginning to build new practices. This is about learning how much sleep you need, and when you need to head to bed and wake up again. I know when I had trouble sleeping at night (I refused to call it insomnia, but it most definitely was!), I thought I’d tried everything to help. I had used all the sleep hygiene strategies like no devices in bed, no TV in bed, do some relaxation as I lay down, have a regular bed-time and wake-up time – and one of the things I...
Source: HealthSkills Weblog - July 2, 2018 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Coping Skills Clinical reasoning ACT - Acceptance & Commitment Therapy Science in practice Health healthcare Resilience Therapeutic approaches biopsychosocial coping strategies Source Type: blogs

Managing sleep problems – a medication-free approach (iii)
More on sleeping the ACT way. Step one was discover – all the things you’re doing to help yourself sleep, but in your attempts to control the uncontrollable (thoughts, feelings, memories, worries, sensations, the environment and so on). And hopefully you’ve seen that these things can be counter-productive. That flash new pillow and bed is pretty useless if you travel somewhere. The pills need to be stopped at some point – and then you have to withdraw from them. And the thoughts, and sensations (including pain) just carry right on there not matter what you do. So step two is to accept: accept what y...
Source: HealthSkills Weblog - July 1, 2018 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: ACT - Acceptance & Commitment Therapy Clinical reasoning Coping strategies Pain conditions Resilience/Health Science in practice Source Type: blogs

Managing sleep problems – a medication-free approach (ii)
Last week I described the “conventional” CBT for insomnia approach (CBTi), but this week I want to introduce an Acceptance and Commitment Therapy (ACT) approach which is superficially similar to CBTi but holds to some of the fundamental principles of ACT: mindfulness, and letting go of control. As is typical for ACT, there are no hard and fast absolutes and instead there is a focus on workability – what works, in context. Most of the content of today’s post is drawn from my personal experience and The Sleep Book by Dr Guy Meadows. There are five basic steps and according to the book it should take f...
Source: HealthSkills Weblog - July 1, 2018 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: ACT - Acceptance & Commitment Therapy Coping strategies Resilience/Health Science in practice biopsychosocial Clinical reasoning healthcare self management Source Type: blogs

Managing sleep problems – a medication-free approach (i)
I’ve recently completed two posts on assessing sleep problems in people experiencing persistent pain, and today I turn my attention to strategies for managing sleep problems – without medication. Why without medication? Because to date there are no medications for insomnia that don’t require a ‘weaning off’ period, during which time people often find their original sleep problems emerge once again… I’m not completely against medications for sleep or pain – but I think they need to be used with care and full disclosure about the effects, side-effects, and the need to eventual...
Source: HealthSkills Weblog - June 25, 2018 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: ACT - Acceptance & Commitment Therapy Chronic pain Clinical reasoning Cognitive Behavioural Therapy Cognitive skills Coping strategies Pain conditions Professional topics Research Science in practice biopsychosocial CBT Health se Source Type: blogs

Assessing problems with sleep and pain – ii
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 - June 17, 2018 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Assessment Chronic pain Clinical reasoning Health Pain conditions Research biopsychosocial coping disability function pain management treatment Source Type: blogs

Assessing problems with sleep & persistent pain
Problems with sleep affect most of us from time to time. We know we might find it difficult to get off to sleep because of a busy mind, a different bedroom, changes to our schedule – but for most of us, sleep returns to our normal fairly quickly. For some of us, though, sleep problems continue for weeks, months or even years. And for people living with persistent pain, sleep can be one of the most difficult things to deal with, yet it’s also one of the most common (McCracken & Iverson, 2002). Studies of sleep problems in people with fibromyalgia show abnormal sleep continuity as well as changes in sleep arc...
Source: HealthSkills Weblog - June 11, 2018 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Chronic pain Clinical reasoning Coping Skills Coping strategies Health Pain conditions Therapeutic approaches acceptance Assessment biopsychosocial science treatment Source Type: blogs

Pain – or disability?
One of the fundamental distinctions we need to make when working with people who experience pain is to understand the difference between experiencing pain – and the behaviour or actions or responses we make to this experience. This is crucial because we can never know “what it is like” to experience pain – and all we have to rely on as external observers is what we see the person doing. Differentiating between the various dimensions associated with our experience of pain makes it far easier to address each part in the distinct ways needed. Let me explain. We know the current definition of pain &ndas...
Source: HealthSkills Weblog - May 28, 2018 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Clinical reasoning Cognitive skills Education/CME Pain Pain conditions biopsychosocial disability Research theory Source Type: blogs

Clinical reasoning – and cognitions
Possibly one of the most hotly discussed aspects of clinical reasoning and pain relates to thoughts and beliefs held by both people experiencing pain and the clinicians who work with them. It’s difficult to avoid reading papers about “pain education”, “catastrophising”, “maladaptive thinking”, but quite another to find a deeper analysis of when and why it might be useful to help people think differently about their pain, or to deal with their thoughts about their experience in a different way. Cognition is defined by the APA Dictionary of Psychology as 1. all forms of knowing and ...
Source: HealthSkills Weblog - May 21, 2018 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Assessment Chronic pain Clinical reasoning Cognitive skills Pain conditions Science in practice biopsychosocial Health healthcare Therapeutic approaches treatment Source Type: blogs

Teamwork: Gaps or overlaps?
For many years now, interprofessional/multidisciplinary teams have been considered the best model for delivering pain management. This stems from studies conducted right back as far as J J Bonica in 1944 (Bonica, 1993), and originally referred to teams consisting of several medical specialties. Bonica later initiated a multidisciplinary/interdisciplinary pain programme in 1960, including 20 people from 14 medical specialties “and other health professions”. In 1977, Bonica and Butler classified pain programmes into five groups – major comprehensive multidisciplinary programmes – more than six discipl...
Source: HealthSkills Weblog - May 13, 2018 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Chronic pain Interdisciplinary teams Professional topics biopsychosocial Clinical reasoning Health healthcare pain management Psychology Research treatment Source Type: blogs

When philosophy and evidence collide: is an occupation-focused approach suitable in pain management?
I have often described myself as a renegade occupational therapist: I like statistics, I think experimental research is a good way to test hypotheses, I don’t make moccasins (though I occasionally wear them!), I’m happy reading research and figuring out how I can apply findings into my clinical practice. Occupational therapy is a profession that continues to evolve. The origins of occupational therapy lie back in the “moral” model of treatment for mental illness when advocates found that giving people things to do helped them become well (mind you, some of the reasons for admission to a “menta...
Source: HealthSkills Weblog - May 6, 2018 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: ACT - Acceptance & Commitment Therapy Chronic pain Clinical reasoning Coping Skills Occupational therapy Pain conditions Research Science in practice pain management Psychology rehabilitation research literature self management T Source Type: blogs

Clinical reasoning in pain – emotions
The current definition of pain includes the words “unpleasant sensory and emotional experience” so we would be surprised if we encountered a person with pain who wasn’t feeling some sort of negative emotion, am I right? Yet… when we look at common pain assessments used for low back pain, items about emotions or worries are almost always included as indicators of negative outcomes (for example, STarTBack – Worrying thoughts have been going through my mind a lot of the time, I feel that my back pain is terrible and it’s never going to get any better, In general I have not enjoyed all the ...
Source: HealthSkills Weblog - April 29, 2018 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Assessment Clinical reasoning Coping strategies Health Humour Pain biopsychosocial Occupational therapy pain management rehabilitation Research Therapeutic approaches treatment Source Type: blogs