The stigma of being a woman in pain
Women, it is often thought, must be much tougher than men when it comes to dealing with pain – after all, don’t women have babies without anaesthetic? Don’t men faint at the sight of a needle? Ummmm, not quite so fast. Now before I begin, in this post I’m referring to cis-gender females, and in the experiments, participants were selected on the basis that they believed that negative gender discrimination was a thing. And as I write this post, I want to be clear that sometimes we have to begin with a very simplified model before research can be conducted on a much more messy cohort – and th...
Source: HealthSkills Weblog - June 20, 2021 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Assessment Coping strategies News Pain Pain conditions Research Science in practice female stigmatism women Source Type: blogs

Why do people with pain report differently on questionnaires than they do in physical performance testing?
One of the topics thrown around by people who don’t have an up-to-date understanding of pain is why people say one thing on a questionnaire, for example, what they can and can’t do, and perform quite differently when asked to do the same task in a clinic. It’s a good question, on the face of it: after all, people should know what they can and can’t do, and be consistent. If there is a difference, well obviously the physical performance test is far more objective than self-report – the therapist is right there watching, so there’s no room for doubt about which measure is The Most Accurate...
Source: HealthSkills Weblog - June 13, 2021 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Assessment Motivation Pain conditions Professional topics Science in practice malingering measurement performance testing Source Type: blogs

Not all pain is the same
When I started working in the field of persistent pain, many of the approaches used were based on the idea that every pain was the same. Oh yes, of course we had neuropathic pain and inflammatory pain, but our treatments tended to approach each person as if they were pretty similar. We later refined that approach and started to look at people in groups. In the service I worked in, we used the Westhaven-Yale Multidimensional Pain Inventory which generates three main psychologically-based profiles – and for a long time this was a very useful way of establishing who needed the three-week residential programme, and who w...
Source: HealthSkills Weblog - May 23, 2021 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Assessment Chronic pain Clinical reasoning Pain conditions Professional topics Research Science in practice Source Type: blogs

What happens to pain over 21 years?
No! I was not born then… I’m much older than that. No, in this longitudinal cohort study, participants recruited from the general public in Sweden were surveyed five times: at inception in 1995, again in 1998, 2003, 2007 and 2016. The article I’m reporting on included all respondents who had completed information on at least 3 of the 5 time points, a total of 1858 people! That’s a decent-sized study. Longitudinal studies are really hard to do but offer us so much information about what happens over time to a group of people and it’s something we need to do more often. The problems with lon...
Source: HealthSkills Weblog - May 16, 2021 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Chronic pain Pain conditions Research longitudinal prospective study trajectory Source Type: blogs

Family and friends matter
I’m going back to my series on behavioural approaches to pain management (it’s a slow process!). For the first two go here and here. Now I want to talk about the impact of family and friends on people living with pain. The people we live with are so influential on what we do and believe about pain. It’s our parents who first taught us the relationship between the word “pain” and the experience we know as pain. It’s our parents and family who responded when we cried, who kissed it better (or not), who told us to “harden up” (or not), who took us to the doctor (or not), who...
Source: HealthSkills Weblog - April 11, 2021 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Back pain Chronic pain Coping strategies Professional topics Science in practice behavioural family pain behaviour spouse Source Type: blogs

Self-care
No, not the Instagram “self-care” of floofy slippers and a glass of wine, or an excuse to indulge in chocolate. No, I’m talking about the gritty self-care that all of us humans need to do, only some of us need to it more regularly or we’ll experience Consequences. Self-care for people living with pain is no luxury, and it does (occasionally) mean walking away from something enjoyable, setting boundaries on demands for time and energy, AND it means many other things too. I’ll talk about my own self-care needs because I can’t talk authentically about anyone else. Most of you will kno...
Source: HealthSkills Weblog - March 28, 2021 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: 'Pacing' or Quota Chronic pain Clinical reasoning Coping Skills Coping strategies Motivation Pain conditions boundaries self management self-care selfcare Source Type: blogs

Modifying pain behaviour (2)
Two concepts that receive limited attention in the allied health literature are nomothetic and idiographic approaches. I’m discussing these concepts here because when we’re considering pain behaviour, I think we can focus much more on “generic” (nomothetic) concepts than we do idiographic ones – and yet we say we’re about the unique person in front of us. Firstly, this site offers a good summary of the difference between nomothetic and idiographic – click Essentially, nomothetic approaches focus on underlying generalities, perhaps traits, and are a solid part of the science o...
Source: HealthSkills Weblog - March 14, 2021 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Assessment Back pain Chronic pain Coping strategies Low back pain Motivation Professional topics Science in practice behavioral pain behavior rehabilitation relational frame theory Source Type: blogs

Pain model – helping to target change
In my recent post on behavioural approaches to pain management, I had a number of commentators ask why do it, why not focus on pain intensity, and aren’t I invalidating a person’s experience if I target a person’s response to their experience. Today’s post will explore some of these points. I suppose my first point needs to distinguish between pain as an experience, and pain behaviour – or what we do when we experience pain. I like to use a pretty old “model” or diagram to help untangle these concepts. It’s drawn from Loeser’s “Onion ring” model, and he w...
Source: HealthSkills Weblog - February 28, 2021 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Clinical reasoning Coping strategies Pain Pain conditions Therapeutic approaches models pain models Source Type: blogs

… the “ so what ” question and why it matters to take a break from work
At the conclusion of each of the courses I teach at University of Otago, I ask students the “so what” question. So what that we learned about neurobiology? So what that we discussed social constructs and how they shape pain behaviour? So what that we learn that thoughts and beliefs influence our pain experience? What does it all mean when we’re sitting with a person experiencing pain? This last week I’ve been on a brief trip to the West Coast of the South Island of New Zealand Aotearoa. It is a wild and isolated part of our country. So wild that in parts the annual rainfall is over 6,000mm (see t...
Source: HealthSkills Weblog - February 21, 2021 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Chronic pain Off topic Professional topics Resilience/Health Science in practice values Source Type: blogs

Modifying pain behaviour (1)
In my post last week I talked about pain behaviour and why pain behaviours are often a good treatment target in pain rehabilitation. I also talked about pain intensity rating scales and how, because rating scales are a form of communication, the numbers we obtain from them aren’t a true measure of pain: they reflect what the person wants to communicate about their pain to someone at that time and in that context. This week I want to discuss modifying pain behaviour, and believe me, we are all in the business of modifying behaviour even if we think we’re doing something completely different! Ethics One ...
Source: HealthSkills Weblog - January 31, 2021 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Chronic pain Clinical reasoning Research Science in practice Therapeutic approaches behavioural clinical communication poain behaviour Source Type: blogs

Pain behaviour: what is it and what do we do about it?
I’m re-reading Fordyce’s classic Behavioral Methods for Chronic Pain and Illness and once again I’m struck by how many of the concepts he introduced and systematically investigated are either mis-interpreted and ignored in our current approaches to helping people with persistent pain. Today I’ll explore just a tiny portion of what Fordyce described. Pain behaviour refers to all the observable actions we do in relation to experiencing pain (NB some people include thoughts as well, but for today I’ll just focus on observable actions). There are roughly two groups of actions: those involuntary...
Source: HealthSkills Weblog - January 24, 2021 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Clinical reasoning Coping strategies Pain Pain conditions Research Science in practice behavioral contextual behavioral science operant conditioning Source Type: blogs

Musing on “ the social ” in pain rehabilitation
What do we think about when we consider “the social” as a factor in pain rehabilitation? Do we think of socioeconomic status? Maybe employment status? Perhaps societal attitudes towards pain and recovery? Do we ask if the person has someone they trust in their life? Maybe we even discuss how a relationship is going, whether the person sees their friends and family? Have we forgotten that possibly the most potent influences on pain behaviour are the people around the person we’re seeing? It will be no surprise to anyone reading my work over the past 10 or more years (yes, really! it HAS been that lon...
Source: HealthSkills Weblog - January 17, 2021 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Chronic pain Clinical reasoning Coping strategies Education Interdisciplinary teams Professional topics Research Science in practice family partners social spouses Source Type: blogs

Radical? Radical!
Welcome to 2021! An interesting start to the year for my US friends, more of the same for my UK and European friends, and life in NZ and Australia goes on with an added dash of uncertainty because of the new! improved! more contagious Covid19! I’ve had a few weeks away from my usual Monday morning writing routine, but I return to the blog today with a lovely book I’ve reviewed. There’s no secret about my personal preference for ACT both for living and flourishing in daily life, and for those of us living with persistent pain. Today’s book review is about Radical Relief: A guide to overcome chroni...
Source: HealthSkills Weblog - January 10, 2021 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: ACT - Acceptance & Commitment Therapy Book reviews, site reviews Chronic pain Coping Skills Coping strategies Science in practice Source Type: blogs

What to do about acute low back pain
I should add another line to that heading: in one easy step! And I’d be inundated with hits and if I could cash in on them I’d be rich! And wrong. If there was a simple recipe for success, I’d expect that by now we’d have it. The very fact that SO MANY options for managing a bout of low back pain exist is a good reason for skepticism should you ever get tempted to take a headline like mine as a cause for celebration. However I do want to talk about acute low back pain because I think clinicians are often probably doing it wrong. First of all, low back pain doesn’t include pain that also ...
Source: HealthSkills Weblog - December 6, 2020 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Back pain Low back pain Pain conditions Research Resilience Resilience/Health Science in practice acute low back pain back to basics pain trajectories Source Type: blogs

Bias: Is pain all the same?
The topic of how we define pain, and how humans respond to pain has come up for me as I mull over the IASP definition of pain. The current (new) definition is this: An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage. Six key notes: Pain is always a personal experience that is influenced to varying degrees by biological, psychological, and social factors.Pain and nociception are different phenomena. Pain cannot be inferred solely from activity in sensory neurons.Through their life experiences, individuals learn the concept of pain.A...
Source: HealthSkills Weblog - November 29, 2020 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Chronic pain Clinical reasoning Education Education/CME Pain conditions acute pain function IASP definition maldynia metaphor pain definition persistent pain purpose Source Type: blogs

Why learning about pain can help – an old study worth revisiting
If you’ve read my blog over the years you’ll see that I love a bit of history. Learning from older studies, and older opinions, can help us position our current thoughts in a larger context. Older studies can also highlight concepts that haven’t grabbed the attention nearly as much as more recent studies but still have value. Today’s post is about a studied published in 2004. It’s one I’ve often used to illustrate how influential our expectations or beliefs are when it comes to pain intensity and pain aversiveness/unpleasantness. Take 31 healthy undergraduate students (50% were wo...
Source: HealthSkills Weblog - November 22, 2020 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Chronic pain Clinical reasoning Cognitive skills Coping strategies Education Research Science in practice Uncategorized Source Type: blogs

Looking beyond the immediate
When I graduated as an occupational therapist, I was told that my profession was “problem-solving” and “motivation”. At the time (early 1980’s) Lela Llorens‘ problem solving process was the fundamental approach taught during our training. This approach is straightforward: identify the problem, identify solutions, select a solution, implement the solution, and review. I’m not sure if this approach is still taught but it’s stayed with me (and those memories of painstakingly completing the problem solving process documentation…). There’s one small step that I thi...
Source: HealthSkills Weblog - November 15, 2020 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Assessment Clinical reasoning Coping strategies Interdisciplinary teams Occupational therapy Pain Pain conditions Professional topics Uncategorized Source Type: blogs

Becoming resilient
Rehabilitation professions are about helping people recover from illness to return to what matters in life. Sometimes as I read the myriad social media posts on ways to help people with pain, I wonder what kind of life rehabilitation professionals live themselves. Does our focus on what’s done during rehabilitation represent the way people live in everyday life? I suspect that because rehabilitation has emerged from a medical model, much of our expectations and the framework for our work has remained in a “fix-it” or “there you go, good as new” mindset. A kind of short-term, out the door an...
Source: HealthSkills Weblog - November 8, 2020 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Chronic pain Clinical reasoning Coping Skills Coping strategies Pain conditions Professional topics Resilience/Health Science in practice adaptability evolution flexibility pain rehabilitation rehabilitation theory Source Type: blogs

Springboard: Beginning to live life again
Springboard is a six week, 120 min once a week programme for people with pain. I developed this programme in the context of New Zealand’s Accident Compensation Corporation (ACC) community-based pain management services. So, why use a group approach and what’s inside Springboard? Pain can be such an isolating experience, and for many people, not only do friends and family not “get it” but neither do some of their health professionals! Living with pain, even for “just” a few months can lead to loneliness because most people don’t know what it is like to experience pain that do...
Source: HealthSkills Weblog - October 11, 2020 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: ACT - Acceptance & Commitment Therapy Coping Skills Coping strategies Groupwork Pain Pain conditions Professional topics Resilience/Health Springboard Source Type: blogs

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