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 25, 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 2, 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 26, 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 19, 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 17, 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 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