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: <a href="http://<a href="http://<figure>http://<figure>click
What a generous host with questions that got me thinking – and I hope my answers also get people thinking too. (Source: HealthSkills Weblog)
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
