Big questions in pain rehabilitation
The last 30 years or more of pain research and management have been exciting for us pain nerds. We’ve learned so much about processes involved in nociception, about the psychology of our responses to nociceptive input, about treatments (that often don’t work terribly well), and we’ve discovered that we (mainly) don’t know what we don’t know. There are some big questions though, that have yet to be answered – and don’t yet share the limelight that neurobiological processes seem to hog. Here are a few of my big questions.
How do we alter public health policy to move from an acute ...
Source: HealthSkills Weblog - August 25, 2019 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Motivation Pain conditions Professional topics Science in practice questions Source Type: blogs
Uncertainty: perennial controversies in pain understanding
As I write this post today, yet again there are new theories being proposed for that most common of experiences: pain. Not only theoretical controversies, but even the definition of pain is being debated – is pain an “aversive” experience? An aversive sensory and emotional experience typically caused by, or resembling that caused by, actual or potential tissue injury. Some researchers have recently “found” a new nociceptive fibre (though they persist in calling it a “pain fibre” – once again perpetuating the idea that pain is one and the same with nociception).
One of the ...
Source: HealthSkills Weblog - August 18, 2019 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Chronic pain Pain conditions Research Resilience/Health Science in practice definition disability living well persistent pain Source Type: blogs
The know-do gap: does social media help change things?
This post is prompted by a Facebook post from Connor Gleadhill asking “in what way is SoMe contributing to knowledge translation (KT)? I’m interested in the experience of those tagged and if anyone is aware if it has been rigorously tested. As far as I’m aware it hasn’t. Is it simply a confirmation bias arena? We are humans after all, and we curate our experience on SoMe.”
Oh such a great question and one reason I still hang out on social media!
I’ve been blogging since 2007, two years before the famous Body in Mind (who have just announced they won’t post any more content)....
Source: HealthSkills Weblog - August 4, 2019 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Clinical reasoning Education Education/CME Professional topics Research blogging community of practice conversations knowledge translation research translation social media Source Type: blogs
Cannabis and cannabinoids for persistent pain?
Over the last 12 months New Zealanders have entered into the debate about cannabis and cannabinoids for medical use. In the coming year we’ll hear even more about cannabis as we consider legalising cannabis for recreational use. There is so much rhetoric around the issue, and so much misinformation I thought it high time (see what I did there?!) to write about where I see the research is at for cannabis and cannabinoids for persistent pain.
For the purposes of this blog, I’m going to use the following definitions: Cannabis = the plant; cannabis-based medication = registered extracts (either synthetic or from...
Source: HealthSkills Weblog - July 21, 2019 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Chronic pain Coping strategies Research Science in practice cannabinoids cannabis medicinal cannabis neuropathic pain persistent pain recreational cannabis Source Type: blogs
Informing — and knowing
Learning is perceived as a process of personal and social construction where people are actively involved in making sense of information they interact with, rather than passively receiving it (Kuhthau 2004). This cumulative and developmental process involves the whole person in thinking, acting, reflecting, discovering ideas, making connections, and transforming prior knowledge, skills, attitudes, and values into new knowledge (Dewey 1933).
I’m an educator for much of my time. When I think about it, I’ve been an educator for most of my clinical career – after all, when I helped people learn how to show...
Source: HealthSkills Weblog - June 16, 2019 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Chronic pain Coping strategies Education Education/CME Professional topics data information knowledge meaning Source Type: blogs
Barriers to good pain rehabilitation
This is a long…… readooops, sorry, not.
Low back pain is, we know, the greatest contributor to days lived with disability (Rice, Smith & Blyth, 2016). And no-one anywhere in the world has found a good mix of services to reduce the number of days lived with disability as a result of this problem. And yet billions of dollars are used to fund research into the many contributors to a shift from acute low back pain to ongoing disability associated with low back pain.
At the same time, treatments that directly target disability, rather than pain (a target considered the most important outcome by Sullivan an...
Source: HealthSkills Weblog - June 9, 2019 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Chronic pain Low back pain Pain conditions Research Science in practice health funding health systems models of care Source Type: blogs
Clinical reasoning models: what ’ s wrong with them?
I’ve been interested in clinical reasoning and models used in clinical reasoning for quite some time. Occupational therapy has several models, including the “occupational therapy problem solving process” by Lela Llorens, the Model of Human Occupation by Gary Kielhofner, and the Canadian Model of Occupational Performance by Polatajko, Townsend and Craik in 2007. All of these models were designed to support occupational therapy clinical reasoning processes, and to capture the essence of what occupational therapy is about.
When it comes to pain rehabilitation, I’ve found the occupational therapy mo...
Source: HealthSkills Weblog - May 26, 2019 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Assessment Clinical reasoning Occupational therapy Pain Pain conditions Physiotherapy Professional topics Psychology Research Science in practice hypotheses models theory Source Type: blogs
Self-management: What do we think about it?
Self-management is all about the person living with their chronic health problem, learning how to maximise their wellbeing and limit the impact of their health problem on their life. The words might be well-known – but how self-management is best carried out, by whom, and when is a vexed question.
I stumbled upon a study carried out by Van Wely, Boiten, Verhoef, Eijckelhof, Van Hooft, Van Staa et al (2019) where, using Q-methodology (more about this shortly), they examined the beliefs about self-management of a group of Dutch physiotherapists.
First of all, why is this something to blog about on a blog about p...
Source: HealthSkills Weblog - May 19, 2019 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Chronic pain Coping Skills Coping strategies Professional topics Research Science in practice independence living well persistent pain Resilience self management Source Type: blogs
Clinical reasoning & meaning-making (a long post)
Clinical reasoning is a cornerstone of evidence-based healthcare, in fact some would argue it’s the cornerstone of all healthcare. While there are many different processes, the ultimate purpose of clinical reasoning is to ensure the person seeking help has their needs identified then met, and the clinician has a basis upon which to decide which treatment they should offer.
The approach we use in clinical reasoning, including the information we prioritise and search for, and the way we synthesise the information to make sense of it will depend on the model we have to explain our treatment approach. For example, if...
Source: HealthSkills Weblog - May 12, 2019 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Chronic pain Clinical reasoning Occupational therapy Pain conditions Physiotherapy Professional topics Psychology Research Science in practice embodiment intersubjectivity making sense persistent pain Source Type: blogs
An experimental study of pharmaceutical cannabis in fibromyalgia
This study is one of the growing number of studies beginning to examine the effects of cannabinoids on pain, and offers a tiny window into what might be happening. Note: the study was performed in collaboration with the cannabis producer, and one of the authors is an employee of this company. Although his role was only to comment on the protocol and final version of the paper, it’s worth noting this relationship.
The study question
In this study, the researchers were looking to understand the analgesic effect of inhaled pharmaceutical-grade cannabis as a plant rather than an extract, using four different variet...
Source: HealthSkills Weblog - May 5, 2019 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Chronic pain Coping strategies News Pain conditions Research cannabis experiment fibromyalgia Source Type: blogs
Pacing, pacing, pacing …
If there’s one pain management and rehabilitation strategy that keeps me awake at night, it’s pacing. Living with persistent pain, I loathe the idea of pacing because I know everyone “booms and busts” from time to time, and few people like the idea of planning every single aspect of every single day as they come to grips with modifying their daily routines. BUT it’s one of the most popular strategies in textbooks, self-help books, and in treatment so there must be something in it, right?
Vexed definitions
One of the problems with the whole pacing concept is defining what we mean by it. I...
Source: HealthSkills Weblog - April 28, 2019 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: 'Pacing' or Quota Chronic pain Clinical reasoning Coping Skills Coping strategies Occupational therapy Pain conditions Physiotherapy Research Science in practice activity management activity pacing pain management pain rehabilita Source Type: blogs
Do you trust me?
Trust – something that needs to be earned, or something that is present at first… and then erodes? Or perhaps, it’s a snap judgement we make on the fly – and judge everything else about a person on that basis?
Firstly, why even discuss trustworthiness in pain rehabilitation? Well, the answer is quite clear: I don’t know how many times I’ve been asked if I can tell whether someone is faking their pain. I’ve read numerous articles on functional capacity testing – and its poor predictive validity (or completely absent investigation of such properties). I’ve had case man...
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, health...
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
