On the problem of coping
Coping. Lots of meanings, lots of negative connotations, used widely by health professionals, rejected by others (why would you need coping skills if you can get rid of your pain?).
I’ll bet one of the problems with coping is that we don’t really know what we’re defining. Is coping the result of dealing with something? Or is it the process of dealing with something? Or is it the range of strategies used when dealing with something? What if, after having dealt with the ‘something’ that shook our world, the world doesn’t go back to the way it was? What if ‘coping’ becomes a...
Source: HealthSkills Weblog - December 2, 2018 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: 'Pacing' or Quota Assessment Chronic pain Clinical reasoning Coping Skills Coping strategies Motivation Research Science in practice activity patterns flexibility Occupational therapy physiotherapy values Source Type: blogs
Tribalism in pain rehabilitation
In this study, female patients and those without prior spine surgery appear to be most likely to benefit from fusion surgery for DDD.” The PCT is essentially a cast around the hips from waist to the top of the leg with a longer leg cast on the side that hurts.
We can see similar appeals to single-factor causal models in studies of core stability – De Blaiser, Roosen, Willems, Danneels, Bossche, & De Ridder (2018) investigating whether this is a risk factor for lower extremity injuries in athletes, while Tayashiki, Mizuno, Kanehisa, & Miyamoto, (2018) investigated the causal effect of intra-abdominal...
Source: HealthSkills Weblog - November 25, 2018 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Clinical reasoning Pain conditions Professional topics Research Science in practice biopsychosocial clinical framework ideology Source Type: blogs
Pain science is not a thing
Today’s post is occasioned by reading several discussions on various forums where the term “pain science” and various adjectives to describe this kind of practice. For those who don’t want to read the rest of my ramblings: no, it’s not a thing, science is an approach to understanding phenomena, and I would have thought all health professionals would use a science-based approach to treatment.
I went on to Google, as you do, to find out when this term began its rise in popularity. Google wasn’t particularly helpful but did show that it’s been around since 2004 at least, and seems to...
Source: HealthSkills Weblog - November 4, 2018 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Assessment Chronic pain Clinical reasoning Education Low back pain Pain conditions Professional topics Research Science in practice biopsychosocial interprofessional multidimensional pain management pain science Source Type: blogs
Wait and see … when do we “ escalate ” care for low back pain?
Prompted by reading a paper by Linton, Nicholas and Shaw (in press), today’s post is about various service delivery models for low back pain and not the content of back pain treatment.
Service delivery in New Zealand is assumed to be based on getting most bang for the buck: we have a mainly socialised healthcare system, along with a unique “no fault, 24 hour” insurance model for accidents whether at work or elsewhere, which means market forces existing in other countries are less dominant. There are, however, many other influences on what gets delivered and to whom.
Back to most bang for buck. With a l...
Source: HealthSkills Weblog - October 28, 2018 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Back pain Interdisciplinary teams Low back pain Professional topics Research Science in practice health systems treatment Source Type: blogs
On “ us ” and “ them ” : what if we ’ re one of “ them ” ?
Over the past few years I’ve been pondering the presumed gap between people living with pain and the people who “treat” or work with them. Most of my readers will know that I live with widespread pain (aka fibromyalgia) or pain that is present in many parts of my body, and the associated other symptoms like DOMS that last for weeks not a day or two, and increased sensitivity to heat, cold, pressure, chilli, sound and so on.
I first “came out” with my pain about 15 years ago: that is, I first disclosed to people I worked with that I had this weird ongoing pain – and finally joined the...
Source: HealthSkills Weblog - October 7, 2018 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Chronic pain Professional topics Research Therapeutic approaches inclusion inequality Source Type: blogs
From the particular to the general – Clinical reasoning in the real world
From the particular to the general –Clinical reasoning in the real world
I make no secret of my adherence to evidence-based healthcare. I think using research-based treatments, choosing from those known to be effective in a particular group of people in a specific context helps provide better healthcare. But I also recognise problems with this approach: people in clinical practice do not look like the “average” patient. That means using a cookie cutter, or algorithm as a way to reduce uncertainty in practice doesn’t, in my humble opinion, do much for the unique person in front of me.
I’...
Source: HealthSkills Weblog - September 30, 2018 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Assessment Clinical reasoning Pain Pain conditions Science in practice biopsychosocial goal-setting healthcare rehabilitation Therapeutic approaches treatment Source Type: blogs
Wandering back from the IASP World Congress
Meetings, meanderings, mind-expansions
I’ve been away for abut 10 days, attending the World Congress of the International Association for the Study of Pain. It was a time of meetings with wonderful people I’ve met via the interwebs, with researchers and clinicians, and most importantly, with people living with pain.
It was also a time for meanderings – around the very walkable city of Boston, embracing history and looking towards the future, and mind meanderings as well.
And because it was a conference, it was also mind-expanding. New ideas, new ways of investigating this human experience of pain, ne...
Source: HealthSkills Weblog - September 23, 2018 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Low back pain Chronic pain Research Occupational therapy Pain conditions Coping strategies Professional topics biopsychosocial pain management conference pain research Source Type: blogs
Six old papers for pain clinicians
We’re rather flighty beasts, us clinicians. From looking at the various ads for courses on the interwebs, it seems we’re all ready to jump on to the next newest thing. This same “what’s new” attitude is present in journals as well – “these references are very old, are there newer ones you can use?”
Here’s a question: what happens to the old stuff? Is it outdated and useless? Do really well-conducted studies have a “use-by” date? Are older therapies always less effective than the new ones? What if this urge to “refresh” means we do actually thro...
Source: HealthSkills Weblog - August 26, 2018 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Pain conditions Professional topics Research Cognitive Behavioural Therapy function Health pain research rehabilitation Therapeutic approaches Source Type: blogs
Myths about exposure therapy
Exposure therapy is an effective approach for pain-related anxiety, fear and avoidance, but exposure therapy is used less often than other evidence-based treatments, there is a great deal of confusion about graded exposure, and when it is used, it is not always well-conducted. It’s not a treatment to be used by every therapist – some of us need to challenge our own beliefs about pain, and whether it’s OK to go “into” the pain a little, or even slightly increase pain temporarily!
Below are some common misconceptions and suggestions for how to overcome them:
Misconception: Exposure therapy cause...
Source: HealthSkills Weblog - August 19, 2018 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Assessment Chronic pain Clinical reasoning Pain conditions Professional topics Research Science in practice acceptance biopsychosocial function graded exposure Occupational therapy pain management rehabilitation Therapeutic app Source Type: blogs
What it means to be a therapist
I wrote the following response to a discussion held recently on a Facebook group Exploring Pain Science – about the term “catastrophising”. It’s a term that elicits great anger and frustration from people living with persistent pain, and I see the term used poorly by clinicians as a judgement about another’s experience. There’s certainly plenty of research showing relationships between high levels of “thinking the worst” about pain, and poorer outcomes – but HOW we as clinicians respond to someone in distress may be more of a problem than the act of a person describing ...
Source: HealthSkills Weblog - July 30, 2018 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: ACT - Acceptance & Commitment Therapy Chronic pain Clinical reasoning Coping strategies Resilience/Health catastrophising distress empathy mindfulness Source Type: blogs
The dynasty of the disc! More history in pain management
Low back pain, despite the multitude of explanations and increasing disability associated with it, has been with humans since forever. Who knows why and I’m not about to conjecture. What’s interesting is that despite ergonomic solutions (fail), increased fitness amongst many people (also a fail), surgical solutions (fail), hands on solutions (fail, fail), and a whole bunch of “special” exercises (fail, fail, fail) we still don’t have a handle on how to reduce disability from it.
I don’t think there will be many people who haven’t seen this:
I’ve never quite worked out why, w...
Source: HealthSkills Weblog - July 29, 2018 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Back pain Low back pain Pain conditions Research biopsychosocial Chronic pain Clinical reasoning disability pain management Therapeutic approaches Source Type: blogs
Learning from old research (digging into history)
I recently submitted a manuscript to a journal. After the usual delay as the reviewers commented on my draft, I received the feedback – one comment stood out to me: “the references are quite old”. I scurried around to find some more recent references and resubmitted, but as I did, I started pondering this drive to continually draw on recent research even if the findings of the older references had not been superseded. There is a sense that maybe journal editors and perhaps people reading the journals think that old research has no merit.
As someone who relishes reading about the history of pain and pain m...
Source: HealthSkills Weblog - July 22, 2018 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Back pain Low back pain Professional topics history Source Type: blogs
Each time we face our fear, we gain strength, courage, and confidence in the doing – Theodore Roosevelt
I’m not certain Theodore Roosevelt actually said that – but who cares?! It’s a great statement. For the person living with persistent pain, though, it can be the last thing you want to hear. After all, it’s tough enough getting up and just doing the normal things let alone challenge yourself! So… how can a health professional help?
Let’s briefly recap. Self efficacy is the confidence I can do something successfully if I wanted to. It’s a robust predictor of many health behaviours including exercise, stopping smoking, eating healthily and coping well with persistent pain (Jackson, W...
Source: HealthSkills Weblog - July 15, 2018 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Back pain Chronic pain Clinical reasoning Coping Skills Coping strategies Professional topics Research Resilience Science in practice biopsychosocial function healthcare pain management physiotherapy rehabilitation self effic Source Type: blogs
The confidence that you ’ ll succeed if you try …
Self efficacy. It’s a word bandied about a lot in pain management, and for a group of clinicians in NZ, it’s been a shock to find out that – oh no! They’re not supporting self efficacy with their patients very much! It means “confidence that if I do this under these conditions, I’ll be successful”.
Self efficacy is part of Bandura’s social learning theory (click here for the Wikipedia entry) where he proposed that much of psychological treatment is driven by a common underlying mechanism: to create and strengthen expectations of personal effectiveness. Bandura recognised that...
Source: HealthSkills Weblog - July 8, 2018 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Clinical reasoning Coping Skills Coping strategies Motivation Pain Pain conditions Professional topics Research Resilience Science in practice biopsychosocial Chronic pain function healthcare pain management rehabilitation Source Type: blogs
Managing sleep problems – a medication-free approach (iv)
The fourth step in learning to sleep well within an ACT framework, is build. My previous posts were: Discover and Accept and Welcome.
In build, we’re beginning to build new practices. This is about learning how much sleep you need, and when you need to head to bed and wake up again.
I know when I had trouble sleeping at night (I refused to call it insomnia, but it most definitely was!), I thought I’d tried everything to help. I had used all the sleep hygiene strategies like no devices in bed, no TV in bed, do some relaxation as I lay down, have a regular bed-time and wake-up time – and one of the things I...
Source: HealthSkills Weblog - July 2, 2018 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Coping Skills Clinical reasoning ACT - Acceptance & Commitment Therapy Science in practice Health healthcare Resilience Therapeutic approaches biopsychosocial coping strategies Source Type: blogs
