Managing sleep problems – a medication-free approach (iii)
More on sleeping the ACT way. Step one was discover – all the things you’re doing to help yourself sleep, but in your attempts to control the uncontrollable (thoughts, feelings, memories, worries, sensations, the environment and so on). And hopefully you’ve seen that these things can be counter-productive. That flash new pillow and bed is pretty useless if you travel somewhere. The pills need to be stopped at some point – and then you have to withdraw from them. And the thoughts, and sensations (including pain) just carry right on there not matter what you do.
So step two is to accept: accept what y...
Source: HealthSkills Weblog - July 1, 2018 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: ACT - Acceptance & Commitment Therapy Clinical reasoning Coping strategies Pain conditions Resilience/Health Science in practice Source Type: blogs
Managing sleep problems – a medication-free approach (ii)
Last week I described the “conventional” CBT for insomnia approach (CBTi), but this week I want to introduce an Acceptance and Commitment Therapy (ACT) approach which is superficially similar to CBTi but holds to some of the fundamental principles of ACT: mindfulness, and letting go of control. As is typical for ACT, there are no hard and fast absolutes and instead there is a focus on workability – what works, in context.
Most of the content of today’s post is drawn from my personal experience and The Sleep Book by Dr Guy Meadows. There are five basic steps and according to the book it should take f...
Source: HealthSkills Weblog - July 1, 2018 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: ACT - Acceptance & Commitment Therapy Coping strategies Resilience/Health Science in practice biopsychosocial Clinical reasoning healthcare self management Source Type: blogs
Managing sleep problems – a medication-free approach (i)
I’ve recently completed two posts on assessing sleep problems in people experiencing persistent pain, and today I turn my attention to strategies for managing sleep problems – without medication. Why without medication? Because to date there are no medications for insomnia that don’t require a ‘weaning off’ period, during which time people often find their original sleep problems emerge once again… I’m not completely against medications for sleep or pain – but I think they need to be used with care and full disclosure about the effects, side-effects, and the need to eventuall...
Source: HealthSkills Weblog - June 24, 2018 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: ACT - Acceptance & Commitment Therapy Chronic pain Clinical reasoning Cognitive Behavioural Therapy Cognitive skills Coping strategies Pain conditions Professional topics Research Science in practice biopsychosocial CBT Health se Source Type: blogs
Assessing problems with sleep and pain – ii
Last week I wrote about my approach to assessing sleep problems in those with persistent pain. As an ex-insomniac I’ve spent a while learning about sleep so I can understand what’s going on, and why sleep can be such a problem. In this week’s post I want to dig a little deeper into what’s going on with poor sleep, as well as some of the unique features of sleep in people experiencing persistent pain.
Having reviewed the five main areas that are fundamental (and can/should be assessed by anyone working with people who experience persistent pain), the next area I want to look at with people is mood. T...
Source: HealthSkills Weblog - June 17, 2018 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Assessment Chronic pain Clinical reasoning Health Pain conditions Research biopsychosocial coping disability function pain management treatment Source Type: blogs
Assessing problems with sleep & persistent pain
Problems with sleep affect most of us from time to time. We know we might find it difficult to get off to sleep because of a busy mind, a different bedroom, changes to our schedule – but for most of us, sleep returns to our normal fairly quickly. For some of us, though, sleep problems continue for weeks, months or even years. And for people living with persistent pain, sleep can be one of the most difficult things to deal with, yet it’s also one of the most common (McCracken & Iverson, 2002). Studies of sleep problems in people with fibromyalgia show abnormal sleep continuity as well as changes in sleep arc...
Source: HealthSkills Weblog - June 10, 2018 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Chronic pain Clinical reasoning Coping Skills Coping strategies Health Pain conditions Therapeutic approaches acceptance Assessment biopsychosocial science treatment Source Type: blogs
Pain – or disability?
One of the fundamental distinctions we need to make when working with people who experience pain is to understand the difference between experiencing pain – and the behaviour or actions or responses we make to this experience. This is crucial because we can never know “what it is like” to experience pain – and all we have to rely on as external observers is what we see the person doing. Differentiating between the various dimensions associated with our experience of pain makes it far easier to address each part in the distinct ways needed.
Let me explain. We know the current definition of pain ̵...
Source: HealthSkills Weblog - May 27, 2018 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Clinical reasoning Cognitive skills Education/CME Pain Pain conditions biopsychosocial disability Research theory Source Type: blogs
Clinical reasoning – and cognitions
Possibly one of the most hotly discussed aspects of clinical reasoning and pain relates to thoughts and beliefs held by both people experiencing pain and the clinicians who work with them. It’s difficult to avoid reading papers about “pain education”, “catastrophising”, “maladaptive thinking”, but quite another to find a deeper analysis of when and why it might be useful to help people think differently about their pain, or to deal with their thoughts about their experience in a different way.
Cognition is defined by the APA Dictionary of Psychology as
1. all forms of knowing and ...
Source: HealthSkills Weblog - May 21, 2018 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Assessment Chronic pain Clinical reasoning Cognitive skills Pain conditions Science in practice biopsychosocial Health healthcare Therapeutic approaches treatment Source Type: blogs
Teamwork: Gaps or overlaps?
For many years now, interprofessional/multidisciplinary teams have been considered the best model for delivering pain management. This stems from studies conducted right back as far as J J Bonica in 1944 (Bonica, 1993), and originally referred to teams consisting of several medical specialties. Bonica later initiated a multidisciplinary/interdisciplinary pain programme in 1960, including 20 people from 14 medical specialties “and other health professions”. In 1977, Bonica and Butler classified pain programmes into five groups – major comprehensive multidisciplinary programmes – more than six discipl...
Source: HealthSkills Weblog - May 13, 2018 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Chronic pain Interdisciplinary teams Professional topics biopsychosocial Clinical reasoning Health healthcare pain management Psychology Research treatment Source Type: blogs
When philosophy and evidence collide: is an occupation-focused approach suitable in pain management?
I have often described myself as a renegade occupational therapist: I like statistics, I think experimental research is a good way to test hypotheses, I don’t make moccasins (though I occasionally wear them!), I’m happy reading research and figuring out how I can apply findings into my clinical practice.
Occupational therapy is a profession that continues to evolve. The origins of occupational therapy lie back in the “moral” model of treatment for mental illness when advocates found that giving people things to do helped them become well (mind you, some of the reasons for admission to a “menta...
Source: HealthSkills Weblog - May 6, 2018 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: ACT - Acceptance & Commitment Therapy Chronic pain Clinical reasoning Coping Skills Occupational therapy Pain conditions Research Science in practice pain management Psychology rehabilitation research literature self management T Source Type: blogs
Clinical reasoning in pain – emotions
The current definition of pain includes the words “unpleasant sensory and emotional experience” so we would be surprised if we encountered a person with pain who wasn’t feeling some sort of negative emotion, am I right? Yet… when we look at common pain assessments used for low back pain, items about emotions or worries are almost always included as indicators of negative outcomes (for example, STarTBack – Worrying thoughts have been going through my mind a lot of the time, I feel that my back pain is terrible and it’s never going to get any better, In general I have not enjoyed all the thing...
Source: HealthSkills Weblog - April 29, 2018 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Assessment Clinical reasoning Coping strategies Health Humour Pain biopsychosocial Occupational therapy pain management rehabilitation Research Therapeutic approaches treatment Source Type: blogs
Clinical reasoning and why models of low back pain need to be integrated
Clinical reasoning has been defined as “the process by which a therapist interacts with a patient, collecting information, generating and testing hypotheses, and determining optimal diagnosis and treatment based on the information obtained.” (thanks to https://www.physio-pedia.com/Clinical_Reasoning#cite_note-Higgs-1). The model or lens through which we do these processes naturally has a major influence on our relationship with the person, the information we think is relevant, the hypotheses we develop, and ultimately the problems we identify and how we treat them. No arguments so far, yes?
So when we come to t...
Source: HealthSkills Weblog - April 22, 2018 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: ACT - Acceptance & Commitment Therapy Assessment Back pain Clinical reasoning Low back pain Pain conditions Professional topics Research Science in practice biopsychosocial pain management Source Type: blogs
Occupational therapists ’ knowledge of pain
I am mightily bothered by health professionals’ lack of knowledge about pain. Perhaps it’s my “teacher” orientation, but it seems to me that if we work in an area, we should grab as much information about that area as possible – and pain and pain management is such an important part of practice for every health professional that I wonder why it’s so often neglected. So, to begin exploring this, I completed a search looking at occupational therapists’ knowledge of pain – and struck gold, kinda.
Angelica Reyes and Cary Brown conducted a survey of Canadian occupational therapi...
Source: HealthSkills Weblog - April 15, 2018 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Education Education/CME Occupational therapy Pain conditions Professional topics Research biopsychosocial Chronic pain Health pain management Source Type: blogs
When it hurts – but it ’ s important to keep doing
To date, despite years of research and billions of dollars, there is no satisfactory way to reduce pain in all people. In fact, our pain reduction treatments for many forms of persistent pain are pretty poor whether we look at pharmaceuticals, surgery, psychological treatments or even exercise. What this means is there are a lot of disillusioned and frustrated people in our communities – yet life carries on, and people do keep doing!
In an effort to understand what might help people who don’t “find a cure”, researchers and clinicians have been looking at mediators. Mediators are factors that explain...
Source: HealthSkills Weblog - March 25, 2018 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Chronic pain Clinical reasoning Coping Skills Coping strategies Pain conditions Research Science in practice acceptance Assessment biopsychosocial disability healthcare pain management self management Therapeutic approaches Source Type: blogs
Do pain management programmes really influence “ doing ” in daily life?
In this study by Persson, Eklund, Lexell & Rivano-Fischer (2017), the aims were to assess longterm changes in MPI profiles over the course of a year; to look at associations between “Adaptive Coper” profiles at follow-up and improvements in occupational performance; and to look at factors at baseline that might be used to predict changes over time. Participants were, as usual, attending a tertiary pain management centre at a University hospital. They took part in a 21 day programme (oh the luxury of time!), and were seen by a team working together (oh the luxury of a co-located team!) including a psychologi...
Source: HealthSkills Weblog - March 18, 2018 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Chronic pain Clinical reasoning Cognitive Behavioural Therapy Coping strategies Groupwork Interdisciplinary teams Occupational therapy Pain conditions Research Assessment disability function Health healthcare pain management Source Type: blogs
Thinking the worst – and willingness to do things despite pain
This study didn’t incorporate contexts of activity – the why question. I think that’s a limitation, however, examining values is not super easy, however it’s worth keeping this limitation in mind when thinking about the results.
The results suggest that when someone is willing to do something even if it increases pain, or while pain is elevated, this has an effect on their performance, disability, the interference they experience from pain, and their mood.
The results also suggest that catastrophising, while an important predictor of pain-related outcomes, is moderated by acceptance.
My question now...
Source: HealthSkills Weblog - March 11, 2018 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: ACT - Acceptance & Commitment Therapy Chronic pain Clinical reasoning Coping strategies Occupational therapy Pain conditions Professional topics Research Resilience/Health Science in practice biopsychosocial disability function h Source Type: blogs
