Using more than exercise for pain management
In the excitement and enthusiasm for exercise as a treatment for persistent pain, I wonder sometimes whether we’ve forgotten that “doing exercise” is a reasonably modern phenomenon. In fact, it’s something we’ve really only adopted since our lifestyle has moved from a fairly physically demanding one, to one more sedentary (Park, 1994). I also wonder if we’ve forgotten that exercise is intended to promote health – so we can do the things we really want or need to do. Remembering, of course, that some people find exercise actually exacerbates their pain (Lima, Abner & Sluka, 2017...
Source: HealthSkills Weblog - March 4, 2018 Category: Anesthesiology Authors: adiemusfree Tags: Assessment Chronic pain Clinical reasoning Coping Skills Coping strategies Occupational therapy Pain conditions Physiotherapy Research Resilience/Health activity biopsychosocial function Motivation pain management rehabilitat Source Type: blogs
One-session instruction in pacing doesn ’ t work
In this study, the “tailored” group underwent seven days of monitoring using an accelerometer, the results were downloaded, analysed and an individualised pacing plan developed by the therapists. The plan was intended to highlight times when the person had high or low levels of activity (as compared with their own average, and averages drawn from previous studies of people with the same diagnosis), and to point out associations between these activity levels and self reported symptoms. Participants were then provided with ideas for changing their activity levels to optimise their ability to sustain activity and ...
Source: HealthSkills Weblog - February 25, 2018 Category: Anesthesiology Authors: adiemusfree Tags: 'Pacing' or Quota Chronic pain Clinical reasoning Coping Skills Coping strategies Occupational therapy Pain conditions Research function Motivation pain management self management Therapeutic approaches values Source Type: blogs
One way of using a biopsychosocial framework in pain management – vi
I could write about a BPS (biopsychosocial) model in every single post, but it’s time for me to explore other things happening in the pain management world, so this is my last post in this series for a while. But it’s a doozy! And thanks to Eric Bowman for sharing an incredibly relevant paper just in time for this post…
One of the problems in pain management is that there are so many assessments carried out by the professionals seeing a person – but very little discussed about pulling this information together to create an overall picture of the person we’re seeing. And it’s this aspect ...
Source: HealthSkills Weblog - February 18, 2018 Category: Anesthesiology Authors: adiemusfree Tags: Assessment Back pain Clinical reasoning Low back pain Pain conditions Professional topics Research Science in practice biopsychosocial disability function Health healthcare pain management rehabilitation Therapeutic approache Source Type: blogs
One way of using a biopsychosocial framework in pain management – v
Theories are an important part of scientific development. Theories are essentially a collection of propositions or hypotheses that build a picture of what is in order to predict or control or somehow explain what’s going on. The extent to which a theory’s predictions represent what actually happens, given a set of circumstances, allows us to place more or less faith in the adequacy (or perhaps accuracy) of that theory. The problem with social theory is that there are so many complex interactions between variables that it’s very hard to generate hypotheses that represent what actually goes on in the world ...
Source: HealthSkills Weblog - February 11, 2018 Category: Anesthesiology Authors: adiemusfree Tags: Chronic pain Clinical reasoning Pain conditions Professional topics Research biopsychosocial disability healthcare pain management values Source Type: blogs
One way of using a biopsychosocial framework in pain management – iv
And yes! There’s more to this series of posts on how I use a biopsychosocial model in practice!
Today’s post is about moving from a conceptual model to a practical model, or how we can use research in our clinical reasoning.
A biopsychosocial model (BPSM) as envisaged by Engel was a framework for clinicians to think about why this person is presenting in this way at this time (and what may be maintaining their situation), as well as what could be done to reduce distress and disability. Engel wanted clinicians to go beyond disease processes, isolated from the people experiencing them, and to explore aspects of h...
Source: HealthSkills Weblog - February 4, 2018 Category: Anesthesiology Authors: adiemusfree Tags: Chronic pain Clinical reasoning Coping strategies Pain conditions Professional topics Research biopsychosocial disability function Health healthcare Low back pain pain management Therapeutic approaches Source Type: blogs
One way of using a biopsychosocial framework in pain management – iii
Before Christmas and the New Year break I was writing about how I use a biopsychosocial model in pain management – and I haven’t finished!
To review: The first post was about the context or the ideas behind Engel’s original model, and my two key clinical questions – why is this person presenting in this way at this time, and what can be done to reduce distress and disability?
The second post was about classical and operant conditioning and why these models are useful when we’re thinking about what a person does when they’re sore – and how their actions communicate to people around ...
Source: HealthSkills Weblog - January 28, 2018 Category: Anesthesiology Authors: adiemusfree Tags: Clinical reasoning Pain Professional topics Research Science in practice biopsychosocial Source Type: blogs
The new year begins
For some of you, the New Year has already started, but I’ve been in a lovely position where I’ve been on leave and haven’t yet started “work” – though the work of living is always present!
It’s traditional at this time to year to review the past year and plan for the coming months, so today’s post is a few musings on both.
Last year I noticed I’d been working on this blog for nearly 10 years! Astonishing really, because it was intended to be a learning experience for me during my recovery from a mTBI. It kinda grew like Topsy, and here I am 10 years down the road still ...
Source: HealthSkills Weblog - January 21, 2018 Category: Anesthesiology Authors: adiemusfree Tags: Uncategorized healthcare biopsychosocial Pain pain management allied health Source Type: blogs
Wishes for the New Year
Filed under: Uncategorized (Source: HealthSkills Weblog)
Source: HealthSkills Weblog - January 2, 2018 Category: Anesthesiology Authors: adiemusfree Tags: Uncategorized Source Type: blogs
Merry Christmas and Peace to All
Filed under: Uncategorized (Source: HealthSkills Weblog)
Source: HealthSkills Weblog - December 23, 2017 Category: Anesthesiology Authors: adiemusfree Tags: Uncategorized Source Type: blogs
One way of using a biopsychosocial framework in pain management – ii
Last week I discussed case formulation as one way of using a biopsychosocial framework in pain management, and I reviewed Benedetti’s description of the process of becoming aware that something’s wrong, seeking relief from that discomfort, then the “meet the therapist moment”, and finally the “receiving the therapy” steps along the way. Benedetti considers this within a neurobiological model (Benedetti, 2013), while Engel (1977) used general systems theory to frame his critique of the original biomedical model.
This week I want to look at a behavioural model. I do this partly because I t...
Source: HealthSkills Weblog - December 17, 2017 Category: Anesthesiology Authors: adiemusfree Tags: Assessment Clinical reasoning Pain Pain conditions Professional topics Research Science in practice biopsychosocial Chronic pain Health Low back pain Psychology Source Type: blogs
One way of using a biopsychosocial framework in pain management – i
While a biopsychosocial ‘model’ (or sociopsychobiological framework) has been widely adopted when attempting to understand pain, many critics argue that it just doesn’t give clinicians a clear way to integrate or prioritise clinical information and generate treatments. The ‘model’ itself has been challenged from many angles – it’s too complex, too simplistic, relies on Bertalanffy’s “general systems theory” which has itself been challenged, it’s too “fuzzy”, and of course there are many who think that psychological and sociocultural aspects of hu...
Source: HealthSkills Weblog - December 10, 2017 Category: Anesthesiology Authors: adiemusfree Tags: Clinical reasoning Coping strategies Professional topics Research Science in practice biopsychosocial treatment Source Type: blogs
What should healthcare professionals learn?
I was lucky enough to spend two days attending the Placebo Symposium in Sydney in November this year – what an experience! A lineup of the cream of researchers exploring placebo and contextual responses (meaning responses) – all were excellent speakers and the focus was on both research and what this means to clinicians. If you’re keen to watch all you can for free over the next two weeks – click here: www.placebo.armchairmedical.tv.
At the end of the symposium, the speakers were asked a question by artist Eugenie Lee what subjects they would want taught if they had all the facilities and students w...
Source: HealthSkills Weblog - December 3, 2017 Category: Anesthesiology Authors: adiemusfree Tags: Research Science in practice biopsychosocial Clinical reasoning healthcare Source Type: blogs
Minding your body: Interoceptive awareness, mindfulness and living well
This study aimed to establish the relationship between various items on two questionnaires used to measure IA and DM: the MAIA (Multidimensional Assessment of Interoceptive Awareness), and the FFMQ (Five Facet Mindfulness Questionnaire). The paper itself discusses the first measure as empirically derived and confirmed by focus groups, and having associations with less trait anxiety, emotional susceptibility and depression – in other words, high scores on this measure (awareness of body sensations and judging those sensations) are associated with important factors influencing our wellbeing. The second measure is descr...
Source: HealthSkills Weblog - November 26, 2017 Category: Anesthesiology Authors: adiemusfree Tags: ACT - Acceptance & Commitment Therapy Chronic pain Clinical reasoning Coping strategies Pain conditions Professional topics Resilience Science in practice biopsychosocial Health mindfulness self management Therapeutic approaches Source Type: blogs
Manage pain – or aim to cure? Why I ’ m committed to pain management
Prominent researchers, clinicians and commentators seem to suggest that aiming to help people live with their pain is aiming too low. That pain cure or at least reduction is The Thing To Do. It’s certainly got a bit of a ring to it – “I can help get rid of your pain” has a sex appeal that “I can help you live with your pain” doesn’t have. And I can recognise the appeal. Persistent pain can be a scourge for those who live with it; it can eat away at every part of life. Imagine waking up one day to find NO PAIN! Excited much?
So why do I keep hammering on about this not very glamorou...
Source: HealthSkills Weblog - November 12, 2017 Category: Anesthesiology Authors: adiemusfree Tags: Chronic pain Clinical reasoning Coping Skills Coping strategies Professional topics Research Resilience/Health Science in practice acceptance function healthcare self management Therapeutic approaches Source Type: blogs
What ’ s the biggest barrier to learning more?
Reading and engaging with clinicians online and face-to-face, it’s clear to me that effectively integrating psychosocial factors into daily clinical reasoning, especially amongst physical or manual therapists, is a real challenge. There’s enough research around showing how poorly these factors are identified and then factored in to change what we do and how we do it for me to be convinced of this. What intrigues me, though, is why – given psychosocial risk factors have, in NZ, been around since 1997 – it’s still a problem.
It’s not ignorance. It’s not holding an alternative viewpoi...
Source: HealthSkills Weblog - November 5, 2017 Category: Anesthesiology Authors: adiemusfree Tags: Assessment Clinical reasoning Pain Pain conditions Professional topics Psychology Science in practice biopsychosocial healthcare pain management Research Source Type: blogs
