The gap in managing pain
If you’ve read my blog for any period of time you’ll know that I like practical research, and research that helps clinicians do what they do with humanity, compassion and evidence. One really enormous gap in the field is rarely mentioned: how do clinicians pull their assessment findings together and use them for clinical reasoning? Especially if you’re part of an interprofessional team (or work in a biopsychosocial framework). The silence in the pain literature is deafening!
There are any number of articles on what can be included in an initial assessment, most of them based on the idea that if factor X i...
Source: HealthSkills Weblog - October 29, 2017 Category: Anesthesiology Authors: adiemusfree Tags: Assessment Chronic pain Clinical reasoning Interdisciplinary teams Pain conditions Professional topics Research Science in practice biopsychosocial pain management rehabilitation Therapeutic approaches Source Type: blogs
Getting persistent pain and disability confused
As I read blogs and tweets and posts on social media, and even peer reviewed papers in journals, I often read that what we’re trying to do in sub-acute pain management is to prevent chronic pain from developing (note, when I talk about pain that goes on beyond healing, more than three months, or has no useful function, I may use the term “chronic” or I may use the more recent term “persistent” – they mean the same thing, except persistent has perhaps less baggage…).
I want to take aim at that focus – to prevent pain from persisting – and think carefully about it. Let...
Source: HealthSkills Weblog - October 15, 2017 Category: Anesthesiology Authors: adiemusfree Tags: Chronic pain Clinical reasoning Pain conditions Professional topics acceptance biopsychosocial disability healthcare pain management rehabilitation science treatment Source Type: blogs
Back to basics about psychosocial factors and pain – v
I’ve been writing about psychosocial factors and pain but I realise that I haven’t actually defined what I mean by psychosocial factors. The strange thing about this term is that it’s often conflated with “psychological” or “psychopathological” when it’s actually not. So… where to begin?
The Collins English Dictionary defines psychosocial as: “of or relating to processes or factors that are both social and psychological in origin”, while the Oxford English Dictionary defines it as “Of or relating to the interrelation of social factors and individual th...
Source: HealthSkills Weblog - October 1, 2017 Category: Anesthesiology Authors: adiemusfree Tags: Chronic pain Clinical reasoning Pain conditions Professional topics Research biopsychosocial Health pain management science Source Type: blogs
Back to basics about psychosocial factors and pain – iv
Part of the definition of pain is that it is “a sensory and emotional experience” – in other words, emotions of the negative kind are integral to the experience of pain. Is it any wonder that poets and authors have written so eloquently about the anguish of unrelieved pain? As I write this, I’ve been pondering the way “psychosocial” has been used when discussing pain, as if those factors aren’t experienced by “normal” people, as if the way we feel about pain and the way people who struggle with their pain feel are two entirely different things.
Chris Eccleston, someone ...
Source: HealthSkills Weblog - September 24, 2017 Category: Anesthesiology Authors: adiemusfree Tags: ACT - Acceptance & Commitment Therapy Chronic pain Coping strategies Occupational therapy Pain conditions Physiotherapy Professional topics Psychology Research Science in practice Therapeutic approaches biopsychosocial Clinical rea Source Type: blogs
Back to basics about psychosocial factors and pain – iii
Last week I discussed some of the areas in the brain, and basic principles, that are currently thought to influence our pain experience. This week I thought I’d introduce one of my favourite ways of considering pain mechanisms, mainly because it helps me think through the four main kinds of mechanisms, and can influence our treatment approach. At this stage I want to raise my hand to acknowledge the following:
My gratitude to Dr John Alchin, longtime friend and colleague, who first pointed this paper out to me and has shared it with hundreds of people who go to see him at the local tertiary pain management centre.
W...
Source: HealthSkills Weblog - September 17, 2017 Category: Anesthesiology Authors: adiemusfree Tags: Education Pain Pain conditions Research Science in practice biopsychosocial Chronic pain Health pain management Source Type: blogs
Back to basics about psychosocial factors and pain (ii)
But what about the bio? No, not the biographical, the biological! It’s something I often get asked – like “if you think pain is psychological/psychosocial factors play a part then you’re obviously not including the biological” – oh woe is me, for no, pain definitely involves the biological. But it’s not quite as simple as we’ve come to believe.
Let’s begin at the very beginning. Can we have pain – and not know about it?
The answer is – no, and that’s exactly why anaesthetics are used. The distinction between pain and nociception is that it’s enti...
Source: HealthSkills Weblog - September 10, 2017 Category: Anesthesiology Authors: adiemusfree Tags: Pain Pain conditions Research Science in practice biopsychosocial theory Source Type: blogs
Back to basics about psychosocial factors in pain (i)
From time to time I see a flurry of tweets or Facebook posts about pain and psychosocial factors. Many of them are informative, intriguing and empathic, but some are just plain wrong. The ones I most get upset about are those arguing that because someone has “psychosocial factors” their pain must be psychological in origin, followed closely by the idea that psychosocial factors equate to psychopathology. This is a series of back to basics posts where I hope to set these things right.
Pain, according to the current definition, is
“an unpleasant sensory and emotional experience associated with actual or po...
Source: HealthSkills Weblog - September 3, 2017 Category: Anesthesiology Authors: adiemusfree Tags: Pain Pain conditions Research Science in practice biopsychosocial Source Type: blogs
Knee pain – and central sensitisation
Conclusion
People living with OA in their knees often spend many years having difficulty managing their pain before they are able to have surgery. From recent research in New Zealand, I don’t think many people are offered a pain “education” approach, and indeed, I’d bet there are a lot of people who don’t get referred for movement-based therapy either. Misunderstanding is rife in OA, with some people uncertain of the difference between osteoarthritis and rheumatoid arthritis, and others very worried that they’re going to “wear the joint out” if they exercise. While OA isnR...
Source: HealthSkills Weblog - August 20, 2017 Category: Anesthesiology Authors: adiemusfree Tags: Assessment Pain Pain conditions Research biopsychosocial Clinical reasoning disability function healthcare rehabilitation science treatment Source Type: blogs
Knee pain – not just a simple case of osteoarthritis
Knee osteoarthritis is, like so many chronic pain problems, a bit of a weird one. While most of us learned that osteoarthritis is a fairly benign disease, one that we can’t do a whole lot about but one that plagues many of us, the disability associated with a painful knee is pretty high – and we still don’t have much of a clue about how the pain we experience is actually generated. Cartilage doesn’t have nociceptive fibres, yet deterioration of cartilage is the hallmark of osteoarthritis, though there are other structures capable of producing nociceptive input around the knee joint. Perhaps, as so...
Source: HealthSkills Weblog - August 13, 2017 Category: Anesthesiology Authors: adiemusfree Tags: Assessment Pain Pain conditions Research Science in practice biopsychosocial Chronic pain disability pain management rehabilitation treatment Source Type: blogs
Conversations about cannabis for chronic pain
The debate about cannabis and derivatives for persistent pain continues to grow in New Zealand, and elsewhere in the world. Many people I’ve treated and who are living with persistent pain say they like to use cannabis (in a variety of forms) to help with pain intensity and sleep, adding their voices to those wanting “medicinal” cannabis to be approved. In the few patients I’ve worked with who have managed to obtain a cannabis product (in NZ it has to be legally prescribed and will generally be in the form of Sativex or similar) the effect doesn’t seem as profound as the real thing (whether sm...
Source: HealthSkills Weblog - August 6, 2017 Category: Anesthesiology Authors: adiemusfree Tags: Chronic pain Therapeutic approaches Research Pain conditions Coping strategies Science in practice Health healthcare biopsychosocial pain management Source Type: blogs
Great expectations – and low back pain
Have you ever wondered why there are so many treatments for low back pain? Like there are actually hundreds of different ways to “treat” back pain… yet the truth is, none of them work for everyone. Actually, most of them seem to help pass the time until low back pain settles of its own accord. Until it’s back again (no pun intended!).
This post is prompted after reading a string of general news articles discussing the common non-specific low back pain – under various guises of “dead butt syndrome“, “Dr Tom: Ouch I’ve hurt my back” and the like – I think it&#...
Source: HealthSkills Weblog - July 30, 2017 Category: Anesthesiology Authors: adiemusfree Tags: Back pain Chronic pain Clinical reasoning Research Health healthcare Low back pain rehabilitation Resilience Therapeutic approaches Source Type: blogs
Primary pain disorders
In a move likely to create some havoc in compensation systems around the world (well, at least in my corner of the world!), the International Association for the Study of Pain has worked with the World Health Organisation to develop a way to classify and thus record persistent pain conditions in the new (draft) ICD-11. While primary headache disorder has been in the classification for some years, other forms of persistent pain have not. Recording the presence of a pain disorder is incredibly important step forward for recognising and (fingers crossed) funding research and treatment into the problem of persistent pain. As t...
Source: HealthSkills Weblog - July 23, 2017 Category: Anesthesiology Authors: adiemusfree Tags: Chronic pain Clinical reasoning Health Research biopsychosocial healthcare Source Type: blogs
Clinical reasoning in persistent pain management
I think we need to take a cold hard look at clinical reasoning in pain management and especially at how we can integrate all the various factors influencing the person sitting in front of us. There are too few papers really addressing how different professions can put their assessment findings together to generate a truly multi-faceted model of why this person is having trouble with their pain. I could find only one paper detailing interprofessional clinical reasoning for chronic pain – and it’s inside a textbook dates from 2008 (Linton & Nicholas, 2008). So it’s no wonder, when a team gets together, ...
Source: HealthSkills Weblog - July 16, 2017 Category: Anesthesiology Authors: adiemusfree Tags: Clinical reasoning Coping strategies Pain conditions Professional topics biopsychosocial Chronic pain pain management Source Type: blogs
Everyday hassles of fibromyalgia
This post has been on my mind for a while now. I live with fibromyalgia (FM) and want to share some of the everyday hassles I face. This isn’t a “oh woe is me” kind of post, it’s more of a “if you’re a clinician working with someone who has fibromyalgia, these are some things to ponder”.
Diagnosis
I worked in chronic pain management for almost 20 years before I recognised that the pains I’d been experiencing most of my adult life actually added up to “…a syndrome of diffuse body pain with associations of fatigue, sleep disturbance, cognitive changes, mood disturba...
Source: HealthSkills Weblog - July 2, 2017 Category: Anesthesiology Authors: adiemusfree Tags: Chronic pain Clinical reasoning Coping strategies Health Pain conditions Professional topics Research Resilience/Health biopsychosocial fibromyalgia pain management Source Type: blogs
Exercise? Who me? Yoga or physiotherapy or education …
This study is a “non-inferiority” study, looking to establish whether yoga or physiotherapy, or indeed education, can help people living with chronic low back pain. Now I’m not going to do a blow-by-blow analysis of the study, that’s for you to do. What I am going to do is look at what the yoga consisted of – and see why, perhaps, yoga is getting so much research interest. BTW, yoga was found to be non-inferior to physiotherapy, and both yoga and PT were more likely than education to have a clinically meaningful response, although neither yoga nor PT were superior to education.
This is the bas...
Source: HealthSkills Weblog - June 25, 2017 Category: Anesthesiology Authors: adiemusfree Tags: Back pain Chronic pain Coping strategies Motivation Pain conditions Professional topics Research Science in practice biopsychosocial function Health Therapeutic approaches Source Type: blogs
