Pacing, pacing, pacing – good, bad, or … ?
There’s nothing that pain peeps seem to like more than a good dispute over whether something is good, or not so good for treatment. Pacing is a perennial topic for this kind of vexed discussion. Advocates say “But look at what it does for me! I can do more without getting my pain out of control!” Those not quite as convinced say “But look at how little you’re doing, and you keep letting pain get in the way of what you really want to do!”
Defining and measuring pacing is just as vexed as deciding whether it’s a good thing or not. Pacing isn’t well-defined and there are several...
Source: HealthSkills Weblog - June 18, 2017 Category: Anesthesiology Authors: adiemusfree Tags: 'Pacing' or Quota Assessment Chronic pain Clinical reasoning Coping Skills Pain conditions Research Science in practice biopsychosocial pain management self management Therapeutic approaches Source Type: blogs
Returning to work, good or bad?- a very complex question
One of the main reasons returning to work is a priority in many healthcare systems is simply that compensation and off-work benefits is the most costly portion of the bill for people with ill health. This naturally leads to a strong emphasis in most rehabilitation, especially musculoskeletal rehabilitation in New Zealand, to help people return to work as soon as practicable. At times the process can be brutal. In my own case, after 18 months of working part-time due to post-concussion symptoms after a “mild” traumatic brain injury, I had the hard word put on me to get back to my job or I’d be sent to work...
Source: HealthSkills Weblog - June 11, 2017 Category: Anesthesiology Authors: adiemusfree Tags: Chronic pain Clinical reasoning Research Return to Work biopsychosocial function Health healthcare pain management RTW Therapeutic approaches Source Type: blogs
Targeting the people who need it most
This study provides some support for using single item questions to identify those who need more in-depth assessment, and those who don’t need this level of attention. I like that! The idea that we can triage those who probably don’t need the whole toolbox hurled at them is a great idea.
Perhaps the New Zealand politicians, as they begin the downhill towards general elections at the end of the year, could be asked to thoughtfully consider rational distribution of healthcare, and a greater emphasis on targeted use of allied health and expensive surgery.
Deyo, R. A., & Mirza, S. K. (2016). Herniated Lu...
Source: HealthSkills Weblog - May 28, 2017 Category: Anesthesiology Authors: adiemusfree Tags: Assessment Back pain Chronic pain Coping strategies Interdisciplinary teams News Pain conditions Professional topics Research biopsychosocial disability healthcare rehabilitation self management treatment Source Type: blogs
Being mindful about mindfulness
I’m generally a supporter of mindfulness practice. It’s been a great discipline for me as I deal with everyday life and everything. I don’t admit to being incredibly disciplined about “making time for meditation” every day – that is, I don’t sit down and do the whole thing at a set time each day – but I do dip in and out of mindfulness throughout my day. While I’m brushing my teeth, slurping on a coffee, driving, sitting in the sun, looking at the leaves on the trees, cuddling my Sheba-dog I’ll bring myself to the present moment and take a couple of minutes to be ...
Source: HealthSkills Weblog - May 21, 2017 Category: Anesthesiology Authors: adiemusfree Tags: Chronic pain Clinical reasoning Pain conditions Relaxation Resilience/Health Science in practice acceptance mindfulness persistent pain willingness Source Type: blogs
The “ Subjective ” – and really hearing
I’m not a physiotherapist. This means I don’t follow the SOAP format because it doesn’t suit me. The first letter is intended to represent “subjective” – and when I look up the dictionary meaning of subjective and compare it with the way “subjective” notes are thought about, I think we have a problem, Houston.
Subjective is meant to mean “based on personal feelings” or more generally “what the person says”. In the case of our experience of pain, we only have our personal feelings to go on. That is, we can’t use an image or X-ray or fMRI or blood ...
Source: HealthSkills Weblog - May 7, 2017 Category: Anesthesiology Authors: adiemusfree Tags: Assessment Clinical reasoning Interdisciplinary teams Occupational therapy Physiotherapy Psychology biopsychosocial healthcare Pain pain management Therapeutic approaches treatment Source Type: blogs
Mulling over the pain management vs pain reduction divide
I’ve worked in persistent pain management for most of my career. This means I am biased towards pain management. At times this creates tension when I begin talking to clinicians who work in acute or subacute musculoskeletal pain, because they wonder whether what I talk about is relevant to them. After all, why would someone need to know about ongoing management when hopefully their pain will completely go?
I have sympathy for this position – for many people, a bout of tendonosis, or a strained muscle or even radicular pain can ebb away, leaving the person feeling as good as new. While it might take a few months...
Source: HealthSkills Weblog - April 30, 2017 Category: Anesthesiology Authors: adiemusfree Tags: ACT - Acceptance & Commitment Therapy Back pain Chronic pain Clinical reasoning Coping strategies Pain conditions Resilience/Health biopsychosocial healthcare pain management rehabilitation Therapeutic approaches Source Type: blogs
… and now what we ’ ve all been waiting for: What do to about central sensitisation in the clinic
For the last couple of weeks I’ve posted about central sensitisation; what it is, and how to assess for it. Today I’m going to turn to the “so what” question, and talk about what this might mean when we’re in the clinic. Remember that most of this material comes from Jo Nijs’ recent talks at the New Zealand Pain Society.
Firstly, remember that pain is an experience that people have, underpinned by neurobiology, but also, depending on the level of analysis, on interactions with others, on systems and how they work, on culture, on individual experiences, and of course, on interacting wi...
Source: HealthSkills Weblog - April 2, 2017 Category: Anesthesiology Authors: adiemusfree Tags: ACT - Acceptance & Commitment Therapy Chronic pain Clinical reasoning Cognitive skills Coping Skills Coping strategies Professional topics Research Science in practice pain management Therapeutic approaches Source Type: blogs
Does central sensitisation matter?
In my last post I discussed some of the mechanisms thought to be involved in central sensitisation, and while many of the details remain pretty unknown, I think the general conclusion is that yes, it really is a thing. What do I mean by central sensitisation? Well, it’s curious, it can refer to the processes at spinal and brain levels that seem to reduce the usual descending inhibitory mechanisms, expand the areas in which neural activity takes place, and allows increased information flow to eventually reach conscious awareness. At the same time it can refer to the experience in which a person feels greater pain than...
Source: HealthSkills Weblog - March 26, 2017 Category: Anesthesiology Authors: adiemusfree Tags: Chronic pain Pain conditions Professional topics Research Science in practice biopsychosocial disability pain management Source Type: blogs
Is central sensitisation really a thing?
It seems odd to me that there’s much argument about central sensitisation in pain circles. I thought the idea of central sensitisation was well-established based on research from some years ago – but apparently there are still arguments about its relevance, and lots of debate about how to identify it clinically. This post is based mainly on a presentation by Jo Nijs from Pain in Motion, at the recent NZ Pain Society meeting in Nelson. In this post I want to briefly review the material presented by Jo suggesting that central sensitisation is a thing. I’ll write more about assessment in a future blog, or th...
Source: HealthSkills Weblog - March 12, 2017 Category: Anesthesiology Authors: adiemusfree Tags: Chronic pain Clinical reasoning Pain conditions Research Science in practice biopsychosocial Health Source Type: blogs
A surfeit of learning
It’s been a busy few weeks as I’ve been at the San Diego Pain Summit and then the New Zealand Pain Society meeting where wonderful speakers presented on topics like exercise for pain, cognitive functional therapy, central sensitisation, opioid use in New Zealand, sensory profiles and other such topics. The chance to meet and spend time with clinicians who are passionate to not only learn about pain, but apply what they’ve learned in clinical practice is something I can’t miss.
What’s difficult, though, is deciding what to apply on Monday morning after having been to meetings or events where th...
Source: HealthSkills Weblog - March 5, 2017 Category: Anesthesiology Authors: adiemusfree Tags: Clinical reasoning Coping strategies Science in practice biopsychosocial healthcare Research Source Type: blogs
What to do with the results from the PCS
The Pain Catastrophising Scale is one of the more popular measures used in pain assessment. It’s popular because catastrophising (thinking the worst) has been identified as an especially important risk factor for slow recovery from pain (Abbott, Tyni-Lenne & Hedlund, 2010), for reporting high levels of pain intensity (Langley, 2011), and for ongoing disability (Elfving, Andersoon & Grooten, 2007). I could have cited hundreds more references to support these claims, BTW.
The problem is, once the PCS is administered and scored: what then? What difference does it make in how we go about helping a person think a ...
Source: HealthSkills Weblog - February 26, 2017 Category: Anesthesiology Authors: adiemusfree Tags: Assessment Back pain Clinical reasoning Coping Skills Coping strategies Education Low back pain Pain conditions biopsychosocial Chronic pain Occupational therapy pain management rehabilitation Therapeutic approaches Source Type: blogs
What is pain for?
We’re told we need pain – without the experience, we risk harming our bodies and living short lives. With pain, and for most people, we learn to not go there, don’t do that, don’t do that AGAIN, and look at that person – don’t do what they’re doing! Thirst, hunger, fear, delicious tastes and smells, the feelings of belonging, of safety and security, of calm and comfort: all of these are experiences we learn about as we develop greater control over our bodies.
Pain is an experience we learn to associate with actual or possible threat to “self”. Let’s take a moment ...
Source: HealthSkills Weblog - February 19, 2017 Category: Anesthesiology Authors: adiemusfree Tags: Coping strategies Pain Pain conditions Resilience/Health acceptance biopsychosocial Clinical reasoning Research Therapeutic approaches values Source Type: blogs
What difference does it make to know about psychosocial risk factors?
The “psychosocial yellow flags” or risk factors for developing ongoing disability after a bout of acute low back pain have been promulgated in New Zealand since 1997. Introduced as part of the Acute Low Back Pain Guidelines, the yellow flags were lauded both locally and internationally and subsequently there have been many international guidelines which have adopted this kind of integration. But what exactly do we do with that information? How does it help if we find out that someone is really afraid their pain means something awful, or if they fear their life will never be the same again, or if they truly worr...
Source: HealthSkills Weblog - January 29, 2017 Category: Anesthesiology Authors: adiemusfree Tags: Clinical reasoning Coping strategies Professional topics biopsychosocial goal-setting healthcare Occupational therapy Pain physiotherapy Therapeutic approaches Source Type: blogs
Empathy and catastrophising influence pain inhibition
This study examined conditioned pain modulation in partners observing their partner undergoing a painful experience. It was carried out by Gougeon, Gaumond, Goffaux, Potvin and Marchand (2016) in an attempt to understand what happens to the pain experience of people watching their loved ones in pain. The experimental protocol was (1) baseline; (2) assessing pain VAS 50; (3) pre-CPT heat pain testing (thermode preimmersion at a fixed temperature); (4) CPT (either at 201Cor71C); and (5) post-CPT heat testing (thermode postimmersion at the same fixed temperature). What they did was ask the participants to submerge their right...
Source: HealthSkills Weblog - January 22, 2017 Category: Anesthesiology Authors: adiemusfree Tags: Coping strategies Pain Pain conditions Professional topics Resilience Science in practice catastrophising conditioned pain modulation empathy mindfulness observed pain Source Type: blogs
On the value of doing, being and becoming
An old occupational therapy tagline was “doing, being, becoming”. The meaning of this phrase is intended to point to the tight relationship between what we do, who we are, and how we develop and grow. As I read blogs discussing an increased emphasis on “real world” outcomes there is something missing from the narratives: that intangible quality that marks the difference between colouring in – and painting. Or filling in a form – and writing a poem. Going from room to room – and dancing. Something about expressing who we are and what we value.
Values are things we hold dear. They ar...
Source: HealthSkills Weblog - January 15, 2017 Category: Anesthesiology Authors: adiemusfree Tags: Health Resilience Wellness biopsychosocial Clinical reasoning Cognitive Behavioural Therapy Motivation Therapeutic approaches values Source Type: blogs
