A new year
So 2016 is over, and 2017 is here. As usual, I find the new year to be a time for reflecting on what is important in life, and what I’d like to see more of this year. Usually I’ll want more balance. More space between frantic activity. Maybe even less frantic activity! And I pretty much always want to learn something new. But this year I want to be a bit different. Yes I’ve been thinking about what’s important, and yes I want more balance, but this year I want to work on a new project as part of this blog.
I’ve been writing for so many years, and one of my main reasons for doing so is to bridg...
Source: HealthSkills Weblog - January 8, 2017 Category: Anesthesiology Authors: adiemusfree Tags: Uncategorized biopsychosocial Chronic pain Therapeutic approaches Source Type: blogs
End-of-year musings
It’s my last post for the year. It has been an extraordinary year, lots of surprises, shocks and enough excitement for anyone! I’m not even going to start on the political changes, here in NZ we’ve had yet another major earthquake, excitement as ACC (our national accident insurer) sets up new pain service contracts (with a LOT of people who haven’t been involved in pain management before… there’s an experiment in the making!), and continuing road cone carnage on the streets of Christchurch.
On the pain news front, I can’t think of any incredibly ground-breaking news – althoug...
Source: HealthSkills Weblog - December 18, 2016 Category: Anesthesiology Authors: adiemusfree Tags: Clinical reasoning Occupational therapy Resilience/Health Science in practice biopsychosocial disability Pain pain management Therapeutic approaches treatment values Source Type: blogs
What do we do with those questionnaires (ii)
In my last post I wrote about the Pain Catastrophising Scale and a little about what the results might mean. I discussed the overall score suggesting a general tendency to “think the worst”, with the three subscales of magnifying or over-estimating the risk; ruminating or brooding on the experience; and helplessness or feeling overwhelmed and that there’s nothing to be done. At the end of the post I briefly talked about how difficult it is to find a clinical reasoning model in physiotherapy or occupational therapy where this construct is integrated – making it difficult for us to know what to do d...
Source: HealthSkills Weblog - November 28, 2016 Category: Anesthesiology Authors: adiemusfree Tags: Assessment Chronic pain Clinical reasoning Low back pain Occupational therapy Physiotherapy biopsychosocial pain management Psychology Therapeutic approaches treatment Source Type: blogs
What do we do with those questionnaires?
Courtesy of many influences in pain management practice, you’d have to have been hiding under a rock or maybe be some sort of dinosaur not to have noticed the increasing emphasis on using questionnaires to measure factors such as pain catastrophising, depression or avoidance. The problem is I’m not sure we’ve all been certain about what to do with the results. It’s not uncommon for me to hear people saying “Oh but once I see psychosocial factors there, I just refer on”, or “they’re useful when the person’s not responding to my treatment, but otherwise…”, ...
Source: HealthSkills Weblog - November 20, 2016 Category: Anesthesiology Authors: adiemusfree Tags: Assessment Chronic pain Clinical reasoning Coping strategies Occupational therapy Physiotherapy Psychology Science in practice biopsychosocial goal-setting healthcare pain management Therapeutic approaches treatment Source Type: blogs
Ups and downs and rocking and rolling
What a week it has been! Not only an unexpected result in the US elections, but also a very large earthquake north of Christchurch, along with a tsunami alert for the entire eastern coastline of New Zealand. Luckily I live far enough away from the shoreline that I didn’t have to evacuate, but the sirens certainly work!
As a result of these events, which I firmly believe are NOT associated except in time, the post I was going to make seems a bit redundant, so I’m going to talk about resilience and what it really means.
For someone who has lived through thousands of earthquakes since September 2010, resilience is...
Source: HealthSkills Weblog - November 13, 2016 Category: Anesthesiology Authors: adiemusfree Tags: ACT - Acceptance & Commitment Therapy Chronic pain Coping Skills Resilience Resilience/Health Therapeutic approaches values Source Type: blogs
Of cabbages and kings …
Well, cabbages for knee osteoarthritis, anyway! In this interesting study, three approaches to managing knee pain from moderate osteoarthritis were put to the test. To be truthful, actually only two active treatments were compared – the third was “usual care”.
In a carefully conducted trial, where participants were randomly allocated to one of three groups, and the study organiser remained blinded to which group people were allocated, topical diclofenac gel, usual care or a cabbage leaf compress were applied over the course of four weeks. Key outcomes were pain intensity and scores on the WOMAC, a commo...
Source: HealthSkills Weblog - October 16, 2016 Category: Anesthesiology Authors: adiemusfree Tags: Chronic pain Coping strategies Resilience/Health biopsychosocial cabbage leaf wrap knee oa knee pain natural remedy osteoarthrits Source Type: blogs
Clinical reasoning “ think aloud ”
Occupational therapists are keen on helping people return to doing the things they value – meaningful activity, or participating in valued occupations (same thing, essentially). So, a person might come to see me because they have low back pain and want to work out how to get to work.
My first step is to understand what it is about the back pain that seems to be stopping the person from doing the tasks involved in their work. I usually begin by taking a history – what does the person understand about how their back pain came on, what’s their theory as to why it’s there, what have they done to help th...
Source: HealthSkills Weblog - October 9, 2016 Category: Anesthesiology Authors: adiemusfree Tags: ACT - Acceptance & Commitment Therapy Assessment Back pain Clinical reasoning Low back pain Occupational therapy Pain conditions Professional topics Psychology Research Science in practice biopsychosocial Chronic pain pain manage Source Type: blogs
Making sense of pain
Humans have an incredible desire for things to make sense. We want things to fit a story or what’s expected – and we get right discombobulated (it’s a word) if we encounter a situation where things don’t make sense. To a certain extent we can blame our use of language for this, because it’s the way we’ve learned to pair words with concepts, and to associate multiple concepts together. For example, we learn “ouch” is associated with that unpleasant sensory and emotional experience that we’ve learned goes along with scrapes or bumps or cuts. We’ve also learned that ...
Source: HealthSkills Weblog - October 3, 2016 Category: Anesthesiology Authors: adiemusfree Tags: ACT - Acceptance & Commitment Therapy Chronic pain Clinical reasoning Coping strategies Pain conditions Resilience/Health concepts flexibility language Source Type: blogs
“ I know my pain doesn ’ t mean I ’ m damaging myself – but I still have pain ”
In the excitement of helping people understand more about pain neuroscience, which I truly do support, I think it’s useful to reflect a little on the history of this approach, and how it can influence the experience people have of their pain.
If we go right back to the origins of pain self management, in the groovy 1960’s and 1970’s – the first truly significant work in chronic pain self management came from Wilbert Fordyce (Fordyce, Fowler & Delateur, 1968). Bill Fordyce was a clinical psychologist working in the Department of Physical Medicine and Rehabilitation, University of Washington, Seat...
Source: HealthSkills Weblog - September 25, 2016 Category: Anesthesiology Authors: adiemusfree Tags: Chronic pain Clinical reasoning Education/CME Pain conditions Science in practice acceptance biopsychosocial healthcare pain management Research Therapeutic approaches Source Type: blogs
Guide, don ’ t instruct: how we talk within sessions
Do you remember your favourite teacher in school? Mine was Mrs Jackson, teacher of my Form 2 class (I think I was 12 years old). She was an outstanding teacher because she expected that we’d do well. She also didn’t tell us what to do – she helped us explore. And if there was one thing I’d like to have happen in therapy sessions with clients, it would be that we learn how to guide instead of instructing.
It’s only recently that I’ve learned why guiding and facilitating is so much more helpful than telling or instructing, and yes it’s because I’ve been reading Villatte, Villat...
Source: HealthSkills Weblog - September 18, 2016 Category: Anesthesiology Authors: adiemusfree Tags: ACT - Acceptance & Commitment Therapy Clinical reasoning Coping strategies Pain Pain conditions Professional topics Resilience/Health Science in practice acceptance and commitment therapy function physiotherapy treatment Source Type: blogs
Dealing with distress
From time to time anyone who works with people trying to help them make changes in their lives will encounter someone who is overwhelmed, distressed and generally not willing to (or able to) take even a tiny step forward. It’s hard for us as therapists because, after all, we want to help people – but hey! This person in front of us just isn’t up to it!
I think many of us who weren’t trained in psychology can find it really hard to know what to do, and like all humans, we deal with feeling helpless by hoping to avoid it.
Some of us will tell people what to do – this is the way most of us were t...
Source: HealthSkills Weblog - September 11, 2016 Category: Anesthesiology Authors: adiemusfree Tags: Chronic pain ACT - Acceptance & Commitment Therapy Coping strategies Professional topics Resilience/Health Science in practice healthcare motivational interviewing Therapeutic approaches biopsychosocial pain management mindfulness Source Type: blogs
Flexibility: not just movement variability
For many therapists, learning the Right Way to treat a person experiencing pain means following rules. Observe this, identify that, follow the yellow brick road and end up with the right result. The problem is that people don’t always respond in the way the rules suggest meaning both clinician and patient can be confused about what to do next. While it’s normal to generate clinical heuristics, or rules of thumb, these can limit the way we approach helping someone.
I’ve been pondering this as I’m reading Villatte, Viullatte and Hayes Mastering the clinical conversation: Language as intervention. I po...
Source: HealthSkills Weblog - September 4, 2016 Category: Anesthesiology Authors: adiemusfree Tags: ACT - Acceptance & Commitment Therapy Clinical reasoning Coping strategies Pain Professional topics Science in practice flexibility Health healthcare Research Therapeutic approaches Source Type: blogs
Being flexible – and how language can make you inflexible
One of the reasons humans seem to dominate our natural world is our flexibility. We don’t have the best eyesight, hearing, strength, speed, stamina or indeed any single attribute that means we’re King (or Queen) of the Jungle, but what we do have is the ability to adapt our environment to maximise the benefits to ourselves. Being flexible means we can find many different ways to achieve a certain goal. It means we don’t get stuck using the same solution when that solution doesn’t work. We try lots of different ways to achieve what we want.
Or are we?
There are plenty of times when I’ve had to...
Source: HealthSkills Weblog - July 31, 2016 Category: Anesthesiology Authors: adiemusfree Tags: Clinical reasoning Psychology ACT - Acceptance & Commitment Therapy Pain conditions Professional topics Health Chronic pain Therapeutic approaches theory Source Type: blogs
Pacing: why do people use it?
Do you recommend pacing as a strategy for your clients/patients? If so, would you please consider taking part in a survey I’m conducting, looking at health professional’s beliefs about the underlying motivations for using pacing. The findings from this study will inform a future study in which I will explore the daily use of pacing as a strategy by people who live with chronic pain. The usual ethical consents have been granted, and your involvement is entirely voluntary, confidential, and anonymous.
I’m looking for health professionals from any discipline, but only if you personally recommend pacing to yo...
Source: HealthSkills Weblog - July 26, 2016 Category: Anesthesiology Authors: adiemusfree Tags: Uncategorized Source Type: blogs
Getting stuck with language
In my last post I talked about the ways in which humans learn to relate abstract concepts and experiences together (symbolic relations). I pointed out that we learn to take another person’s point of view as part of developing empathy, and that by interacting with our world we become aware of our place (here) and someone or something else’s place (there). We also learn “me” and “you” (not me), along with near and far, now and then and myriad other abstract concepts that our language can allow us to understand. I suggested that the flexibility of symbolic relations and the relational frami...
Source: HealthSkills Weblog - July 24, 2016 Category: Anesthesiology Authors: adiemusfree Tags: ACT - Acceptance & Commitment Therapy Coping strategies Pain Pain conditions Professional topics Research Resilience/Health Science in practice biopsychosocial Chronic pain Clinical reasoning Therapeutic approaches Source Type: blogs
