Words are never enough – but does that stop us?
Pain may be said to follow pleasure as its shadow; but the misfortune is that in this particular case, the substance belongs to the shadow, the emptiness to its cause. CHARLES CALEB COLTON, Lacon
I can bear any pain as long as it has meaning. HARUKI MURAKAMI, 1Q84
But pain … seems to me an insufficient reason not to embrace life. Being dead is quite painless. Pain, like time, is going to come on regardless. Question is, what glorious moments can you win from life in addition to the pain? LOIS MCMASTER BUJOLD, Barrayer
Language is not just words, but what those words symbolise. We use movements of lips, tongue and t...
Source: HealthSkills Weblog - July 17, 2016 Category: Anesthesiology Authors: adiemusfree Tags: ACT - Acceptance & Commitment Therapy Clinical reasoning Education/CME Pain Professional topics Research biopsychosocial Health healthcare pain management Therapeutic approaches treatment Source Type: blogs
Words are never enough – but does that stop us?
Pain may be said to follow pleasure as its shadow; but the misfortune is that in this particular case, the substance belongs to the shadow, the emptiness to its cause. CHARLES CALEB COLTON, Lacon
I can bear any pain as long as it has meaning. HARUKI MURAKAMI, 1Q84
But pain … seems to me an insufficient reason not to embrace life. Being dead is quite painless. Pain, like time, is going to come on regardless. Question is, what glorious moments can you win from life in addition to the pain? LOIS MCMASTER BUJOLD, Barrayer
Language is not just words, but what those words symbolise. We use movements of lips, tongue and t...
Source: HealthSkills Weblog - July 17, 2016 Category: Anesthesiology Authors: adiemusfree Tags: ACT - Acceptance & Commitment Therapy Clinical reasoning Education/CME Pain Professional topics Research biopsychosocial Health healthcare pain management Therapeutic approaches treatment Source Type: blogs
Ambiguity and uncertainty
Humans vary in how comfortable we are with uncertainty or ambiguity: Tolerance of ambiguity is a construct discussed in cognitive and experimental research literature, and refers to the willingness to prefer black and white situations, where “there is an aversive reaction to ambiguous situations because the lack of information makes it difficult to assess risk and correctly make a decision. These situations are perceived as a threat and source of discomfort. Reactions to the perceived threat are stress, avoidance, delay, suppression, or denial” (Furnham & Marks, 2013, p. 718). Tolerance to uncertainty is ...
Source: HealthSkills Weblog - July 10, 2016 Category: Anesthesiology Authors: adiemusfree Tags: Assessment Clinical reasoning Coping strategies Pain Pain conditions Professional topics acceptance ambiguity healthcare pain management Research Therapeutic approaches treatment uncertainty Source Type: blogs
Values and why they matter in pain management
I’m away from my desk, visiting Auckland this week, so this post will not be in my usual format. Having time away allows me breathing space to think about things (even more than usual), and I’ve been thinking about values and their place in our lives.
We all have values, things we believe are important. Values underpin the decisions we make, our priorities, and even the way we interpret events that are usually considered value-free. Value judgements are part of being human, I think. They can be prosocial – or not.
When I looked up values, this definition appeared: the regard that something is held to dese...
Source: HealthSkills Weblog - July 3, 2016 Category: Anesthesiology Authors: adiemusfree Tags: ACT - Acceptance & Commitment Therapy Chronic pain Clinical reasoning Professional topics Uncategorized Source Type: blogs
Did it help? Questions and debate in pain measurement
Pain intensity, quality and location are three important domains to consider in pain measurement. And in our kete*of assessment tools we have many to choose from! A current debate (ongoing debate?) in the august pages of Pain (International Association for the Study of Pain) journal shows that the issue of how best to collate the various facets of our experience of pain is far from decided – or even understood.
The McGill Pain Questionnaire (MPQ) is one of the most venerable old measurement instruments in the pain world. It is designed to evaluate the qualities of pain – the “what does it feel like̶...
Source: HealthSkills Weblog - June 26, 2016 Category: Anesthesiology Authors: adiemusfree Tags: Assessment Coping strategies Pain Pain conditions Science in practice biopsychosocial Clinical reasoning Research values Source Type: blogs
What is our goal in pain management?
One of the cool things about having worked in chronic pain management since the mid-1980’s is that I’ve seen a few things come and a few things go. Some things remain, of course, and the things that seem most long-lived are debates about pain reduction vs living with pain. On one hand, there’s an enormous industry set up to help people reduce their pain experience through pharmacology, injection procedures, surgery, hands-on therapy, movement practice, and novel approaches like brain stimulation and even mirror therapy. On the other hand, there’s a smaller but equally well-established industry est...
Source: HealthSkills Weblog - June 19, 2016 Category: Anesthesiology Authors: adiemusfree Tags: ACT - Acceptance & Commitment Therapy Chronic pain Clinical reasoning Coping Skills Coping strategies Pain conditions Professional topics Research Resilience/Health pain management Therapeutic approaches treatment values Source Type: blogs
The positive power of what we say during treatment
Expectations form one of the important predictors of response to treatment, especially in the case of treatments for pain. A person’s belief or expectation that a treatment will reduce their pain is thought to be part of the response to placebo – and indeed, part of the response to almost any treatment. Much of the research into expectancies has been carried out in experimental models where healthy people are given a painful stimulus, then provided with some sort of treatment along with a verbal (or written) instruction that is thought to generate a positive belief in the effectiveness of that treatment. The ...
Source: HealthSkills Weblog - June 12, 2016 Category: Anesthesiology Authors: adiemusfree Tags: Coping strategies Pain Research Science in practice acute pain Chronic pain conditioning expectations mental imagery placebo procedures treatment verbal instruction Source Type: blogs
A new definition of pain
The IASP definition of pain has been revolutionary. It has helped shift the focus away from mechanisms involved in producing the experience we all know, towards defining the nature of that experience. The definition is relatively simple, easy to remember and contains several important qualitative definitions that are integral to the experience. For those of you who haven’t attended one of my classes, the definition is:
Pain
An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.
Note: The inability to communicate verbally does not negate ...
Source: HealthSkills Weblog - May 29, 2016 Category: Anesthesiology Authors: adiemusfree Tags: News Pain Pain conditions Professional topics biopsychosocial Clinical reasoning Health pain management Research Source Type: blogs
How do help someone change their beliefs about pain?
This post is my little attempt to educate clinicians! Some of you will know I really don’t like the term “pain education” or “educating” people. The reason doesn’t go back as far as the original definition of “educate” which is, according to the Online Etymology Dictionary “educate (v.) mid-15c., “bring up (children), to train,” from Latin educatus, past participle of educare “bring up, rear, educate” (source also of Italian educare, Spanish educar, French éduquer), which is a frequentative of or otherwise related to educere “bring out, le...
Source: HealthSkills Weblog - May 10, 2016 Category: Anesthesiology Authors: adiemusfree Tags: Chronic pain Clinical reasoning Coping strategies Professional topics biopsychosocial healthcare pain management Therapeutic approaches Source Type: blogs
Why does “ doing exercise ” work?
Bless all the physiotherapists in the world, they keep us doing exercises. And exercises are good because they get us doing the things we want to do in our daily lives. But how does it work? This is not an exposition on exercise physiology – I’m not au fait enough with physiology to do that and there are many other people out there with vast amounts of knowledge giving us the benefit of their wisdom who have written at length about exercise and why it’s important. Instead I want to talk about some observations – and maybe pose some critical questions too.
For many years I’ve worked in a chro...
Source: HealthSkills Weblog - May 1, 2016 Category: Anesthesiology Authors: adiemusfree Tags: 'Pacing' or Quota Assessment Chronic pain Clinical reasoning Coping Skills Coping strategies Low back pain Occupational therapy Pain conditions Physiotherapy Psychology Science in practice pain management Research Source Type: blogs
Why does “doing exercise” work?
Bless all the physiotherapists in the world, they keep us doing exercises. And exercises are good because they get us doing the things we want to do in our daily lives. But how does it work? This is not an exposition on exercise physiology – I’m not au fait enough with physiology to do that and there are many other people out there with vast amounts of knowledge giving us the benefit of their wisdom who have written at length about exercise and why it’s important. Instead I want to talk about some observations – and maybe pose some critical questions too.
For many years I’ve worked in a chro...
Source: HealthSkills Weblog - May 1, 2016 Category: Anesthesiology Authors: adiemusfree Tags: 'Pacing' or Quota Assessment Chronic pain Clinical reasoning Coping Skills Coping strategies Low back pain Occupational therapy Pain conditions Physiotherapy Psychology Science in practice pain management Research Source Type: blogs
Self-managing chronic pain
I have long been a proponent of helping people who live with pain to take control of their situation and actively self-manage as much as possible. My rationale has been that people who feel they are in control of some parts of their life are more likely to feel confident when their pain flares up, or when they have a life set-back. Today I took a second look at some of the papers on self-management published over the past few years, and I think it’s time to be a little critical.
The first issue to deal with is defining self-management. To me, self-management means knowing as much as possible about the health conditio...
Source: HealthSkills Weblog - April 24, 2016 Category: Anesthesiology Authors: adiemusfree Tags: Chronic pain Coping Skills Coping strategies Research disability Health pain management self management Source Type: blogs
Pain measurement: Measuring an experience is like holding water
Measurement in pain is complicated. Firstly it’s an experience, so inherently subjective – how do we measure “taste”, for example? Or “joy”? Secondly, there’s so much riding on its measurement: how much pain relief a person gets, whether a treatment has been successful, whether a person is thought sick enough to be excused from working, whether a person even gets treatment at all…
And even more than these, given it’s so important and we have to use surrogate ways to measure the unmeasurable, we have the language of assessment. In physiotherapy practice, what the person ...
Source: HealthSkills Weblog - April 17, 2016 Category: Anesthesiology Authors: adiemusfree Tags: Assessment Chronic pain Clinical reasoning Research Source Type: blogs
How does chronic pain management work? A self concept hypothesis
In my previous post looking at how chronic pain management works, I put forward the hypothesis that
“What DOES change is [people's] self efficacy or belief that they CAN do what’s important in their lives – by hook or by crook. And even more importantly, they have something to DO that’s important to them. Maybe something that hasn’t been studied in sufficient detail is what a person wants to be able to do, what’s their motivation, what are their valued occupations? That’s a hypothesis about therapeutic change I think we need to ponder.”
Later in the comments I mentioned the idea of renegotiating sel...
Source: HealthSkills Weblog - August 31, 2014 Category: Occupational Therapists Authors: adiemusfree Tags: Coping strategies Motivation Research Resilience/Health Return to Work biopsychosocial Chronic pain Clinical reasoning function pain management rehabilitation treatment Source Type: blogs
How does chronic pain management work? A hypothesis to ponder
There have been increasing calls for clinicians and researchers to move away from using grouped results from randomised controlled studies because these fail to distinguish between those people who do really well and those who do not. Eminent researchers like Amanda Williams, Chris Eccleston and Steven Morley have said it’s time to move away from “black box” RCTs in chronic pain, and begin to use more sophisticated methodologies to examine not only outcomes but processes during therapy (Williams, Eccleston & Morley, 2012). While early studies comparing CBT-approaches to chronic pain vs waiting list ...
Source: HealthSkills Weblog - August 24, 2014 Category: Occupational Therapists Authors: adiemusfree Tags: Cognitive behavioral therapy Coping strategies Research biopsychosocial Chronic pain Clinical reasoning Cognitive Behavioural Therapy pain management self management Therapeutic approaches Source Type: blogs
