Pain management and the political
There are only a few more weeks before a general election in New Zealand. This means the usual rounds of promises, muck-racking, hoardings and defaced hoardings. As I browse the research into chronic pain, and bemoan the lack of attention to the SOCIAL of the biopsychosocial model, I find myself looking at factors that almost entirely depend on a political solution. Let me explain.
Social. What is meant to fit into this part of Engel’s model? Drawing from one of his earlier works, Engel stated in his Cartwright Lecture at Columbia University College of Physicians and Surgeons (1977), that
“Health restored is no...
Source: HealthSkills Weblog - August 17, 2014 Category: Occupational Therapists Authors: adiemusfree Tags: Chronic pain Pain conditions Research Return to Work biopsychosocial disability Health healthcare pain management political Source Type: blogs
Should we take their word for it? Patient-reported vs observed functional outcomes
Pain is a subjective experience. There’s no direct means to measure what it is like to be in pain. Disability, or the impact of pain on what we do in daily life is, on the other hand, able to be observed as well as reported on by people with pain. A question that has always fascinated me is the relationship between what an individual says they can or can’t do, versus what they can be observed to do.
One of the more common ways to determine disability by observation is the “functional capacity evaluation” – and readers of my blog will know that I’m not especially fond of them when they...
Source: HealthSkills Weblog - August 10, 2014 Category: Occupational Therapists Authors: adiemusfree Tags: Assessment Coping strategies Groupwork Interdisciplinary teams Occupational therapy Pain conditions Professional topics Chronic pain Clinical reasoning function pain management Research Source Type: blogs
Pacing – Activity management concepts (a longer than usual post)
This study used actigraphy to monitor movements, and correlated this data with self-reported pain and fatigue. This study found that “high pacers” had more severe, escalating symptoms, and activity pacing was related to lower physical activity. Karsdorp & Vlaeyen (2009) found that activity avoidance but not activity pacing was associated with disability, and challenged the notion that pacing as an intervention is essential in pain management. van Huet, Innes, & Whiteford (2009) on the other hand, found that “graduates” from a pain management programme continued to use pacing strategies...
Source: HealthSkills Weblog - August 3, 2014 Category: Occupational Therapists Authors: adiemusfree Tags: 'Pacing' or Quota Chronic pain Clinical reasoning Coping strategies Pain conditions Research activity disability pain management Therapeutic approaches Source Type: blogs
Coalface conversations
Knowing about something doesn’t hit the heart or mind nearly as well as doing it. As regular readers of my blog will know, I teach various aspects of pain management to postgraduate health professionals who come from a wide range of disciplines. Hopefully I can guide people towards thinking about the range of factors that can influence what goes on between delivering a treatment and the eventual outcome. It’s difficult, though, because much of what I need to do is based on giving access to information rather than opportunities to practice and then integrate this material.
I thought about this the other day when...
Source: HealthSkills Weblog - July 27, 2014 Category: Occupational Therapists Authors: adiemusfree Tags: Back pain Clinical reasoning Cognitive behavioral therapy Coping strategies Pain conditions biopsychosocial Chronic pain Cognitive Behavioural Therapy pain management Therapeutic approaches Source Type: blogs
Better ways to meet the needs of people with chronic pain
In this study, participants were randomised into two groups – one group received usual care, while the other received automated symptom monitoring via voice-recorded phone calls or the internet, along with one face-to-face meeting with a nurse care management, who discussed medications with a pain physician, followed by a phone call to discuss the care plan, and two other calls, one at one month and one at three months. Additional calls were provided on the basis of symptom records. Patients in the intervention group benefited, with reduced scores on pain severity and interference as recorded by the Brief Pain Inve...
Source: HealthSkills Weblog - July 20, 2014 Category: Occupational Therapists Authors: adiemusfree Tags: Chronic pain Groupwork Pain conditions Research function healthcare Occupational therapy pain management physiotherapy self management Source Type: blogs
How much attention to psychosocial issues?
I’ve been asked, from time to time, to give some sort of screening questions or questionnaires that medical practitioners can use in their practice, so that I can avoid covering so much psychosocial material, especially in my teaching job. I’ve struggled with this for many reasons, and have had a hard time pinning down why I’m not all that keen to do it. Now I don’t want to stop medical practitioners from considering psychosocial factors when they’re assessing pain, far from it – quite the opposite in fact! But at the same time I worry about developing a “Dummies Guide”.
Psyc...
Source: HealthSkills Weblog - July 13, 2014 Category: Occupational Therapists Authors: adiemusfree Tags: Pain conditions Professional topics biopsychosocial Chronic pain Clinical reasoning healthcare pain management Source Type: blogs
An apology to the Australasian Faculty of Musculoskeletal Medicine
Some months ago I wrote a blog post about fibromyalgia, and mentioned that a group of clinicians seem to believe that psychosocial issues are not important when nociception can be abolished. A commentator took issue with my comment, and I very quickly amended the post. You can read the amended version here.
I also offered an invitation to the people who were offended by my statement that : if you’re able to demonstrate HOW you integrate biopsychosocial approaches in your practice, I’ll publish it.
Today, however, I found out that the AFMM has written to the University and wishes me to be censured, and that I s...
Source: HealthSkills Weblog - July 9, 2014 Category: Occupational Therapists Authors: adiemusfree Tags: News Professional topics AFMM apology Australasian Faculty of Musculoskeletal Medicine biopsychosocial dialogue discussion Source Type: blogs
Complex regional pain syndrome: yes, it’s complex
Complex regional pain sydrome or “CRPS” (pronounced CRIPS) is an enigma. It’s complex. It involves different body systems. It’s very, very painful, and it can be incredibly disabling. It has had lots of different names over the years – in 1982 when I trained it was called “causalgia” or “Sudeck’s atrophy”, but in 1993 the International Association for the Study of Pain developed guidelines for diagnosing and managing this complex pain problem.
Since then we’ve heard a lot about CRPS, at least those of us working in the pain management field have. I am not so...
Source: HealthSkills Weblog - July 6, 2014 Category: Occupational Therapists Authors: adiemusfree Tags: Chronic pain Pain conditions Research pain management Source Type: blogs
Managing pain is an experiment
I’ve been thinking a lot about clinical reasoning recently. There’s been a lot written about clinical reasoning, but not as often applied to pain management, which is a shame. One definition of clinical reasoning is that it is a “complex process that uses cognition, metacognition, and discipline-specific knowledge to gather and analyse patient information, evaluate its significance, and weigh alternative actions” (Simmons, 2009). It’s often used synonymously with with decision-making and clinical judgment. It’s not diagnosis alone, although it includes diagnostic reasoning, and it ...
Source: HealthSkills Weblog - June 29, 2014 Category: Occupational Therapists Authors: adiemusfree Tags: Clinical reasoning Professional topics Chronic pain healthcare pain management Source Type: blogs
Healing the ache within the pain.
Filed under: Uncategorized (Source: HealthSkills Weblog)
Source: HealthSkills Weblog - June 23, 2014 Category: Occupational Therapists Authors: adiemusfree Tags: Uncategorized Source Type: blogs
Gaps, and answering gritty questions
Research journals are full of really interesting studies, but some of the studies I’ve been reading lately seem to lack something. While they’re interesting, they don’t seem to approach some of the gritty questions clinicians need answers to. There are enormous gaps in our understanding of processes of healthcare delivery.
I like to get practical when I want to ponder things. I’ll weed the garden, prune the roses, take some photographs, and recently I’ve even taken to getting out in the garage to carve and sand wood, rip pallets apart – and while I do, I let my mind wander over things th...
Source: HealthSkills Weblog - June 23, 2014 Category: Occupational Therapists Authors: adiemusfree Tags: Chronic pain Clinical reasoning Research biopsychosocial Source Type: blogs
