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 i...
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 l...
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

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 18, 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&rs...
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 p...
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 28, 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 ...
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 wi...
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 reason...
Source: HealthSkills Weblog - June 30, 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 24, 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

Interrupted by Pain
If there’s one thing I loathe, it’s being interrupted when I’m in the middle of something. There I am, working away at something, in the flow, knowing where I’m going and what I’m doing then BANG! something gets in the way! I wasn’t aware, but there is a science of interruptions – mainly studied within ergonomics or human factors research (the study of work and humans) – and this science has begun to unravel some of the issues associated with interruptions. Interruptions are not only annoying, they’re also a good way to provoke mistakes! Pain is, as Geert Crombez and ot...
Source: HealthSkills Weblog - June 16, 2014 Category: Occupational Therapists Authors: adiemusfree Tags: 'Pacing' or Quota Cognitive skills Coping strategies Pain conditions Research attention Chronic pain memory mindfulness Occupational therapy pain management Source Type: blogs

Infographic on fibromyalgia
Source: MBA-Healthcare-Management.comFiled under: Pain conditions Tagged: fibromyalgia (Source: HealthSkills Weblog)
Source: HealthSkills Weblog - June 13, 2014 Category: Occupational Therapists Authors: adiemusfree Tags: Pain conditions fibromyalgia Source Type: blogs

Non-drug approaches for people with fibromyalgia
No-one wants to be told their pain is “in your head”. But given our increasingly sophisticated understanding of pain neurobiology, there’s plenty of reason to agree that thinking, feeling and doing things differently makes life far more rewarding and rich than feeling helpless, fatigued and sore. Some proponents of purely biomedical interventions, notably musculoskeletal physicians, argue that if only the “source of the nociception” was found, the nerve “zapped” or anaesthetised, then all this psychosocial claptrap could be safely ignored. I think this belief shows ignorance and pe...
Source: HealthSkills Weblog - March 23, 2014 Category: Occupational Therapists Authors: adiemusfree Tags: Coping strategies Pain Pain conditions Research Therapeutic approaches biopsychosocial CBT Chronic pain Cognitive Behavioural Therapy fibromyalgia pain management Source Type: blogs

Individualising explanations with case formulation
One of the assumptions of a multidimensional model of pain, particularly chronic pain, is that somehow all the various elements get pulled together to explain why this person is presenting in this way at this time. It’s also one of the least-discussed aspects of pain management: case formulation. Case formulation is the process of generating a set of hypotheses to explain what is going on when a person has chronic pain. It needs to reflect what is known about biological mechanisms, including comorbidities; psychological aspects such as beliefs, attitudes, expectations, pre-existing strengths and capabilities; and soc...
Source: HealthSkills Weblog - March 16, 2014 Category: Occupational Therapists Authors: adiemusfree Tags: Chronic pain Clinical reasoning Pain conditions Professional topics Assessment biopsychosocial function healthcare rehabilitation Therapeutic approaches treatment Source Type: blogs

How well do people understand their neuropathic pain?
In this study, 75 people with neuropathic pain were asked to sort a series of statements about neuropathic pain according to their level of agreement with them. This is known as Q-methodology. The sorted statements are then analysed to identify common features amongst them. Four factors were identified: Neuropathic pain is a nervous system problem, psychology influences the pain experience and acceptance, and being open to psychological interventions – this group of respondents had tried psychological treatments, their pain was on average about 6 – 7 years. Neuropathic pain is nerve damage, psychology is irrel...
Source: HealthSkills Weblog - March 10, 2014 Category: Occupational Therapists Authors: adiemusfree Tags: Cognitive skills Coping strategies Pain Pain conditions Research biopsychosocial CBT Chronic pain Education healthcare neuropathic pain Source Type: blogs

When chronic pain is there before surgery
In this study, therefore, the researchers monitored the use of opioids pre and post-operatively. After some serious statistical work, the group found that younger people, anaesthetic technique, having a total knee replacement (as opposed to a total hip replacement), and longer stays were more likely to use a greater amount of opioid. And, more importantly, the scores obtained for fibromyalgia corresponded the most – an increased opioid consumption of 9.1mg for every 1-point increase on the 0 – 31 point scale. What does this mean for nonmedical clinicians working with people in that important post-operative per...
Source: HealthSkills Weblog - March 2, 2014 Category: Occupational Therapists Authors: adiemusfree Tags: Coping strategies Occupational therapy Pain Pain conditions Physiotherapy Chronic pain function pain management self management surgery surgical pain THKR total knee joint replacement Source Type: blogs

Don’t worry, be happy: Could optimism counteract negative effects of pain?
Warning: there is an earworm contained in this post! How on earth could anyone be happy when they have pain, huh? Well, more about that in a minute, first let’s look at this interesting study from Maastricht University by Jantine Boselie, Linda Vancleef, Tom Smeets and Madelon Peters. We know that having chronic pain reduces a person’s ability to undertake complex cognitive tasks, particularly those that involve making decisions or problem solving. People become overwhelmed, fatigued and then perform poorly when they need to maintain concentration when they’re experiencing pain, and researchers have foun...
Source: HealthSkills Weblog - February 23, 2014 Category: Occupational Therapists Authors: adiemusfree Tags: Coping strategies Pain Pain conditions Research Resilience Health Source Type: blogs

An acerbic opinion versus a sweet solution towards chronic pain
CONCLUSION: Glucose sublingual is and effective analgesic in infants between 1 and 12 months of age Barry E. Levin,1,2 Vanessa H. Routh,3 Ling Kang,2 Nicole M. Sanders,4 and Ambrose A. Dunn-Meynell1,2. Neuronal Glucosensing. What Do We Know After 50 Years? DIABETES, VOL. 53, OCTOBER 2004 Min-tsai Liu1, 2, Susumu Seino3, and Annette L. Kirchgessner1, 2 Identification and Characterization of Glucoresponsive Neurons in the Enteric Nervous System. The Journal of Neuroscience, December 1, 1999, 19(23):10305-10317 J. Antonio Gonzàlez1, Frank Reimann2 and Denis Burdakov1.Dissociation between sensing and metabolism of gluco...
Source: HealthSkills Weblog - February 17, 2014 Category: Occupational Therapists Authors: adiemusfree Tags: Pain conditions Professional topics Therapeutic approaches Chronic pain healthcare Source Type: blogs

Teams, roles, and contributions
I’m quite keen to generate some more discussion about how individual professions can contribute within Interdisciplinary/Interprofessional Team without being defensive of their contribution, nor allowing other disciplines to encroach on their specialist skills. I really struggle with the whole concept of “role definition” because so often I see “the OT role is…” without considering that there are a number of core areas many health professionals in pain management use such as goal setting, relaxation, pain “education”, activity pacing/management, relaxation, biofeedback, cogn...
Source: HealthSkills Weblog - February 5, 2014 Category: Occupational Therapists Authors: adiemusfree Tags: Interdisciplinary teams Professional topics Uncategorized Chronic pain chronic pain management healthcare occupational therapist Source Type: blogs

Interdisciplinary? Or serial monotherapy?
This report, somewhat old now but still relevant, found that IDTs are better for mental health of members and there is lower staff turnover.  This report, from 2013, finds that the data are not yet clear about cost effectiveness. What seems evident is that the more complex a patient’s problems, and the more chronic, the greater the need for interdisciplinary teams, and the more cost effective the outcomes. For more information on interdisciplinary teams – the District of Columbia Area Health Education Center has an excellent module on IDT Open access to the Canadian Pharmacists Review article on interdisc...
Source: HealthSkills Weblog - February 2, 2014 Category: Occupational Therapists Authors: adiemusfree Tags: Interdisciplinary teams Professional topics Research Chronic pain healthcare pain management teamwork Source Type: blogs

Research opportunity!
This study has been approved by the Department of Orthopaedic Surgery & Musculoskeletal Medicine, University of Otago, Christchurch. If you have any concerns about the ethical conduct of the research you may contact the University of Otago Human Ethics Committee through the Human Ethics Committee Administrator (Ph 64 3 479 8256). Any issues you raise will be treated in confidence and investigated and you will be informed of the outcome. Filed under: Professional topics, Research Tagged: Chronic pain, health professional, Pain, spirituality (Source: HealthSkills Weblog)
Source: HealthSkills Weblog - January 27, 2014 Category: Occupational Therapists Authors: adiemusfree Tags: Professional topics Research Chronic pain health professional spirituality Source Type: blogs

Sugar-coated nerves: the pseudo-science of neural prolotherapy
Conclusion The question as to the efficacy of Neural Prolotherapy, as practiced and taught around the world by Dr Lyftogt, is outside the scope of this article. There are no published trials upon which to base any firm conclusions.   Anecdotally, there may be face validity for this treatment but to date there has been no discussion of placebo effect, observer bias, expectation bias, reversion to the mean of the conditions being treated etc.   But what is abundantly clear is that published animal experimental research by leading neurobiologists Professor Douglas Zochodne and Associate-Professor Geoffrey Bove does ...
Source: HealthSkills Weblog - January 26, 2014 Category: Occupational Therapists Authors: adiemusfree Tags: Education/CME Professional topics Chronic pain medical procedures musculoskeletal prolotherapy Source Type: blogs

Worrying about health
You may wonder why I’m writing about health anxiety: how does this fit with pain management? Read on – the connection is pretty clear. Health anxiety (or hypochondriasis) is thought to be fairly common in the community, maybe 5% lifetime prevalence. It involves being extraordinarily worried about the meaning of body symptoms, over-interpreting the significance of ambiguous body sensations.  As you can probably imagine, people who experience health anxiety turn up in many different guises in the health system. It’s distressing to the person, not just because they’re afraid they have some dire di...
Source: HealthSkills Weblog - January 19, 2014 Category: Occupational Therapists Authors: adiemusfree Tags: Cognitive behavioral therapy Pain conditions Research CBT healthcare Source Type: blogs

The unmentionable pain down there
Chronic pain isn’t a popular topic in health, or even socially. Chronic pain “down there” (yes, I’m talking genitals and in both women AND men) must be the least popular topic in pain management. I think it might be a throwback to the Victorian past, or maybe that pelvic pain isn’t usually a compensable pain so it doesn’t get blamed for work loss, but whatever, it’s just not featured all that often in pain management. Courtesy of my wonderful friend Sandy Hilton from Entropy Physio Therapy I’ve been prodded into looking at this problem, and came across a preprint of the Briti...
Source: HealthSkills Weblog - January 12, 2014 Category: Occupational Therapists Authors: adiemusfree Tags: Chronic pain Clinical reasoning Interdisciplinary teams Pain conditions healthcare pelvic pain physiotherapy Source Type: blogs

Coping: neither good, nor bad, but “it depends”
Coping is a concept we often use in chronic pain management. Our aim as clinicians is to help people with chronic pain cope with their pain so they can do more of what is important to them. Most of us know that coping mediates between the individual and whatever challenge he or she is facing. Coping reduces the impact of the challenge. Most of us also know that there are a range of coping strategies that people can use – and most of us have learned that coping strategies can be “adaptive” or “maladaptive”, “active” or “passive”, “approach” or “avoidant...
Source: HealthSkills Weblog - January 6, 2014 Category: Occupational Therapists Authors: adiemusfree Tags: Chronic pain Clinical reasoning Coping strategies Research disability pain management Source Type: blogs