How much “ pain ed ” do people need? And what to do when someone is not convinced …
This post has been a long time coming. There’s no doubt that giving explanations about pain mechanisms is common, and that we’ve (health professionals) been doing it a looooong time. Yes, way back to the 1970’s! In the early 1980’s when I started working in this field it was already commonplace to offer people an explanation for chronic pain (and to explain why some pains are such pains, while others bother us less – even when they involve the same degree of nociceptive input). Of course, way back then we used Gate Control Theory (GCT) to explain the distinction between hurt and harm, to explo...
Source: HealthSkills Weblog - November 27, 2022 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Chronic pain Clinical reasoning Education/CME Research Science in practice biopsychosocial Explain pain pain explanations PNE Therapeutic approaches Source Type: blogs
Frustration in the clinic
I’m prompted to write this post because it’s something I see in social media so often – a clinician gets frustrated. Things don’t work. The person getting treatment doesn’t respond in the way that was expected. The person doesn’t look like what the clinician usually sees. The evidence doesn’t fit with practice. All the things! So I thought today I’d write about emotions and thoughts that might turn up – and what might underlie those feelings. (For people living with pain – we also have frustration in the clinic. Things don’t work out. The therapist isn’...
Source: HealthSkills Weblog - November 20, 2022 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Clinical reasoning Coping Skills Pain Professional topics Research Resilience Science in practice biopsychosocial Health healthcare pain management Therapeutic approaches Source Type: blogs
What do occupational therapists add to pain management/rehabilitation?
Coming from a small profession that has side-stepped (more or less) a conventional biomedical model, I’ve found my inclusion in pain management and rehabilitation is not always easily understood by other clinicians. It doesn’t help that occupational therapists practice in very diverse settings, and what we do may look superficially like handing out raised toilet seats, playing with kids, doing work-site assessments or hand therapy!
Today I hope to remedy this a bit, and extend a challenge to clinicians from other professions to sum up what your profession adds in 25 words or less (the first sentence in this...
Source: HealthSkills Weblog - October 16, 2022 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Chronic pain Interdisciplinary teams Occupational therapy Professional topics Therapeutic approaches Source Type: blogs
Making sense: Does it help people with pain?
I love it when my biases are challenged (seriously, I do!). And in the study I’m talking about today, my biases are sorely challenged – but perhaps not as much as I initially thought.
Lance McCracken is one of my favourite researchers investigating processes of acceptance and living a good life in the presence of chronic pain. In this paper, he collaborates with a colleague currently involved in the INPUT pain management programme established at Guy’s and St Thomas’ NHS originally by Michael Nicholas who draws on a CBT model of pain management, and now more firmly in the third wave camp of ACT (A...
Source: HealthSkills Weblog - October 2, 2022 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: ACT - Acceptance & Commitment Therapy Assessment Chronic pain Coping strategies Pain conditions Research Science in practice coherence inflexibility measurement pain management Source Type: blogs
Ways to stop good clinicians leaving pain management (iii)
I’m an old hack when it comes to teamwork and pain management: I’ve worked in this field a long time. I’m familiar with reactions to both interpersonal differences within a team (and the myriad ways these can be expressed), and to the discourse that happens when posting a publicly available message. In fact, that’s why I publish on social media: so we can have open conversations rather than ones hidden behind paywalls, or in rarified academic settings. Humans are odd, and when poked – even when poked with good evidence – want to react, to bite back. The following comments are not about any specific organisation...
Source: HealthSkills Weblog - September 19, 2022 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Chronic pain Clinical reasoning Interdisciplinary teams Occupational therapy Physiotherapy Professional topics Psychology Research Science in practice conflict healthcare teamwork Source Type: blogs
“ The social ” – a brief look at family
Our most important relationships, the ones we learn most from, probably occur in families (Bowlby, 1978). As kids, even before we begin to speak, we observe our family members – and there’s reasonable evidence showing that how well these early relationships develop influences our experience of pain and how we express it.
I had the occasion to read a little about adolescent and children’s pain, and the influence of parents on young people as they grow up. There’s a great deal of research interest in children’s pain because children with persistent pain grow up to be adults – usually al...
Source: HealthSkills Weblog - September 11, 2022 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Assessment Back pain Chronic pain Low back pain Research Science in practice adolescents biopsychosocial family pain management partners spouse Source Type: blogs
Ways to stop good clinicians leaving pain management (ii)
Last week I started a series of posts on how we can stop good clinicians leaving pain management. I began with funding because, at least in New Zealand, lack of funding is a significant part of the problem of staff retention.
Now I want to look at how we prepare clinicians to work in pain management.
One of the major barriers in New Zealand is the dominance of musculoskeletal rehabilitation in physiotherapy clinics around the country. How could direct access to musculoskeletal rehabilitation be a bad thing, you ask? Well, it’s mainly because pain management is not musculoskeletal rehabilitation – and yet...
Source: HealthSkills Weblog - August 7, 2022 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Chronic pain Clinical reasoning Interdisciplinary teams Occupational therapy Pain conditions Physiotherapy Professional topics Psychology Science in practice Health healthcare pain management Source Type: blogs
Ways to stop good clinicians leaving pain management (i)
After the heartbreaking post last week that seemed to resonate with so many around the world, I thought I’d look at what we can do to stop good clinicians leaving pain management.
While our jurisdictions have differences in pay rates, reimbursement approaches and treatment codes, at the heart of good healthcare is good people who want to help. So why, when healthcare is populated with caring clinicians, do we strike bullying, lack of support for one another, non-existent teamwork, and poor career pathways? What is going on?
I’ll tackle these in bite-sized chunks, starting with the funders. And of course, ...
Source: HealthSkills Weblog - July 31, 2022 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Chronic pain Interdisciplinary teams Professional topics Science in practice Clinical reasoning Health healthcare Therapeutic approaches Source Type: blogs
Why healthcare keeps losing good clinicians (or, why I walked away for a second time)
Guest post written by a wonderful PT who has walked away from the profession.
Why healthcare keeps losing good clinicians (or, why I walked away for a second time)
Firstly, I don’t know if the above statement is true. I just know a lot of good people who’ve left healthcare, across many different professions. And I highly recommend reading “This is going to Hurt” by Adam Kay, or if you don’t have the attention span, it’s now a TV series in 25 minute bites.
Last week I resigned from my position as a Physiotherapist and Keyworker, working for a supplier on the ACC pain contract and other physical injury c...
Source: HealthSkills Weblog - July 24, 2022 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Chronic pain Pain conditions Physiotherapy Professional topics Resilience/Health healthcare pain management Source Type: blogs
Biopsychological pain management is not enough
I recently read a preprint of an editorial for Pain, the IASP journal. It was written by Prof Michael Nicholas, and the title reads “The biopsychosocial model of pain 40 years on: time for a reappraisal?” The paper outlines when and how pain became conceptualised within a biopsychosocial framework by the pioneers of interprofessional pain management: John Loeser (1982) and Gordon Waddell (1984). Nicholas points out the arguments against a biopsychosocial model with some people considering that despite it being a “holistic” framework, it often gets applied in a biomedical and psychological way. In ot...
Source: HealthSkills Weblog - July 17, 2022 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Back pain Chronic pain Coping strategies Interdisciplinary teams Low back pain Motivation Occupational therapy Physiotherapy Psychology Science in practice Therapeutic approaches biopsychosocial pain management Research Source Type: blogs
Scopes, roles, interprofessional practice and person-centred healthcare
A topic that almost immediately gets my hackles up is the one of scopes and roles in pain management and rehabilitation. It’s like “Oooh but that’s MY stuff, get out of it!” and I can see Gollum saying “my preciousssss”…
I trained and graduated in 1984. As a raw newbie occupational therapist I couldn’t articulate much of what my profession brought to healthcare, except that I knew “doing”, “activities” or “occupation” was important to human wellbeing, and that I’d been trained to analyse these. I’ve learned a lot since then a...
Source: HealthSkills Weblog - July 10, 2022 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Assessment Clinical reasoning Interdisciplinary teams Professional topics Research Science in practice Chronic pain Health healthcare interprofessional pain management teamwork Therapeutic approaches Source Type: blogs
The added stress of chronic pain on life
For a minute, I’d like you to grab an ice-cube. If you don’t have one handy, try this at home or when you’re having your next gin and tonic. Hold onto that ice-cube. Keep holding onto it. Put a cloth underneath if it’s going to melt, but keep holding it. Now do your grocery shopping list. Or balance your accounts. While holding the ice-cube.*
Now add some exercises. Exercises you don’t care for, but feel like you have to do “because they’ll help you get better”.
Keep holding onto the ice-cube. Oh, it’s melted?! Fine – go grab another. Hand too cold to pick ...
Source: HealthSkills Weblog - June 19, 2022 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Chronic pain Clinical reasoning Occupational therapy Physiotherapy Psychology Therapeutic approaches biopsychosocial pain management Source Type: blogs
Help me solve this puzzle
The IASP definition of pain is:
An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage.
Six key notes and etymology:
Pain is always a personal experience that is influenced to varying degrees by biological, psychological, and social factors.Pain and nociception are different phenomena. Pain cannot be inferred solely from activity in sensory neurons.Through their life experiences, individuals learn the concept of pain.A person’s report of an experience as pain should be respected.Although pain usually serves an adaptive role, it may ...
Source: HealthSkills Weblog - June 12, 2022 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Chronic pain Clinical reasoning Pain conditions Research healthcare Source Type: blogs
The demise of practical pain management
Cast your mind back to the last time you decided to create a new habit. It might have been to eat more healthy food, to do daily mindfulness, to go for a walk each day. Something you chose, something you decided when, where and how you did it, something that you thought would be a great addition to your routine.
How did it go? How long did it take to become a habit you didn’t need to deliberately think about? How did you organise the rest of your life to create room for this new habit? What did other people say about you doing this?
While we all know a reasonable amount about motivation for change – impo...
Source: HealthSkills Weblog - May 29, 2022 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Chronic pain Coping strategies Health Motivation Occupational therapy Physiotherapy Professional topics Psychology Resilience/Health biopsychosocial pain management Therapeutic approaches Source Type: blogs
The complex world of identifying nociplastic pains
Towards the end of 2017, IASP put forward a new mechanistic classification: nociplastic pain. The definition is: “Pain that arises from altered nociception despite no clear evidence of actual or threatened tissue damage causing the activation of peripheral nociceptors or evidence for disease or lesion of the somatosensory system causing the pain.
Note: Patients can have a combination of nociceptive and nociplastic pain”.
This was great news! Prior to this, the term “central sensitisation” was used and abused to describe processes involved in ongoing pain that wasn’t inflammatory or neuro...
Source: HealthSkills Weblog - May 15, 2022 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Assessment Chronic pain Clinical reasoning Coping strategies Interdisciplinary teams Pain conditions Professional topics Research Science in practice biopsychosocial nociplastic Source Type: blogs
