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
Women, partner violence and pain
As the potential for greater repression of women’s autonomy grows (Afghanistan, United States, Mexico), along with racist and misogynist statements from business leaders (DGL CEO Simon Henry) it’s timely to look at pain in women. We already know that more women than men present with persistent pain (Blyth, n.d.), while women who are seen for their pain are more often misdiagnosed, offered psychiatric medication or psychological intervention only and have their experiences dismissed as “hysterical, fabricated, or nonexistent” (Samulowitz, et al., 2018). My daughter, when attending Emergency Departmen...
Source: HealthSkills Weblog - May 8, 2022 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Chronic pain Professional topics Research Science in practice biopsychosocial gender Health pain management partner violence Source Type: blogs
Rehab Fails: What goes wrong in rehab 4
It’s not hard to choose rehab fails, the problem is more about when to stop! I tell a lie, it’s more about how to make changes so these things don’t happen.
Today’s #rehabfail is all about attempting to carve bits of a person off so each profession gets “their” bit to do with what they will. Oh boy, this is a doozy, and it comes to me off the back of seeing the return of the age-old argument about whether pain is “all about the bio” or whether the person gets a look-in. Cuz if it’s all bio then we just treat that bio and be done with it, right? It’s a question ...
Source: HealthSkills Weblog - April 10, 2022 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Interdisciplinary teams Pain Pain conditions Professional topics biopsychosocial Chronic pain Health healthcare pain management Research Therapeutic approaches Source Type: blogs
Rehab Fails: What goes wrong in pain rehabilitation 3
I’m beginning to think this series could grow into a monster – so many #rehabfails to pick from!
Today’s post is about rehabilitation that doesn’t fit into the person’s life. Or that the person hasn’t been supported to fit the rehabilitation into their life. THEIR life, not ours!
You know what I mean: for six to twelve weeks, this person has been coming along to their treatment sessions, doing the things the therapist suggests. They make progress and it’s time to end the programme. “Good bye patient” the therapist says. And the patient skips off into the sunset, f...
Source: HealthSkills Weblog - April 3, 2022 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Assessment Clinical reasoning Coping Skills Coping strategies Interdisciplinary teams Occupational therapy Pain conditions Physiotherapy Professional topics Psychology Research Resilience/Health Science in practice Uncategorized Source Type: blogs
What goes wrong in pain rehabilitation (2)
One size does not fit all. Cookie cutter treatments fail to take into account the huge variability each person brings into a clinical encounter, particularly when the person is living with persisting pain. Not really earth shattering news, is it?!
Let me unpack this one.
When we’re treating a person with an acute musculoskeletal injury, let’s say a lateral ankle sprain, I’m going to hazard a guess that most of the recovery occurs without our assistance (don’t shoot the messenger – go read Chen et al, 2019). In essence, we’re creating an environment that supports tissues to do what...
Source: HealthSkills Weblog - March 27, 2022 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Chronic pain Clinical reasoning Interdisciplinary teams Motivation Pain conditions Professional topics Research Science in practice Health healthcare pain management Therapeutic approaches Source Type: blogs
Rehab fails: What goes wrong in pain rehabilitation (1)
Well obviously I’m not going to cover everything that goes wrong – and certainly not in one post! But inspired by some conversations I’ve had recently, I thought I’d discuss some of the common #fails we do in rehabilitation. Things that might explain why people with pain are thought to be “unmotivated” or “noncompliant” – because if the rehab doesn’t ‘work’ of course it’s the person with pain who’s at fault, right? So for today, here goes.
Starting at the wrong intensity
One of the main things that happens when someone’s in pain...
Source: HealthSkills Weblog - March 20, 2022 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: ACT - Acceptance & Commitment Therapy Chronic pain Clinical reasoning Cognitive behavioral therapy Cognitive skills Motivation Occupational therapy Pain conditions Physiotherapy Psychology Resilience/Health Science in practice biop Source Type: blogs
Making sense of pain
It’s been said many times, so many times I can’t locate the originator of the saying “humans are meaning-making machines” – no more so than when a person experiences pain. Whether it’s a stubbed toe, sprained ankle, thundering headache – or, in my case, weird and ongoing widespread body pain AKA fibromyalgia – we would like to make sense of what’s going on. And mostly we tell simple stories about what we were doing, what happened to the body and that’s that.
In the case of weird or persistent pains the challenge becomes harder. The original story might not fit ...
Source: HealthSkills Weblog - March 6, 2022 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Chronic pain Coping strategies Research Resilience/Health pain management Therapeutic approaches Source Type: blogs
Reflective practice
In occupational therapy and some other health professions, reflective practice is a vital part of professional clinical activity. In others – not so much. And the term reflective practice has a heap of assumptions attached to it, so it may mean different things to different people.
I thought I’d unpack a bit about reflective practice today because I think it needs to be part of working with people experiencing pain. It helps us get out of our own mindset (when it’s done well), and opens a space for questioning what we do and why we do it – and as you probably all know, questioning is part of who...
Source: HealthSkills Weblog - February 13, 2022 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Clinical reasoning Pain Professional topics Research Science in practice Therapeutic approaches critical thinking Health healthcare reflective practice supervision Source Type: blogs
Experiential avoidance – and persistent pain
Most of us will recognise that when we experience a pain, we firstly notice where it is, and the sensory qualities of it. We automatically make judgements about that pain – some of this judgement is about whether we recognise this pain (have we had it before?), some is about whether it’s important enough to interrupt what we’re doing (should I drop this hot cup of coffee, or can I hold onto it long enough to place the cup carefully on the bench), and some is about how we feel emotionally (yes, swearing is common when we smack our thumb with a hammer!).
In our response to acute pain, we often want to a...
Source: HealthSkills Weblog - January 23, 2022 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: ACT - Acceptance & Commitment Therapy Assessment Chronic pain Clinical reasoning Coping strategies Research Science in practice Therapeutic approaches pain management Source Type: blogs
Your patient has psychosocial risk factors: what now?
Congratulations! You’re an insightful clinician who’s offered your patient a screening assessment to find out if she or he has psychosocial risk factors – and yes! they do! Well done. Now what?
Do you…
send your patient to the nearest psychologist?spend at least one treatment session offering pain neurobiology education?scramble to find a “psychologically informed physio” to send them to, because it takes really highly trained and special clinicians to work with these peoplegive your patient the same exercise prescription you were going to anyway because, after all, they still have...
Source: HealthSkills Weblog - January 16, 2022 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Back pain Chronic pain Clinical reasoning Occupational therapy Pain conditions Physiotherapy Professional topics Psychology Research Science in practice biopsychosocial healthcare pain management Therapeutic approaches Source Type: blogs
Making first contact: What to do with all that information! Part 5
People come to see us because they have a problem. So the formulation approach I’m taking today begins from “the problem” and works back and forward. It’s called a “network” model, and is something many of us do without knowing that’s what we’re doing. The network model can also be called a functional analysis where we’re looking at what happens, and what a person does, and the ongoing consequences or loops that occur over time.
Angelina comes to see you because her neck is very sore. She’s not sure why it’s sore, or what happened to start it off, but sh...
Source: HealthSkills Weblog - January 9, 2022 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: ACT - Acceptance & Commitment Therapy Assessment Clinical reasoning Cognitive behavioral therapy Interdisciplinary teams Occupational therapy Pain conditions Physiotherapy Professional topics Psychology Resilience/Health Therapeutic Source Type: blogs
Making first contact: What to do with all that information! Part 4
In the previous few posts on what to do with all that assessment information I’ve talked about generating a formulation to guide treatment, and a little about how teams might work together to generate one. This post is a little different because I want to situation the discussion around the ultimate aim of therapy.
I usually work with people who have long-standing pain that hasn’t changed much and doesn’t seem to be disappearing. I’m not a nihilist, but I do wonder if clinicians are trying too hard to “change pain” when the body doesn’t seem to respond all that much to whatever...
Source: HealthSkills Weblog - December 12, 2021 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: ACT - Acceptance & Commitment Therapy Assessment Clinical reasoning Coping strategies Interdisciplinary teams Occupational therapy Pain conditions Physiotherapy Psychology Science in practice Uncategorized Source Type: blogs
Making first contact: what to do with all that information! Part 3
In my last post I described the “4 P” model (sometimes called the 5P!) of formulation for pain. In today’s post I want to talk about an integrated approach for a team.
Teamwork in pain management is an enormous thing – IASP (International Association for the Study of Pain) endorses multidisciplinary (I prefer interprofessional) teamwork but gives little information on how teams best work together. In fact, research exploring teamwork processes in pain management is remarkably absent, even though there’s considerable research elsewhere in healthcare showing that effective teamwork is quite ...
Source: HealthSkills Weblog - December 5, 2021 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Assessment Chronic pain Clinical reasoning Interdisciplinary teams Professional topics Psychology Research Science in practice biopsychosocial case formulation Health healthcare pain management teamskills teamwork Source Type: blogs
Making first contact: What to do with all that information! part 2
Last week I described some of the reasons for using a case formulation approach when working through initial assessment information, and today I’m going to describe one approach for organising a formulation. This is the “4 P” formulation, and it’s one that’s often used in mental health (Bolton, 2014).
In the 4 P model, there are four questions to ask yourself:
Preconditions – Why is this person vulnerable to this problem?Precipitating factors – Why now? This can mean “why is this person having symptoms now?” or “why is this person presenting to this person ...
Source: HealthSkills Weblog - November 28, 2021 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Assessment Chronic pain Clinical reasoning Pain conditions Professional topics Research Science in practice biopsychosocial case formulation Occupational therapy pain management Therapeutic approaches Source Type: blogs
Making first contact: what to do with all that information! part 1
Last post I wrote I said I’d continue with a process for structuring and synthesising the information we gather from the initial contact we make with the person. This process is integral to clinical reasoning, and somewhat surprisingly, there’s not a great deal of research to give us guidance on the best way to do this – and it’s even more challenging for those of us working in an interprofessional team setting, where different professions, personalities and assumptions are part of it.
If we work backwards from the end point, we might get some clues about what to do. Our end point is to help this...
Source: HealthSkills Weblog - November 21, 2021 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: ACT - Acceptance & Commitment Therapy Assessment Clinical reasoning Interdisciplinary teams Occupational therapy Pain Pain conditions Physiotherapy Professional topics Psychology Science in practice Uncategorized Source Type: blogs
