Making the first contact
How do we begin working with someone who is asking for help with their persistent pain? In this post I’ll describe some of the considerations I have when I begin, because as Benedetti points out, the “meet the therapist moment” is one of the most potent times in the therapeutic ritual (Benedetti, 2011). It’s the time when the person’s expectations and the clinician’s empathy and competence meet, and the “meaning response” blooms.
My two clinical questions are:
Why is this person presenting in this way at this time, and what’s maintaining their predicament? And wh...
Source: HealthSkills Weblog - October 17, 2021 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: ACT - Acceptance & Commitment Therapy Assessment Chronic pain Clinical reasoning Science in practice biopsychosocial initial assessment Occupational therapy pain management subjective Therapeutic approaches Source Type: blogs
Thought experiment: Would therapists be out of a job if we could “ fix ” persistent pain?
Every few years someone, somewhere, announces that “it won’t be long before we have a treatment to rid the world of persistent pain.” And there’s a hiss and roar to celebrate this momentous finding, and much ado about how wonderful it will be.
I’m still waiting. BUT I thought it might be an interesting thought experiment to wonder what might happen if a “cure” was available for fibromyalgia.
As readers will know, I have lived with what eventually was named “fibromyalgia” since my early 20’s, and probably longer. I’ve dabbled in various treatments ove...
Source: HealthSkills Weblog - October 10, 2021 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Chronic pain Pain conditions Professional topics Research Science in practice biopsychosocial pain management Therapeutic approaches Source Type: blogs
Pain – or pain-related disability?
I’m struck at how often clinicians focus on pain intensity when how much pain intrudes on life matters more. I wonder whether new therapists might not have read some of the old studies looking at the relationship between pain intensity and disability – because while there is a relationship there, it’s not nearly as strong as we might think.
Let’s define a couple of terms first: pain is, I think most of us can agree, “an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage”. (click for full definition and not...
Source: HealthSkills Weblog - October 3, 2021 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Uncategorized Source Type: blogs
One plus one may not always equal two
If it hurts – take notice, and avoid it. Learn from it. If there are other people around, make sure your behaviour is noticeable so they take care of you and don’t do what you just did. If they look after you, you’ll probably do the same thing again when you hurt, if they don’t you probably won’t.
This is one description of pain behaviour and how it works. It’s the only part of our pain experience that we can share directly with one another (actions and words). The “doing” part is also the part that is most affected by pain – even distress is signalled to others ...
Source: HealthSkills Weblog - September 26, 2021 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Uncategorized Chronic pain Clinical reasoning pain management Research Source Type: blogs
“ Research says ” – and why lived experience matters
Discussion section? The only bits read by some people – if they go past the abstract? These sections are important, but not perhaps for the reasons you might think. When I first started reading research papers, I used to think the Background was intended to highlight an unanswered question, and the Discussion was to put the answer (from the Results) into context and to establish “where next”? And there’s truth to this perspective. But it’s a beginner’s look at research. It’s a start to understanding the context of a piece of investigation. Reading these sections does give an insigh...
Source: HealthSkills Weblog - September 12, 2021 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Uncategorized Source Type: blogs
Adam ’ s slow recovery
Not long ago I wrote about Adam Meakins back pain, and the astonishing response he’s had from fellow clinicians as he’s documented his recovery. Sadly, the polarised views of how therapists should approach a person with low back pain show me just how appallingly badly we adhere to low back pain guidelines… and worse, the kind of language and attitudes shown to a colleague who knows what he’s doing, demonstrates why change is so very slow.
What do I mean? Well, Adam has been following evidence-based low back pain guidelines that haven’t really changed a great deal since the advent of New Zea...
Source: HealthSkills Weblog - August 22, 2021 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Back pain Clinical reasoning Coping strategies Low back pain Occupational therapy Physiotherapy Professional topics Psychology Research Science in practice healthcare pain management Source Type: blogs
“ Just a little scratch ”
Discussion
I haven’t described the second experiment because of space, but go ahead and read it. Essentially they added some more participants, varied the procedure a little to reduce the memory burden on participants, and added a “medium” underprediction element into the process. The results showed similar outcomes – lower ratings of pain in both the “you won’t feel a thing” and the “it’ll hurt but not much” experiments, and yet again, less trust in the experimenter suggesting that it wouldn’t hurt.
Lessons to learn?
Think carefully about inflatin...
Source: HealthSkills Weblog - August 15, 2021 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Pain Psychology Research Health Therapeutic approaches Source Type: blogs
When therapists get hurt
“Physician, heal thyself” – usually used to suggest that the person should fix their own problems before trying to fix someone else. And when a therapist gets hurt all the armchair critics (social media proclamists) go off pointing the finger and telling that person what to do – even when the therapist is doing exactly what evidence suggests is the right thing to do.
Adam Meakins has hurt his back while lifting weights in the gym – he’s documenting his progress on social media, which I think is both a very brave thing to do and also something I’d love to see more of. If you want...
Source: HealthSkills Weblog - August 8, 2021 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Back pain Coping strategies Low back pain Pain conditions Professional topics Resilience/Health Science in practice pain management Source Type: blogs
When living with pain is too hard
Living with persistent pain can be really hard, and clinicians, family and the person with pain can be worried about suicidal thoughts and possible actions. There’s good reason to be concerned, too, as a recent study from the 2012 Canadian Community Health Survey shows.
Grocott, Sommer and El-Gabalawy (2021) used the data obtained from this Canadian Health Survey to explore the relationships between pain intensity and suicidality in people with arthritis, migraines and low back pain.
The first question is how many people in the overall population involved in this study had any of the three diagnostic groups &...
Source: HealthSkills Weblog - August 1, 2021 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Chronic pain Coping strategies Low back pain Pain conditions Professional topics Research biopsychosocial Clinical reasoning Health Suicidal thoughts Therapeutic approaches Source Type: blogs
Why I don ’ t trust my clinical reasoning: and why this matters
“See someone experienced” I hear people with pain say. “They’ll know what’s wrong with you.”
Well, based on the research I’ve read, I wouldn’t be so sure. In fact, I’m certain my own clinical reasoning is biased, prone to errors that I don’t notice, and influenced by factors that most clinicians would be horrified to think they, too, were influenced by.
Let me give you a few to ponder:
I’m interested in women and pain – and there’s a lot of evidence showing that women’s pain doesn’t get the same kind of diagnostic and managem...
Source: HealthSkills Weblog - July 11, 2021 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Interdisciplinary teams Occupational therapy Pain conditions Physiotherapy Professional topics Psychology Research Science in practice Chronic pain Clinical reasoning healthcare Source Type: blogs
Knowledge gaps for working together
Whenever we work with someone living with pain, we form a team. A team, by definition, is “a distinguishable set of two or more people who interact dynamically, interdependently, and adaptively towards a common and valued goal/objective/mission” (Salas et al., 1992). So while many clinicians work outside an interprofessional team, they are always working in a team consisting of at least the person with pain, and themselves.
There’s a good deal of research on teamwork, and a heap of references in pain management literature on the benefits and, indeed, the need, to work in a team for best outcomes (both in terms...
Source: HealthSkills Weblog - June 27, 2021 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Chronic pain Clinical reasoning Interdisciplinary teams Professional topics Research Science in practice pain management teamwork Source Type: blogs
The stigma of being a woman in pain
Women, it is often thought, must be much tougher than men when it comes to dealing with pain – after all, don’t women have babies without anaesthetic? Don’t men faint at the sight of a needle?
Ummmm, not quite so fast. Now before I begin, in this post I’m referring to cis-gender females, and in the experiments, participants were selected on the basis that they believed that negative gender discrimination was a thing. And as I write this post, I want to be clear that sometimes we have to begin with a very simplified model before research can be conducted on a much more messy cohort – and th...
Source: HealthSkills Weblog - June 20, 2021 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Assessment Coping strategies News Pain Pain conditions Research Science in practice female stigmatism women Source Type: blogs
Why do people with pain report differently on questionnaires than they do in physical performance testing?
One of the topics thrown around by people who don’t have an up-to-date understanding of pain is why people say one thing on a questionnaire, for example, what they can and can’t do, and perform quite differently when asked to do the same task in a clinic. It’s a good question, on the face of it: after all, people should know what they can and can’t do, and be consistent. If there is a difference, well obviously the physical performance test is far more objective than self-report – the therapist is right there watching, so there’s no room for doubt about which measure is The Most Accurate...
Source: HealthSkills Weblog - June 13, 2021 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Assessment Motivation Pain conditions Professional topics Science in practice malingering measurement performance testing Source Type: blogs
Not all pain is the same
When I started working in the field of persistent pain, many of the approaches used were based on the idea that every pain was the same. Oh yes, of course we had neuropathic pain and inflammatory pain, but our treatments tended to approach each person as if they were pretty similar. We later refined that approach and started to look at people in groups. In the service I worked in, we used the Westhaven-Yale Multidimensional Pain Inventory which generates three main psychologically-based profiles – and for a long time this was a very useful way of establishing who needed the three-week residential programme, and who w...
Source: HealthSkills Weblog - May 23, 2021 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Assessment Chronic pain Clinical reasoning Pain conditions Professional topics Research Science in practice Source Type: blogs
What happens to pain over 21 years?
No! I was not born then… I’m much older than that. No, in this longitudinal cohort study, participants recruited from the general public in Sweden were surveyed five times: at inception in 1995, again in 1998, 2003, 2007 and 2016. The article I’m reporting on included all respondents who had completed information on at least 3 of the 5 time points, a total of 1858 people! That’s a decent-sized study.
Longitudinal studies are really hard to do but offer us so much information about what happens over time to a group of people and it’s something we need to do more often. The problems with long...
Source: HealthSkills Weblog - May 16, 2021 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Chronic pain Pain conditions Research longitudinal prospective study trajectory Source Type: blogs
