Family and friends matter
I’m going back to my series on behavioural approaches to pain management (it’s a slow process!). For the first two go here and here. Now I want to talk about the impact of family and friends on people living with pain.
The people we live with are so influential on what we do and believe about pain. It’s our parents who first taught us the relationship between the word “pain” and the experience we know as pain. It’s our parents and family who responded when we cried, who kissed it better (or not), who told us to “harden up” (or not), who took us to the doctor (or not), who...
Source: HealthSkills Weblog - April 11, 2021 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Back pain Chronic pain Coping strategies Professional topics Science in practice behavioural family pain behaviour spouse Source Type: blogs
Self-care
No, not the Instagram “self-care” of floofy slippers and a glass of wine, or an excuse to indulge in chocolate. No, I’m talking about the gritty self-care that all of us humans need to do, only some of us need to it more regularly or we’ll experience Consequences.
Self-care for people living with pain is no luxury, and it does (occasionally) mean walking away from something enjoyable, setting boundaries on demands for time and energy, AND it means many other things too.
I’ll talk about my own self-care needs because I can’t talk authentically about anyone else. Most of you will kno...
Source: HealthSkills Weblog - March 28, 2021 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: 'Pacing' or Quota Chronic pain Clinical reasoning Coping Skills Coping strategies Motivation Pain conditions boundaries self management self-care selfcare Source Type: blogs
Modifying pain behaviour (2)
Two concepts that receive limited attention in the allied health literature are nomothetic and idiographic approaches. I’m discussing these concepts here because when we’re considering pain behaviour, I think we can focus much more on “generic” (nomothetic) concepts than we do idiographic ones – and yet we say we’re about the unique person in front of us.
Firstly, this site offers a good summary of the difference between nomothetic and idiographic – click
Essentially, nomothetic approaches focus on underlying generalities, perhaps traits, and are a solid part of the science o...
Source: HealthSkills Weblog - March 14, 2021 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Assessment Back pain Chronic pain Coping strategies Low back pain Motivation Professional topics Science in practice behavioral pain behavior rehabilitation relational frame theory Source Type: blogs
Pain model – helping to target change
In my recent post on behavioural approaches to pain management, I had a number of commentators ask why do it, why not focus on pain intensity, and aren’t I invalidating a person’s experience if I target a person’s response to their experience. Today’s post will explore some of these points.
I suppose my first point needs to distinguish between pain as an experience, and pain behaviour – or what we do when we experience pain. I like to use a pretty old “model” or diagram to help untangle these concepts. It’s drawn from Loeser’s “Onion ring” model, and he w...
Source: HealthSkills Weblog - February 28, 2021 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Clinical reasoning Coping strategies Pain Pain conditions Therapeutic approaches models pain models Source Type: blogs
… the “ so what ” question and why it matters to take a break from work
At the conclusion of each of the courses I teach at University of Otago, I ask students the “so what” question. So what that we learned about neurobiology? So what that we discussed social constructs and how they shape pain behaviour? So what that we learn that thoughts and beliefs influence our pain experience? What does it all mean when we’re sitting with a person experiencing pain?
This last week I’ve been on a brief trip to the West Coast of the South Island of New Zealand Aotearoa. It is a wild and isolated part of our country. So wild that in parts the annual rainfall is over 6,000mm (see t...
Source: HealthSkills Weblog - February 21, 2021 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Chronic pain Off topic Professional topics Resilience/Health Science in practice values Source Type: blogs
Modifying pain behaviour (1)
In my post last week I talked about pain behaviour and why pain behaviours are often a good treatment target in pain rehabilitation. I also talked about pain intensity rating scales and how, because rating scales are a form of communication, the numbers we obtain from them aren’t a true measure of pain: they reflect what the person wants to communicate about their pain to someone at that time and in that context.
This week I want to discuss modifying pain behaviour, and believe me, we are all in the business of modifying behaviour even if we think we’re doing something completely different!
Ethics
One ...
Source: HealthSkills Weblog - January 31, 2021 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Chronic pain Clinical reasoning Research Science in practice Therapeutic approaches behavioural clinical communication poain behaviour Source Type: blogs
Pain behaviour: what is it and what do we do about it?
I’m re-reading Fordyce’s classic Behavioral Methods for Chronic Pain and Illness and once again I’m struck by how many of the concepts he introduced and systematically investigated are either mis-interpreted and ignored in our current approaches to helping people with persistent pain. Today I’ll explore just a tiny portion of what Fordyce described.
Pain behaviour refers to all the observable actions we do in relation to experiencing pain (NB some people include thoughts as well, but for today I’ll just focus on observable actions). There are roughly two groups of actions: those involuntary...
Source: HealthSkills Weblog - January 24, 2021 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Clinical reasoning Coping strategies Pain Pain conditions Research Science in practice behavioral contextual behavioral science operant conditioning Source Type: blogs
Musing on “ the social ” in pain rehabilitation
What do we think about when we consider “the social” as a factor in pain rehabilitation? Do we think of socioeconomic status? Maybe employment status? Perhaps societal attitudes towards pain and recovery? Do we ask if the person has someone they trust in their life? Maybe we even discuss how a relationship is going, whether the person sees their friends and family?
Have we forgotten that possibly the most potent influences on pain behaviour are the people around the person we’re seeing?
It will be no surprise to anyone reading my work over the past 10 or more years (yes, really! it HAS been that lon...
Source: HealthSkills Weblog - January 17, 2021 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Chronic pain Clinical reasoning Coping strategies Education Interdisciplinary teams Professional topics Research Science in practice family partners social spouses Source Type: blogs
Radical? Radical!
Welcome to 2021! An interesting start to the year for my US friends, more of the same for my UK and European friends, and life in NZ and Australia goes on with an added dash of uncertainty because of the new! improved! more contagious Covid19!
I’ve had a few weeks away from my usual Monday morning writing routine, but I return to the blog today with a lovely book I’ve reviewed. There’s no secret about my personal preference for ACT both for living and flourishing in daily life, and for those of us living with persistent pain. Today’s book review is about Radical Relief: A guide to overcome chroni...
Source: HealthSkills Weblog - January 10, 2021 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: ACT - Acceptance & Commitment Therapy Book reviews, site reviews Chronic pain Coping Skills Coping strategies Science in practice Source Type: blogs
What to do about acute low back pain
I should add another line to that heading: in one easy step! And I’d be inundated with hits and if I could cash in on them I’d be rich! And wrong.
If there was a simple recipe for success, I’d expect that by now we’d have it. The very fact that SO MANY options for managing a bout of low back pain exist is a good reason for skepticism should you ever get tempted to take a headline like mine as a cause for celebration. However I do want to talk about acute low back pain because I think clinicians are often probably doing it wrong.
First of all, low back pain doesn’t include pain that also ...
Source: HealthSkills Weblog - December 6, 2020 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Back pain Low back pain Pain conditions Research Resilience Resilience/Health Science in practice acute low back pain back to basics pain trajectories Source Type: blogs
Bias: Is pain all the same?
The topic of how we define pain, and how humans respond to pain has come up for me as I mull over the IASP definition of pain. The current (new) definition is this:
An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage.
Six key notes:
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...
Source: HealthSkills Weblog - November 29, 2020 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Chronic pain Clinical reasoning Education Education/CME Pain conditions acute pain function IASP definition maldynia metaphor pain definition persistent pain purpose Source Type: blogs
Why learning about pain can help – an old study worth revisiting
If you’ve read my blog over the years you’ll see that I love a bit of history. Learning from older studies, and older opinions, can help us position our current thoughts in a larger context. Older studies can also highlight concepts that haven’t grabbed the attention nearly as much as more recent studies but still have value.
Today’s post is about a studied published in 2004. It’s one I’ve often used to illustrate how influential our expectations or beliefs are when it comes to pain intensity and pain aversiveness/unpleasantness.
Take 31 healthy undergraduate students (50% were wo...
Source: HealthSkills Weblog - November 22, 2020 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Chronic pain Clinical reasoning Cognitive skills Coping strategies Education Research Science in practice Uncategorized Source Type: blogs
Looking beyond the immediate
When I graduated as an occupational therapist, I was told that my profession was “problem-solving” and “motivation”. At the time (early 1980’s) Lela Llorens‘ problem solving process was the fundamental approach taught during our training. This approach is straightforward: identify the problem, identify solutions, select a solution, implement the solution, and review. I’m not sure if this approach is still taught but it’s stayed with me (and those memories of painstakingly completing the problem solving process documentation…).
There’s one small step that I thin...
Source: HealthSkills Weblog - November 15, 2020 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Assessment Clinical reasoning Coping strategies Interdisciplinary teams Occupational therapy Pain Pain conditions Professional topics Uncategorized Source Type: blogs
Becoming resilient
Rehabilitation professions are about helping people recover from illness to return to what matters in life. Sometimes as I read the myriad social media posts on ways to help people with pain, I wonder what kind of life rehabilitation professionals live themselves. Does our focus on what’s done during rehabilitation represent the way people live in everyday life?
I suspect that because rehabilitation has emerged from a medical model, much of our expectations and the framework for our work has remained in a “fix-it” or “there you go, good as new” mindset. A kind of short-term, out the door an...
Source: HealthSkills Weblog - November 8, 2020 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Chronic pain Clinical reasoning Coping Skills Coping strategies Pain conditions Professional topics Resilience/Health Science in practice adaptability evolution flexibility pain rehabilitation rehabilitation theory Source Type: blogs
Springboard: Beginning to live life again
Springboard is a six week, 120 min once a week programme for people with pain. I developed this programme in the context of New Zealand’s Accident Compensation Corporation (ACC) community-based pain management services.
So, why use a group approach and what’s inside Springboard?
Pain can be such an isolating experience, and for many people, not only do friends and family not “get it” but neither do some of their health professionals! Living with pain, even for “just” a few months can lead to loneliness because most people don’t know what it is like to experience pain that do...
Source: HealthSkills Weblog - October 11, 2020 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: ACT - Acceptance & Commitment Therapy Coping Skills Coping strategies Groupwork Pain Pain conditions Professional topics Resilience/Health Springboard Source Type: blogs
