N of 1 studies – great examples
This study examined whether it’s more fruitful to expose people to many activities they’ve previously avoided, or instead, to limit the number of activities each person was exposed to. This is SUCH an important component of therapy where people have avoided doing things that bother them because they anticipate either that their pain will go to untolerable levels (or interfere with other important things like sleep) or because they’re worried they’ll do harm to themselves. Why? Because doing things in one safe space is not life. We do lots of activities in lots of different spaces, and most of them a...
Source: HealthSkills Weblog - March 12, 2023 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Chronic pain Clinical reasoning Low back pain Research Science in practice pain management single case experimental design Source Type: blogs

If a rose is a rose by any other name, how should we study treatment processes in pain management & rehabilitation?
A new instalment in my series about intensive longitudinal studies, aka ecological momentary assessment (and a host of other names for methods used to study daily life in real time in the real world). Daily life is the focus of occupational therapy – doing what needs to be done, or a person wants to do, in everyday life. It’s complex because unlike a laboratory (or a large, well-controlled randomised controlled trial) daily life is messy and there is no way to control all the interacting factors that influence why a person does what they do. A technical term for the processes involved is microtemporality, o...
Source: HealthSkills Weblog - January 29, 2023 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Assessment Clinical reasoning Professional topics Research Science in practice intensive longitudinal research Occupational therapy Pain rehabilitation research methods single case experimental design Source Type: blogs

The joy of having many data points
Researchers and clinicians are drawn to studies with many participants. Especially randomised controlled trials, where two groups are randomly divided and one gets “the real thing” while the other does not. The joy comes from knowing that results from these kinds of studies suggest that, all things being equal, the differences between the groups is “real” and not just by chance. When we come to analyse the graphs from these kinds of studies, what we hope to see are two nice bell-shaped curves, with distinct peaks (the arithmetic mean) and long tails either side – and a clear separation betw...
Source: HealthSkills Weblog - December 11, 2022 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Assessment Occupational therapy Physiotherapy Professional topics Psychology Research Science in practice Uncategorized Chronic pain Clinical reasoning Health pain management Therapeutic approaches Source Type: blogs

Caring For Those in Chronic Pain: How Spouses Cope
Photo credit Justin Follis Traditional marriage vows generally contain the words "through sickness and in health." For some couples, chronic sickness in the form of a painful disease can come close to defining their lives. I set out to see how these caregivers coped with this change, chronic pain, in their marriages. Research first led to Lynn Greenblatt, a family caregiver for her husband who was diagnosed with Complex Regional Pain Syndrome (CRPS) in July 2008. I began by asking Lynn how she provides the care that her husband needs.  Lynn's Story: "My husband Seth has been in constant severe burning p...
Source: Minding Our Elders - August 6, 2022 Category: Geriatrics Authors: Carol Bradley Bursack 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

Spinal Cord Stimulators Manage Pain without Tingling
Boston Scientific is releasing in the United States its Wavewriter Alpha line of spinal cord stimulators. The four Wavewriter Alpha pain management devices provide Bluetooth connectivity, allow patients to still be scanned under MRI, given certain precautions, and offer so-called Fast Acting Sub-perception Therapy (FAST). FAST is exciting because it provides near immediate pain relief without causing paresthesia, a tingling sensations that patients commonly report when utilizing spinal cord stimulators. Paresthesia-free stimulation therapies are already in existence, but they take a few days or even weeks to finally st...
Source: Medgadget - January 15, 2021 Category: Medical Devices Authors: Medgadget Editors Tags: Neurology Neurosurgery Orthopedic Surgery Pain Management bostonscientific paresthesia 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

Part 5 - Why Do We Lump the Non-Cancer Pain Syndromes Together?
by Drew Rosielle (@drosielle)A Series of Observations on Opioids By a Palliative Doc Who Prescribes A Lot of Opioids But Also Has Questions.This is the 5th post in a series about opioids, with a focus on how my thinking about opioids has changed over the years. See also:Part 1 – Introduction, General Disclaimers, Hand-Wringing, and a Hand-Crafted Graph.Part 2 – We Were Wrong 20 years Ago, Our Current Response to the Opioid Crisis is Wrong, But We Should Still Be Helping Most of our Long-Term Patients Reduce Their Opioid DosesPart 3 – Opioids Have Ceiling Effects, High-Doses are Rarely Therapeutic, and Another Hand-Cr...
Source: Pallimed: A Hospice and Palliative Medicine Blog - October 6, 2019 Category: Palliative Care Tags: opioid pain rosielle The profession Source Type: blogs

MKSAP: 60-year-old woman with persistent constipation
Test your medicine knowledge with the  MKSAP challenge, in partnership with the American College of Physicians. A 60-year-old woman is evaluated for persistent constipation symptoms of 2 years’ duration. She has reflex sympathetic dystrophy syndrome involving the right arm and neck that began 3 years earlier and requires chronic opioid analgesic therapy. She reports passing two hard […]Find jobs at  Careers by KevinMD.com.  Search thousands of physician, PA, NP, and CRNA jobs now.  Learn more. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - May 25, 2019 Category: General Medicine Authors: < span itemprop="author" > < a href="https://www.kevinmd.com/blog/post-author/mksap" rel="tag" > mksap < /a > < /span > Tags: Meds Gastroenterology Source Type: blogs

The Folly of Self Referral
By HANS DUVEFELT, MD A lot of Americans think they should be able to make an appointment with a specialist on their own, and view the referral from a primary care provider as an unnecessary roadblock. This “system” often doesn’t work, because of the way medical specialties are divided up. If belly pain is due to gallbladder problems you need a general surgeon. If it’s due to pancreas cancer, you need an oncologic surgeon. If the cause is Crohn’s disease, any gastroenterologist will do, but with Sphincter of Oddi problems, you’ll need a gastroenterologist who does ERCPs, and not all of them do. Now, of ...
Source: The Health Care Blog - May 17, 2019 Category: Consumer Health News Authors: Christina Liu Tags: Medical Practice Physicians Hans Duvefelt primary care Source Type: blogs

A New Arizona Law Limits A Doctor's Freedom To Prescribe Painkillers : Shots - Health News : NPR
It started with a rolled ankle during a routine training exercise.Shannon Hubbard never imagined it was the prologue to one of the most debilitating pain conditions known to exist, called­­­­­­­complex regional pain syndrome.It's a condition that causes the nervous system to go haywire, creating pain disproportionate to the actual injury. It can also affect how the body regulates temperature and blood flow.For Hubbard, it manifested several years ago following surgery on her foot. That's a common way for it to take hold."My leg feels like it's on fire pretty much all the ...
Source: Psychology of Pain - July 8, 2018 Category: Anesthesiology Source Type: blogs

Experiences from the First StimRouter Implanted in Patients in Canada
As a shadowing medical student in family medicine clinics in Toronto, I’d seen patients with chronic pain of a neurogenic origin and always felt heartbroken. I’d looked on in helplessness as we consoled the patients and offered them physiotherapy, bedrest, and pain killers. We and the patients knew none of these options were curative, and subsequently tiptoed around that subject. Fortunately, Health Canada approved a new solution earlier this year: a peripheral nerve stimulator called the Bioness StimRouter. It’s a minimally invasive neuromodulation device consisting of an implanted lead, an external pulse generator,...
Source: Medgadget - June 28, 2018 Category: Medical Devices Authors: Ben Ouyang Tags: Anesthesiology Exclusive Pain Management Rehab Source Type: blogs

Use of a Case Study Method To Explore Sensory-Processing Characteristics of Children With Complex Regional Pain Syndrome
Place holdercoming soon! (Source: ABC Therapeutics Occupational Therapy Weblog)
Source: ABC Therapeutics Occupational Therapy Weblog - April 2, 2018 Category: Occupational Health Tags: OT practice Source Type: blogs

Abbott Releases Proclaim DRG Dorsal Root Ganglion Stimulator for Chronic Pain
Abbott is releasing in the U.S. its Proclaim DRG neurostimulation system to fight chronic pain in patients with complex regional pain syndrome in their legs. The product consists of an implantable neuromodulator that stimulates the dorsal root ganglion (DRG), an Apple iPad for programming the device, and an iPod touch for the patient control of the device. In a recent clinical trial, dorsal root ganglion stimulation has shown markedly better outcomes over spinal cord stimulation in many patients suffering from chronic pain in the lower extremities. Bluetooth wireless connectivity is used to change the settings on the impl...
Source: Medgadget - October 16, 2017 Category: Medical Devices Authors: Editors Tags: Neurology Neurosurgery Pain Management Source Type: blogs

Opioid Induced Hyperalgesia Prevented by Buprenorphine?
“Buprenorphine is a kappa receptor antagonist. For these reasons, buprenorphine might be unique in its ability to treat chronic pain and possibly OIH.” The opioid crisis has been fueled by the use of opioids to treat chronic pain.  Practice patterns have changed, but doctors are still criticized for their roles in the overuse of opioids.  I’ve sat through community ‘heroin forums’ (sometimes on stage) as sheriffs, politicians, and ‘recovered addicts’ firmly pointed fingers at health professionals.  I, meanwhile, kept my finger under the table, but had the thought that some of the people pointing ...
Source: Suboxone Talk Zone - February 5, 2017 Category: Addiction Authors: Jeffrey Junig MD PhD Tags: Acute Pain Buprenorphine Chronic pain Suboxone treatment buprenorphine treats chronic pain chronic pain treatment opioid induced hyperalgesia opioid pain relief pain vs. addiction Source Type: blogs