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
Persistent pain and movement practices
Here I go, stepping into “the bio” to write about movement. Oh dear, what am I doing?
Movement practices of various kinds are part and parcel of pain management. In fact, to read some of the material in social media-land, exercise is the be-all and end-all of pain management, maybe with a dash of psychology. Can we please stop doing this?
I’ve said it often, for many forms of persistent pain, especially the most common forms – nonspecific chronic low back pain, fibromyalgia, and osteoarthritic pain – movement is a good thing, but the effect sizes are small for both pain intensity and d...
Source: HealthSkills Weblog - December 18, 2022 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Chronic pain Clinical reasoning Low back pain Occupational therapy Physiotherapy Psychology Resilience/Health Science in practice movement optimism movement practices pain management Research Therapeutic approaches 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
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
I am stupid
Conclusion: Isaac Asimov is stupid(Sorry, no post yesterday because I was doing some heavy cerebral processing.)He ' d have been the first to admit it. All of us are susceptible to cognitive errors and biases. I ' d like to think that Asimov was less susceptible than most, but he must have had his own foibles. It ' s a constant struggle to be mindful and think straight. For my own part, I once had a romanticized view of the Chinese revolution, I was an anthropogenic climate change skeptic, and I entertained the likelihood that medical intervention, on balance, did more harm than good. (Viz Illich, Medical Nemesis.)&nb...
Source: Stayin' Alive - October 28, 2022 Category: American Health 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
Fibromyalgia is not a trash can diagnosis [PODCAST]
Subscribe to The Podcast by KevinMD. “How would you like to see your career slip away from you as you gradually become less and less able to sleep, to rest, to feel awake, to feel like your memory is failing you, to be taking pills every night on call because your legs ache so badly,
Read more…
Fibromyalgia is not a trash can diagnosis [PODCAST] originally appeared in KevinMD.com. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - July 21, 2022 Category: General Medicine Authors: The Podcast by KevinMD Tags: Podcast Rheumatology Source Type: blogs
A Summer Roundup of Caregiver and Elder-Friendly Products, Services, and Technology
Photo image credit Jelly Drops (image of the inventor and his grandma!)
Dear Readers: It’s once again time for what has become a bi-annual look at products and services available to caregivers and/or older adults. I’m better acquainted with some of these products and services than others, and in some cases, I note that. Unless I say otherwise these mentions are not meant as an endorsement. Let’s go…
Clothing
CareZips: Joe & Bella is a new, modern adaptive-apparel brand for older adults. Their newest line is CareZips® by Joe & Bella, a patented easy-dressing pant for adults living with changes due to incontin...
Source: Minding Our Elders - July 10, 2022 Category: Geriatrics Authors: Carol Bradley Bursack Source Type: blogs
Fibromyalgia is not a trash can diagnosis
Yet again, while reading an article about fibromyalgia, I was hit with another pejorative term in the first few lines. The authors describe the usual characteristics of fibromyalgia and then say,“and a high level of catastrophizing related to pain.” If you do a Google search for“catastrophizing,” it tells you that it is“aRead more …Fibromyalgia is not a trash can diagnosis originally appeared inKevinMD.com. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - June 2, 2022 Category: General Medicine Authors: < span itemprop="author" > < a href="https://www.kevinmd.com/post-author/margaret-macdonald" rel="tag" data-wpel-link="internal" > Margaret Macdonald, MD < /a > < /span > Tags: Conditions Rheumatology 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
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
Trial By Error: My Exchange of Letters on Amygdala Retraining; That Undead Lightning Process Study
By David Tuller, DrPH Earlier this week, I wrote to Helena Liira of the Helsinki University Central Hospital about a new trial of “amygdala and insula retraining” for so-called “functional disorders”—fibromyalgia and irritable bowel syndrome along with ME/CFS and long Covid. (I critiqued the trial here.) In particular, I wondered how the investigators justified use […] (Source: virology blog)
Source: virology blog - February 10, 2022 Category: Virology Authors: David Tuller Tags: Uncategorized amygdala Finland functional disorders Source Type: blogs
Food Intolerances: A Warning of Bad Things Ahead
I’ve recently discussed how the majority of food intolerances, whether to FODMAPs, histamine, nightshades, fructose, etc., are really manifestations of dysbiosis and SIBO. Here is another way to view these phenomena: Food intolerances are your body’s signal to you that serious deterioration in your health is coming.
In other words, if all you do is choose to reduce or eliminate the offending food, you are still left with the massive disruption of your intestinal microbiome that caused the food intolerance in the first place, along with increased intestinal permeability and endotoxemia. So say you eliminate ferm...
Source: Wheat Belly Blog - November 1, 2021 Category: Cardiology Authors: Dr. Davis Tags: Open microbiota prebiotic probiotic sibo small intestinal bacterial super gut undoctored wheat belly 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
“This Doesn’t Usually Hurt that Much”: Patients With Fibromyalgia Spectrum Disorder
By HANS DUVEFELT
Specialists in orthopedics and general surgery often want us, the primary care doctors, to manage postoperative pain. I don’t like that.
First, I don’t know as much as the surgeons about the typical, expected recovery from their procedures. My own appendectomy in Sweden in 1972 was an open one that I stayed in the hospital for several days for (and nobody mentioned that there were such things as pain medications). I’m sure a laparoscopic one leaves you in less pain, but I don’t personally know by how much.
Postoperative pain could be an indicator of complications. Why would a surgeon not w...
Source: The Health Care Blog - August 6, 2021 Category: Consumer Health News Authors: Christina Liu Tags: Medical Practice Physicians Primary Care fibromyalgia spectrum disorder Hans Duvefelt Source Type: blogs
