Clinical reasoning and why models of low back pain need to be integrated
Clinical reasoning has been defined as “the process by which a therapist interacts with a patient, collecting information, generating and testing hypotheses, and determining optimal diagnosis and treatment based on the information obtained.” (thanks to https://www.physio-pedia.com/Clinical_Reasoning#cite_note-Higgs-1). The model or lens through which we do these processes naturally has a major influence on our relationship with the person, the information we think is relevant, the hypotheses we develop, and ultimately the problems we identify and how we treat them. No arguments so far, yes?
So when we come to t...
Source: HealthSkills Weblog - April 22, 2018 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: ACT - Acceptance & Commitment Therapy Assessment Back pain Clinical reasoning Low back pain Pain conditions Professional topics Research Science in practice biopsychosocial pain management Source Type: blogs
Yoga for people with back pain
Whenever my lower back gets tight (which happens more often than not after being glued to my work chair for hours on end), I sit on the floor and slowly move into my favorite yoga pose: half lord of the fishes, also known as a seated spinal twist. Just a twist to the left and right never fails to restore my sore back.
Yoga is one of the more effective tools for helping soothe low back pain. The practice helps to stretch and strengthen muscles that support the back and spine, such as the paraspinal muscles that help you bend your spine, the multifidus muscles that stabilize your vertebrae, and the transverse abdominis in th...
Source: Harvard Health Blog - April 14, 2018 Category: Consumer Health News Authors: Matthew Solan Tags: Back Pain Yoga Source Type: blogs
Neurostimulation Enhanced by Digital Health: Interview with CEO of NeuroMetrix
Neurostimulation has the capacity to stop pain signals from traveling up to the brain, but to mask the pain effectively and for long periods of time clinicians have turned to implants. That is because conventional TENS (Transcutaneous Electrical Nerve Stimulation) devices don’t have the strength and focus to comfortably quell pain in long intervals.
NeuroMetrix, a publicly traded company based in Waltham, MA, has developed technologies that overcome many of the limitations of TENS devices, allowing the firm’s main product, the Quell Wearable Pain Relief device, which we tested out a few years ago, to fight pain...
Source: Medgadget - April 4, 2018 Category: Medical Devices Authors: Editors Tags: Exclusive Medicine Orthopedic Surgery Pain Management Source Type: blogs
America's War on Pain Pills Is Killing Addicts and Leaving Patients in Agony - Reason.com
Craig, a middle-aged banking consultant who was on his school ' s lacrosse team in college and played professionally for half a dozen years after graduating, began developing back problems in his early 30s. " Degenerative disc disease runs in my family, and the constant pounding on AstroTurf probably did not help, " he says. One day, he recalls, " I was lifting a railroad tie out of the ground with a pick ax, straddled it, and felt the pop. That was my first herniation. "After struggling with herniated discs and neuropathy, Craig consulted with " about 10 different surgeons " and decided to have his bottom three vertebrae ...
Source: Psychology of Pain - March 23, 2018 Category: Anesthesiology Source Type: blogs
10 Health Benefits of Daily Exercise
“A bear, however hard he tries, grows tubby without exercise.” – A. A. Milne
You don’t need to knock yourself out at the gym each day to reap the many health benefits of daily exercise. With simple planning and a determination to engage in a healthier lifestyle, you can add easy stints of exercise to your schedule without breaking too much of a sweat. Best of all, you may realize some of these 10 health benefits of daily exercise.
Exercise elevates your mood
When you are physically active, it stimulates brain chemicals that make you feel better and lifts your mood. Some experts say that exercise of any intensity, s...
Source: World of Psychology - March 21, 2018 Category: Psychiatry & Psychology Authors: Suzanne Kane Tags: Habits Health-related LifeHelper Self-Help Source Type: blogs
One way of using a biopsychosocial framework in pain management – vi
I could write about a BPS (biopsychosocial) model in every single post, but it’s time for me to explore other things happening in the pain management world, so this is my last post in this series for a while. But it’s a doozy! And thanks to Eric Bowman for sharing an incredibly relevant paper just in time for this post…
One of the problems in pain management is that there are so many assessments carried out by the professionals seeing a person – but very little discussed about pulling this information together to create an overall picture of the person we’re seeing. And it’s this aspect ...
Source: HealthSkills Weblog - February 18, 2018 Category: Anesthesiology Authors: adiemusfree Tags: Assessment Back pain Clinical reasoning Low back pain Pain conditions Professional topics Research Science in practice biopsychosocial disability function Health healthcare pain management rehabilitation Therapeutic approache Source Type: blogs
Think twice before tapering opioids in some patients
Bill is a 58-year-old male with a history of head and neck cancer as well as chronic low back pain who presents to his new primary care doctor for a routine checkup and visit for a medication refill. He works in construction and has been on chronic opioid therapy after his cancer — with a stable dose of 15 mg of oxycodone for over five years.
At his new primary care visit, after a few meet and greet pleasantries, his new primary care doctor discusses his current medication regimen with him — ibuprofen 400mg TID and oxycodone 15mg BID. His physician expresses significant concern with his medication regimen, telling Bill...
Source: Kevin, M.D. - Medical Weblog - February 4, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/casey-grover-and-lee-goldman" rel="tag" > Casey Grover, MD and Lee Goldman, MD < /a > Tags: Conditions Oncology/Hematology Source Type: blogs
One way of using a biopsychosocial framework in pain management – iv
And yes! There’s more to this series of posts on how I use a biopsychosocial model in practice!
Today’s post is about moving from a conceptual model to a practical model, or how we can use research in our clinical reasoning.
A biopsychosocial model (BPSM) as envisaged by Engel was a framework for clinicians to think about why this person is presenting in this way at this time (and what may be maintaining their situation), as well as what could be done to reduce distress and disability. Engel wanted clinicians to go beyond disease processes, isolated from the people experiencing them, and to explore aspects of h...
Source: HealthSkills Weblog - February 4, 2018 Category: Anesthesiology Authors: adiemusfree Tags: Chronic pain Clinical reasoning Coping strategies Pain conditions Professional topics Research biopsychosocial disability function Health healthcare Low back pain pain management Therapeutic approaches Source Type: blogs
Mind games during the 2ww
A patient sent me this queryThis is our first icsi cycle and am on 5th day of embryo transfer. Initially had cramps and it raised a bit more but since yesterday night I see no symptom and I am worried. Plus sometime bloating, my breasts has been so hard and am feeling I have been bit more aggressive than usual , am not on complete bed rest but tend to roam in home only . Medicines include progynova, ecoflora , folic acid and vitamin tablets , progesterone injection- aquagest alternative days and some progesterone vaginally daily two times. My skin is so so dry . I heard people saying tat u should get lower back pain or leg...
Source: Dr.Malpani's Blog - January 31, 2018 Category: Reproduction Medicine Source Type: blogs
Acupuncture for headache
It is easy to ridicule a 2000-year-old treatment that can seem closer to magic than to science. Indeed, from the 1970s to around 2005, the skeptic’s point of view was understandable, because the scientific evidence to show that acupuncture worked, and why, was weak, and clinical trials were small and of poor quality.
But things have changed since then. A lot.
Thanks to the development of valid placebo controls (for example, a retractable “sham” device that looks like an acupuncture needle but does not penetrate the skin), and the publication of several large and well-designed clinical trials in the last decade, we ha...
Source: Harvard Health Blog - January 25, 2018 Category: Consumer Health News Authors: Helene Langevin, MD Tags: Complementary and alternative medicine Headache Health Pain Management Source Type: blogs
Forget the PC police and telemedicine: Give your patient a hug
Today, the public has criticized health care as too high in technology and too low in touching. Computers take patients’ histories, provide a differential diagnosis, supply educational materials and even submit a bill for the services that we render. A new specialty — telemedicine — offers health care service to rural areas that were previously underserved or couldn’t afford the latest diagnostic technology. Telemedicine, a technology in its infancy, offers improved access to care, greater efficiency in diagnosis and treatment, improvement in productivity. Although telemedicine technology is accepted by patients, o...
Source: Kevin, M.D. - Medical Weblog - January 23, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/neil-baum" rel="tag" > Neil Baum, MD < /a > Tags: Physician Primary Care Source Type: blogs
One way of using a biopsychosocial framework in pain management – ii
Last week I discussed case formulation as one way of using a biopsychosocial framework in pain management, and I reviewed Benedetti’s description of the process of becoming aware that something’s wrong, seeking relief from that discomfort, then the “meet the therapist moment”, and finally the “receiving the therapy” steps along the way. Benedetti considers this within a neurobiological model (Benedetti, 2013), while Engel (1977) used general systems theory to frame his critique of the original biomedical model.
This week I want to look at a behavioural model. I do this partly because I t...
Source: HealthSkills Weblog - December 17, 2017 Category: Anesthesiology Authors: adiemusfree Tags: Assessment Clinical reasoning Pain Pain conditions Professional topics Research Science in practice biopsychosocial Chronic pain Health Low back pain Psychology Source Type: blogs
What to do for stubborn low back pain
A while back, I covered the updated evidence-based treatment guidelines for acute (less than four weeks) and subacute (less than twelve weeks) low back pain. I promised a post on chronic (more than twelve weeks) back pain.
Well, as I write this, I am suffering from a recurrence of my own low back pain, which radiates down my right leg at times. This has been literally and figuratively a pain in my rear end, for years.
Being a doctor who practices what I preach, I am putting all the advice I dispense to good use.
First, look for possible triggers
This fall, I had gotten away from my regular core-strengthening routine (night...
Source: Harvard Health Blog - December 7, 2017 Category: Consumer Health News Authors: Monique Tello, MD, MPH Tags: Back Pain Health Pain Management Source Type: blogs
Minding your body: Interoceptive awareness, mindfulness and living well
This study aimed to establish the relationship between various items on two questionnaires used to measure IA and DM: the MAIA (Multidimensional Assessment of Interoceptive Awareness), and the FFMQ (Five Facet Mindfulness Questionnaire). The paper itself discusses the first measure as empirically derived and confirmed by focus groups, and having associations with less trait anxiety, emotional susceptibility and depression – in other words, high scores on this measure (awareness of body sensations and judging those sensations) are associated with important factors influencing our wellbeing. The second measure is descr...
Source: HealthSkills Weblog - November 26, 2017 Category: Anesthesiology Authors: adiemusfree Tags: ACT - Acceptance & Commitment Therapy Chronic pain Clinical reasoning Coping strategies Pain conditions Professional topics Resilience Science in practice biopsychosocial Health mindfulness self management Therapeutic approaches Source Type: blogs
Prescribe exercise like you prescribe medicine
We have all seen and heard the story: a patient who is overweight and has heart problems (or arthritis, diabetes, low back pain or any number of other chronic conditions) is told by their doctor that they need to exercise.
The patient agrees, “Yes, I really will try to start an exercise program.”
Six months later, the patient is back in the doctor’s office, and the conversation goes something like this:
“Well, I started going to the gym, but it really didn’t help.”
OR
“I started walking around my neighborhood, but the kids, work or any number of other life factors impeded the program.”
OR
“I did try to ex...
Source: Kevin, M.D. - Medical Weblog - November 17, 2017 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/nicole-l-stout" rel="tag" > Nicole L. Stout, DPT < /a > Tags: Conditions Cardiology Primary Care Source Type: blogs
