Complexity and chronic pain*
*Persistent didn’t alliterate so well!
I’ve been pondering what makes persistent pain so complicated? What is it about this problem that means clinicians use terms like ‘heart-sink’, or ‘problematic’, or ‘difficult’ when they talk about people living with pain?
While nociception and all the associated neurobiological processes associated with pain are undoubtedly complex (and poorly understood), I don’t think this is what people mean when they describe chronic pain is complex. After all, there are loads of body systems and disease processes that are complex.
I...
Source: HealthSkills Weblog - April 7, 2024 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Chronic pain Professional topics Science in practice healthcare pain management Source Type: blogs
Pain Practice Support from Occupational Therapy Australia
This is a landing page for pain resources from Occupational Therapy Australia – click (Source: HealthSkills Weblog)
Source: HealthSkills Weblog - March 11, 2024 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Uncategorized Source Type: blogs
“ Exercise ” – what does it do for people living with persistent pain?
No, I’m not going to assemble a bunch of papers and point out the effect sizes of exercise on pain and disability! In fact, I’m not even going to point to much research in this post. I want to pose some questions and put some thoughts out for discussion.
See, the people I’ve seen over the years who live with pain have, by and large, not been great ‘exercisers’ before their pain came on, and many haven’t really changed their lifestyle a heap since their pain either. In fact, there is research showing that people with chronic pain don’t change the overall quantity of their activit...
Source: HealthSkills Weblog - March 10, 2024 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Assessment Chronic pain Clinical reasoning Occupational therapy Physiotherapy Psychology Resilience Science in practice Health Research Source Type: blogs
ACT plus exercise, vs exercise alone …
and what a shame there was no ACT alone group…
No secret here, I like ACT (Acceptance and Commitment Therapy) as an approach for living well with chronic pain. I like it for many reasons, but probably the most compelling ones are that the hierarchy between therapist and person living with pain is minimised (we’re both humans finding our way through life) and that it doesn’t require the person to delve into challenging or disputing thoughts – this in turn enhances adherence to the core elements of ACT: living a life aligned with what really matters to this person. People seem to find using ACT mor...
Source: HealthSkills Weblog - March 3, 2024 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: ACT - Acceptance & Commitment Therapy Chronic pain Pain conditions Physiotherapy Professional topics Psychology Research Science in practice pain management Therapeutic approaches Source Type: blogs
Living with pain is social: The Chronic Pain Couple book review
Over the past year or so I’ve kept returning to ‘the social’ part of our multifactorial pain experience.* Pain can be extraordinarily isolating, and our current sociopolitical emphasis maintains a focus on ‘what the individual should do.’ In New Zealand, our accident compensation legislation is a no-fault, 24/7 everywhere, all-the-time innovation but it falls short in critical areas. One is the continued focus on ‘physical findings’ to validate a diagnosis (and to show that the resultant impact on an individual is entirely due to a personal injury caused by accident), and the other...
Source: HealthSkills Weblog - February 25, 2024 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Chronic pain Coping strategies Professional topics Health pain management Therapeutic approaches Source Type: blogs
The difficult balance between evidence-based healthcare … and person-centred self-management
For decades I’ve been an advocate for evidence-based healthcare because the alternative is ’eminence-based healthcare’ (for healthcare, read ‘medicine’ in the original!). Eminence-based healthcare is based on opinion and leverages power based on a hierarchy from within biomedicine (read this for more!). EBHC appealed because in clinical practice I heard the stories of people living with chronic pain who had experienced treatment after treatment of often invasive and typically unhelpful therapies, and EBHC offered a sifting mechanism to filter out the useless from the useful.
Where has EBHC...
Source: HealthSkills Weblog - February 18, 2024 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Chronic pain Clinical reasoning Coping strategies Pain conditions Professional topics Research Science in practice pain management Therapeutic approaches Source Type: blogs
Circling back to supported self-management
I’ve been writing a bit about supported self-management over the last few months. Partly because it’s topical given that medications and exercise offer very small reductions in pain and disability, and people do have lives outside of swallowing a pill and doing 3×10 reps! And partly because it is what we end up doing. It is the bulk of what people living with pain use to have lives.
Self-management refers to a broad range of strategies people with pain use in their daily lives to help them live well. I’m aware of the multiple definitions that exist for self-management, and that the level of agreem...
Source: HealthSkills Weblog - February 11, 2024 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Chronic pain Coping strategies Pain conditions Professional topics Research Science in practice biopsychosocial Health self-management Source Type: blogs
Guarding and flow: an observational study
This study is an observational study of physiotherapists watching videos of people with chronic low back pain doing movements. The movements are pretty decontextualised (ie they’re not integrated with everyday life activities) but they are the kinds of movement that people can find difficult. They were: reaching forward with arms horizontal in standing position (reach forward), bending down towards the toes in standing position (forward-bend), standing from sitting stand), and sitting from standing (stand-to-sit). The videos were of 10 people with low back pain, and were chosen from a larger set of 16 people all perf...
Source: HealthSkills Weblog - February 4, 2024 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Assessment Chronic pain Clinical reasoning Coping strategies Low back pain Physiotherapy pain management Research Source Type: blogs
Book review: Your Pain Playbook by Helen Roome
There is an enormous missing link in pain management today. That link is, as I see it, how to translate from theory (decontextualised ideas) to daily life. To my life, to your life, to the unique and varied lives people living with pain had before their pain arrived.
Your Pain Playbook is written by Helen Roome, pain occupational therapist living and working in South Africa. The South African vibe runs through her book, giving this Kiwi a lovely taste of Helen’s country via the metaphors she uses – ever heard of the ‘Go-away bird’? It’s a bird that warns impala of impending danger and Hele...
Source: HealthSkills Weblog - January 28, 2024 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Book reviews, site reviews Coping strategies Chronic pain Occupational therapy pain management Source Type: blogs
The words we use to talk about pain
Are you a ‘pain sufferer’? A ‘pain warrior’? A ‘pain victim’? Do you ‘ache’ or is it a ‘stabbing’ pain? Do you even know what ‘lancinating’ means?
And let’s add in: are you a ‘catastrophiser’? Has your pain been developed through ‘chronification’? Is your body ‘unbalanced’ or ‘asymmetrical’? Do you ‘comply’ or ‘adhere’? Are you ‘motivated’?
The ways we talk about pain are weird! We blithely use words, us clinicians and researchers (and yes, people with pain)...
Source: HealthSkills Weblog - January 21, 2024 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Assessment Chronic pain Clinical reasoning Professional topics Resilience/Health Science in practice biopsychosocial healthcare Source Type: blogs
Self-management skills we don ’ t often discuss
I’m back from my summer break (I’m in Aotearoa/New Zealand – we shut down over Christmas/New Year just like the US and UK do over July/August!), and I want to begin with a cracker of a topic: medication management!
Now I am not a prescriber. I don’t hold any ability to write prescriptions of any kind, not even exercise ;-). Yet most of the people I’ve seen in clinical practice have started their journey living with pain by being prescribed medications.
All medications have side effects, true effects (well… maybe), adverse effects, and the human factor: taking them in the way that o...
Source: HealthSkills Weblog - January 14, 2024 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Chronic pain Coping strategies Research Science in practice pain management self-management Therapeutic approaches Source Type: blogs
Self monitoring – focusing on pain too much? or an essential part of living with pain?
I was just a tiny bit surprised when I looked at the results of my self-management strategy survey: self monitoring was smack bang in the middle of the list! Take a look yourself –
Self monitoring is not something we discuss much in pain management circles. It’s like ‘Oooh if you keep noticing your pain you’re fixating on it and that’s bad!’ and yet I suspect it forms part of the background interoceptive awareness that most of us do whether we live with pain or not.
Let’s take a deeper look at it.
The ‘definition’ I used was ‘noticing your pain i...
Source: HealthSkills Weblog - December 17, 2023 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Coping Skills Coping strategies biopsychosocial Chronic pain interoception pain management Research Therapeutic approaches Source Type: blogs
Self-management skills that are not top of the pops
When I carried out my informal survey of the pain self-management skills people had used in the past week, there were no real surprises. Movement, activity management (pacing – and I will have more to say about this in a couple of weeks!), sleep, attention management and doing something fun were all at the top of the list. Others were lower down and while they don’t get to shine as much, I’m not so sure they are as seldom used as this wee survey suggests.
At the bottom of the list is having hands-on treatment for relaxation or to feel good. OK, perhaps understandable because the whole ongoing debat...
Source: HealthSkills Weblog - December 10, 2023 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Chronic pain Coping strategies Occupational therapy Psychology Research Resilience/Health Science in practice assertiveness Clinical reasoning pain management Therapeutic approaches Source Type: blogs
“ S/he ’ s just not taking the message on board ” – A word to clinicians
I’ve heard it many times, probably said it myself some years back. You’ve presented an idea to the person, but they just don’t seem to be ‘getting it.’ What to do, what to do?
The context of this kind of problem is often when someone’s pain isn’t settling down, or when some kind of self-management strategy is being recommended. To the clinician, the message is probably quite logical: “Here’s some information about pain that I am telling you about” and the unspoken assumption is that the person ought to listen carefully, maybe ask some questions, but essentially...
Source: HealthSkills Weblog - December 4, 2023 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Back pain Chronic pain Clinical reasoning Coping Skills healthcare Occupational therapy pain management Therapeutic approaches Source Type: blogs
What are the most commonly used pain self-management strategies?
This study also demonstrates how novel interventions can be examined in groups with small numbers, but still allowing us to measure important changes. As an exploratory design, single case study design replicated with several participants is a method we need to use more.
In a systematic review and meta-analysis, Blasco-Belled and colleagues (2023) found that positive psychology interventions do enhance positive affect and reduce anxiety but didn’t alter depression. There were not many studies included in this analysis suggesting that we still have a hang-up on promoting joy and compassion and all the good things i...
Source: HealthSkills Weblog - November 26, 2023 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Chronic pain Clinical reasoning Coping Skills Coping strategies Occupational therapy Resilience Resilience/Health Science in practice biopsychosocial pain management Research Therapeutic approaches Source Type: blogs
