MedWorm provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest medical blog items that have been tagged with 'chronic pain'. Sat, 03 Sep 2011 01:59:53 +0100 http://www.medworm.com/index.php?rid=5182094&cid=t_102545_129_f&fid=36035&url=http%3A%2F%2Fwww.everydayhealth.com%2Fblog%2Flife-with-chronic-pain%2Fhow-dry-i-am-day-to-day-life-with-sjogrens-syndrome%2F Many of us who live with autoimmune diseases wonder how many different ones we can have. Sometimes they seem to be piling up on us in a world in which one usually has one disease, we can have several. There are times they “bleed” into each other like sand art when the tide rises and life can become very confusing. There is something about we mere mortals that drives us on to find a name for our suffering. Usually, we know something is wrong long before we get a label from a doctor. It often involves seeing many physicians and hearing their guesses as to what we have wrong with us. Each of them cannot know everything but the good ones do know what to do about it when they don’t know; they send you to a specialist. We keep the appointments because, secretly, we need to know our sym... Life with Chronic Pain blogs http://www.medworm.com/rss/comments.php?id=5182094 Fri, 02 Sep 2011 14:42:14 +0100 5182094 http://www.medworm.com/index.php?rid=5159490&cid=t_102545_129_f&fid=36035&url=http%3A%2F%2Fwww.everydayhealth.com%2Fblog%2Flife-with-chronic-pain%2Fwelcome-to-the-human-condition%2F Sometimes life comes at us with such force, surprise and ruthlessness, it stuns us. I don’t have any more answers than you do but I do have it whacking me in the face or elsewhere, every day of my life. I know if you’re reading this, you do, also. This week has been a good example of that as so much is going on in our little world as well as the impending danger for millions of Americans facing a hurricane in the east. Let me use yesterday as an example. Jim, my dear man, who had just returned from a trip to California on family business had missed his flight because the hotel did not give him the wake-up call he had requested. While he was in CA he went to visit an old friend many miles from where he was staying to discover that old friend’s wife had been found dead tha... Life with Chronic Pain blogs http://www.medworm.com/rss/comments.php?id=5159490 Thu, 25 Aug 2011 22:04:24 +0100 5159490 http://www.medworm.com/index.php?rid=5159895&cid=t_102545_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F08%2F23%2Fself-management-a-very-vexing-definition%2F Self management is one of those terms that is used to describe the aim of cognitive behavioural programmes for chronic pain. It’s even in my description of this blog! At the same time, it’s difficult to arrive at a definition of self management that “everyone” agrees upon. Self management can mean helping people to be “actively involved in their health care and to provide a variety of creative and individualized strategies to deal with their health problem in their daily life and ultimately to live as normally as possible despite their symptoms” (Zuffery & Schulz, 2009) – but the Devil is in the details! What exactly does being “actively involved” mean?  Can it mean accessing treatments like massage, injections, acupuncture &#8220... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=5159895 Mon, 22 Aug 2011 19:21:38 +0100 5159895 http://www.medworm.com/index.php?rid=5140055&cid=t_102545_129_f&fid=36035&url=http%3A%2F%2Fwww.everydayhealth.com%2Fblog%2Flife-with-chronic-pain%2Fthe-public-you-versus-the-private-you-in-a-life-of-chronic-pain%2F Early on in a life of chronic pain we learn to guard ourselves against being hurt by callous comments from others. We say, “I’m fine, thanks.” What we’re really thinking is, “If only you knew, even as I stand here my knees are buckling, my rear is throbbing and I’m trying to concentrate on what you’re saying. I don’t think you could handle the truth and I don’t want to see that cold dead look come into your eyes if I dump the truth on you.” We ask the checker at the supermarket to keep our cloth bags light; which we bring with us because we’re “green” citizens and because the plastic bags will leave our fingers numb for the rest of the day. We continue to watch as the checker puts a five-pound bag of sugar and a five-pound bag of flour topped off by a half gallon ... Life with Chronic Pain blogs http://www.medworm.com/rss/comments.php?id=5140055 Thu, 18 Aug 2011 22:15:36 +0100 5140055 http://www.medworm.com/index.php?rid=5140334&cid=t_102545_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F08%2F18%2Feducation-or-a-cognitive-behavioural-approach%2F In this study by Day, Thorn & Kapoor, the two approaches were used with a group of people from a rural area, with relatively low socio-economic status, and a reading grade level of about 8.  Both groups received a group-based programme of 10 sessions of 90 minutes.  They both received a workbook and additional reading material.  The CBT group had home-learning and also participated in behavioural activities such as relaxation in-session, while the education group did not. Interestingly, this study presents qualitative information on how participants experienced the sessions, rather than outcomes measures, so it’s difficult to establish whether pain, disability, mood or acceptance were influenced.  Instead it presents thematic analysis from in-depth interviews of the participa... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=5140334 Wed, 17 Aug 2011 19:35:42 +0100 5140334 http://www.medworm.com/index.php?rid=5139737&cid=t_102545_87_f&fid=39187&url=http%3A%2F%2Fdrlindagalloway.files.wordpress.com%2F2011%2F08%2F803342_pills_1.jpg A nurse recently asked a very important question that bears repeating: What effect does long-term use of pain pills have on pregnant women? She was concerned because of the increase in number of pregnant women who are taking pain pills on a long term basis based on previous surgeries, accidents or a history of chronic pain. The most common “pain pills” prescribed are opiates which effectively eliminate or reduce pain but have a great tendency to be abused. Opioids are natural and synthetic type drugs that have the characteristics of morphine. It can only be obtained with a prescription and unfortunately physicians contribute to the problem of dependency and abuse through their lack of scrutiny regarding patient requests. My present home state of Florida has the unsavory distinction of ... Better Health blogs http://www.medworm.com/rss/comments.php?id=5139737 Wed, 17 Aug 2011 19:00:46 +0100 5139737 http://www.medworm.com/index.php?rid=5139880&cid=t_102545_109_f&fid=34750&url=http%3A%2F%2Fpsychcentral.com%2Fblog%2Farchives%2F2011%2F08%2F16%2Fbest-of-our-blogs-august-16-2011%2F Our society has an unshakeable desire to be “normal.” Whatever normal means. In fact, I have forsaken my own truth at times, because the idea of being normal, problem-free, low-maintenance, unencumbered by illness or age seemed too attractive not to embrace. But the fact is whether you’re dealing with chronic pain, physical or mental illness, financial issues or weight gain, being free of life and all of its abnormalities is near impossible. Why are we trying to hide ourselves in an effort to be perfect and illness free? I realized this after seeing friends I hadn’t seen in a decade. While at first burdened that my life had veered too far from normal (in both my personal and professional choices), I finally had to laugh at myself. I realized that all this pressure t... World of Psychology blogs http://www.medworm.com/rss/comments.php?id=5139880 Tue, 16 Aug 2011 11:37:01 +0100 5139880 http://www.medworm.com/index.php?rid=5118830&cid=t_102545_129_f&fid=36035&url=http%3A%2F%2Fwww.everydayhealth.com%2Fblog%2Flife-with-chronic-pain%2Fthe-view-from-both-sides-of-the-sheets%2F As an RN of 35 years, I have always been fascinated by the way people embrace or reject their physical frailties. There is so much diversity in the way each of us responds to pain, disease, life and death. I’ve seen large men fall to the ground in a faint while getting an injection and held down screaming children while they received treatment or a simple exam. I wonder when we learn to be submissive and decide “it’s for your own good?” The truth is sometimes it is good care, sometimes it isn’t. A good, principled nurse or doctor knows the difference. Just ask one of us who we would let treat us or a member of our family. At the same time we are either participants in our care or we shift into neutral and expect someone else to make our decisions for us. Those of us who have stru... Life with Chronic Pain blogs http://www.medworm.com/rss/comments.php?id=5118830 Thu, 11 Aug 2011 20:38:21 +0100 5118830 http://www.medworm.com/index.php?rid=5119027&cid=t_102545_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F08%2F12%2Fnot-just-neural-plasticity-health-system-plasticity%2F In chronic pain management there seems to be a pretty consistent pathway for people to finally get to interdisciplinary treatment.  First a referral from the primary care physician or GP to one or more specialist medical people – maybe an orthopaedic surgeon, or a rheumatologist, or a psychiatrist, or a neurologist.  This person will carry out investigations, get the results, make a determination that the problem is “not theirs” – and suggest some kind of management, or a referral to another kind of orthopaedic surgeon, or a rheumatologist, or a psychiatrist, or a neurologist… who will repeat the same. Finally, after many investigations and referrals and consultations, around 3 years later, the person makes it to a chronic pain management centre.  (btw I am... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=5119027 Thu, 11 Aug 2011 20:17:04 +0100 5119027 http://www.medworm.com/index.php?rid=5119028&cid=t_102545_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F08%2F10%2Flow-mood-and-catastrophising-one-is-bad-two-is-worse%2F This study shows that irrespective of the measures used to identify catastrophising and low mood in people with chronic pain, there is an increased risk of disability in people who have both problems, and more importantly, this is now shown in three different countries.  While the total number of participants isn’t enormous (in the 100′s rather than 1000′s), it is still a significant finding.  It also shows that having catastrophising is potentially a more problematic issue than simply having low mood. What should we learn from this? I think it’s critical that treatment providers working with those who have subacute musculoskeletal problems routinely assess (or at least screen for) the presence of catastrophising.  While low mood is troublesome, it seems to have ... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=5119028 Tue, 09 Aug 2011 19:16:48 +0100 5119028 http://www.medworm.com/index.php?rid=5096786&cid=t_102545_129_f&fid=36035&url=http%3A%2F%2Fwww.everydayhealth.com%2Fblog%2Flife-with-chronic-pain%2Fgardening-in-the-dark%2F Oh yes, it’s true. I do garden in the dark. It does sound a bit dangerous, I’ll grant you that, but it’s not exactly brain surgery or nuclear fission. The only victims might be a live yellow daisy, “dead headed” in error. I do take pity on these victims and bring them indoors and stick them in a small vase, poor things. I do have the guidance of a porch light and a couple of solar powered “rock” lights. Twilight is actually the best time because I can still enjoy the view, there is usually a cool breeze whipping up from the Columbia River and there are no dangerous UVA/UVB rays to worry about. This strange behavior became necessary, for me, many years ago when I first began to have pain in my sitter, fatigue and skin rashes on any area where the sun struck me. I was completel... Life with Chronic Pain blogs http://www.medworm.com/rss/comments.php?id=5096786 Fri, 05 Aug 2011 15:03:03 +0100 5096786 http://www.medworm.com/index.php?rid=5097140&cid=t_102545_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F08%2F02%2Fmore-managing-migraines-without-medication%2F Anyone familiar with migraine will know the first signs of an impending attack. What might be a little less familiar is the precursor to the “first signs”, and what may also be unfamiliar is the thoughts that accompany those first symptoms. Today I want to talk about ways to manage this phase of a migraine – without medication. As an aside, some people have suggested that there are ways to completely get rid of migraine, often suggesting that one of the problems could be around the numerous nerves that innervate the face, neck and scalp. One of the common suggestions is to have chiropractic or osteopathic treatment to “do something” to the nerves in this area. I put the “do something” in quotation marks because I really don’t know what the so... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=5097140 Mon, 01 Aug 2011 18:30:04 +0100 5097140 http://www.medworm.com/index.php?rid=5077886&cid=t_102545_129_f&fid=36035&url=http%3A%2F%2Fwww.everydayhealth.com%2Fblog%2Flife-with-chronic-pain%2Fmy-eyes-tell-me-yes-yes-but%2F There’s “No, No” in my heart and because I’m a slow learner, my body is always telling me I did too much. I don’t believe a day passes without life pitching something in my face which I know my body cannot handle. There is always dirt, dust, laundry, empty shelves and hunger. I’ve learned after many years some parts of my life are gone forever. Others, I have reclaimed in some form or shape but it is all different, changed. I am different because of the many changes in my physical shell which I drag around, also known as my body. I have to always remind myself it’s not the real me. I am my spirit, my love received and given, my laughter and my joy, often in truly bizarre circumstances. Some of us are blessed to be born “smart asses.” Awe, come on, and admit it. Some days ... Life with Chronic Pain blogs http://www.medworm.com/rss/comments.php?id=5077886 Thu, 28 Jul 2011 20:31:56 +0100 5077886 http://www.medworm.com/index.php?rid=5069843&cid=t_102545_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F07%2F26%2Fmanaging-migraines-without-medication%2F Ahhh, migraine – psychedelia without the high… nausea without the alcohol… The diagnostic criteria: A) At least 5 attacks fulfilling B-D; B) lasting untreated 4-74 hours; C) two of the following: unilateral, pulsating, moderate or severe pain intensity, worsening with physical activity; D) one of the following: nausea and/or vomiting, photophobia or phonophobia; E) not attributed to another disorder. (International Classification of headache disorders, 2004) (go here for one of the most comprehensive sites on migraine) The main treatment for migraine is to use medication – best evidence to date suggests:  “Only two pharmacological treatments have been shown to be effective in placebo-controlled randomized trials: topiramate and local injection of botulinum to... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=5069843 Tue, 26 Jul 2011 01:42:59 +0100 5069843 http://www.medworm.com/index.php?rid=5062519&cid=t_102545_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F07%2F25%2Fusing-the-chronic-pain-acceptance-questionnaire%2F Over the past few months I’ve been using the Chronic Pain Acceptance Questionnaire (CPAQ-8) as part of a battery of questionnaires used at intake and outcome measures.  Along with the CPAQ-8, we use the Tampa Scale for Kinesiophobia, the Depression Anxiety Stress Scale, the Pain Anxiety Symptoms Scale, the Pain  Catastrophising Scale, Pain Self Efficacy Questionnaire, and Pain Disability Index. The CPAQ-8 consists of two subscales: Pain Willingness and Activity Engagement.  Together they measure “acceptance” or psychological flexibility associated with chronic pain. Let me pull this apart a bit.  Pain Willingness refers to how prepared a person might be to experience an increase in pain so they can get something important done.  For example, I love to dance and I&#82... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=5062519 Sun, 24 Jul 2011 19:15:16 +0100 5062519 http://www.medworm.com/index.php?rid=5062247&cid=t_102545_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fliving-with-severe-chronic-pain%2F2011.07.24 Living Beyond Pain For people with severe chronic pain like Kelly Young and Teresa Shaffer—both of whom have become patient advocates—coping with agony is a fact of life.  Young suffers from rheumatoid arthritis while Shaffer’s pain is linked primarily to another degenerative bone disease. Chronic pain is one of the most difficult—and common—medical conditions.  Estimated to affect 76 million Americans—more than diabetes, cancer and heart disease combined—it accompanies illnesses and injuries ranging from cancer to various forms of arthritis, multiple sclerosis and physical trauma. Pain is defined as chronic when it persists after an injury or illness has otherwise healed, or when it lasts three months or longer. The experience of pain can vary dramatically, depending in pa... Better Health blogs http://www.medworm.com/rss/comments.php?id=5062247 Sun, 24 Jul 2011 14:00:04 +0100 5062247 http://www.medworm.com/index.php?rid=5050955&cid=t_102545_129_f&fid=36035&url=http%3A%2F%2Fwww.everydayhealth.com%2Fblog%2Flife-with-chronic-pain%2Fcome-sit-in-my-seat-with-me%2F As most of you who read this blog regularly know, I am plagued by sacroiliac joint pain. I have other problems but today, since I am lying here on a painful behind and have been intensely trying to get out of this current flare, it is on my mind. I thought you might be interested in knowing what life is like in my shoes, my seat and my life right now. It’s been almost three months since I flew to California with my daughter to begin the process of cleaning out my mother-in-law’s house. I don’t fly well…at least without my wings. Even on an airplane I am bottom challenged and find them grossly uncomfortable. Three days after flying home I picked up our 31 pound rough-coated Jack Russell, Annie because she couldn’t get into the car to go to the vet’s. The combination of all of t... Life with Chronic Pain blogs http://www.medworm.com/rss/comments.php?id=5050955 Thu, 21 Jul 2011 20:27:49 +0100 5050955 http://www.medworm.com/index.php?rid=5036612&cid=t_102545_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F07%2F18%2Fwhat-matters-patient-determined-outcomes-and-clinicianresearcher-outcomes%2F It’s easy to forget, sometimes, that when we choose an outcome measure, we need to seriously consider who will use the measures in the end.  Of course, I am assuming that we’re all using outcome measures – we are, aren’t we?  If anyone isn’t, shame on you – how on earth will you establish whether what you’re doing is having an effect? And don’t come at me with “oh but I just ask them” because I don’t want to have to list all the response bias, demand characteristics, and lack of consistency problems again. kthx. Anyway, where was I? That’s right, the end-user in outcome measures.  Over the past few years, interest has risen in identifying the range of outcome measures that can be/should be used in research of treatm... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=5036612 Sun, 17 Jul 2011 19:30:31 +0100 5036612 http://www.medworm.com/index.php?rid=5028749&cid=t_102545_129_f&fid=36035&url=http%3A%2F%2Fwww.everydayhealth.com%2Fblog%2Flife-with-chronic-pain%2Flife-may-be-weird-but-you-dont-have-to-be%2F Those of us who live with chronic pain each day have many choices to make. I know from first hand or should I say my “First Tushy” experience that we all feel helpless and robbed of choices more times than not, but that isn’t totally true. I realize “First Tushy” doesn’t have quite the elevation of First Lady but there you have it; my life. We are not mere victims. We remain the pilots of our planes as well as the captains of our own ships. I know we often have our doubts. We feel more enslavement than freedom; more the conquered than the victors and finally, hopelessly weird. I think that’s enough metaphors to choke a good sized horse but I’m certain you sense my direction. Today, after five years of chatting with all of you who also suffer, I would like to share three of ... Life with Chronic Pain blogs http://www.medworm.com/rss/comments.php?id=5028749 Thu, 14 Jul 2011 20:24:47 +0100 5028749 http://www.medworm.com/index.php?rid=5029273&cid=t_102545_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F07%2F12%2Fself-efficacy-and-fear-of-movement-mediate-pain-intensity-and-disability-in-acute-pain%2F Most clinicians working in chronic pain management are well aware that the time it takes for people to finally be referred for management of their pain is far too long and some of the readers of this blog who work with people who have acute pain may wonder whether anything I write about applies to them and the people they treat.  To both groups of readers – today’s post should apply! Arguably the most common reason for people seeing a doctor is because of a musculoskeletal pain.  Treatment is usually quite simple: diagnosis, pain relief, anti-inflammatories and gradual return to function.  It’s this last part of treatment that seems to cause the most trouble for people - what if the pain doesn’t settle, what if I’m damaging my body, how long should I &#8220... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=5029273 Mon, 11 Jul 2011 19:29:01 +0100 5029273 http://www.medworm.com/index.php?rid=5008472&cid=t_102545_129_f&fid=36035&url=http%3A%2F%2Fwww.everydayhealth.com%2Fblog%2Flife-with-chronic-pain%2Flife-can-become-very-weird-living-with-chronic-pain%2F I know. You’re thinking life is weird already but let me say, if you’re newly diagnosed, “You ain’t seen nothin’ yet!” If you are one of us who live with connective tissue or rheumatoid disease you may see a certain set of weirdness. If you suffer from back pain or had a previous injury, you’re not excluded, either. It’s amazing what life can do to twist, shape and torment us. If our diseases or injuries don’t do enough in that department then there are always the medications to take up the slack and pile it on. Get your sense of humor ready and if you don’t have one, well, blessings upon you my friend because you’re going to need one. The other day I was fitted for a sacroiliac belt to aid my sacroiliac joints to stay put. All that was missing at the fitting was Scar... Life with Chronic Pain blogs http://www.medworm.com/rss/comments.php?id=5008472 Thu, 07 Jul 2011 20:13:33 +0100 5008472 http://www.medworm.com/index.php?rid=5008671&cid=t_102545_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2Fi2yELjH7SyI%2F This is a repost from my blog on PsychCentral: There are changes afoot in the use of opioid agonists for chronic pain treatment. This blog has described the epidemic of opioid dependence that has killed tens of thousands of people across the country over the past few years, and the changes are directed toward reducing the harm caused by this epidemic. A number of interventions have been proposed. Vicodin, the number one-selling medication in the country, contains the opioid hydrocodone combined with acetaminophen, the agent in Tylenol. Hydrocodone and Vicodin are currently ‘Schedule III’ medications, and will likely move to Schedule II, where oxycodone, Oxycontin, and Percocet are currently assigned. The change will have significant impact on the use of Vicodin and hydrocodone, since m... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=5008671 Wed, 06 Jul 2011 01:05:01 +0100 5008671 http://www.medworm.com/index.php?rid=4997843&cid=t_102545_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F07%2F04%2F%25e2%2580%259coh-wad-some-power-the-giftie-gie-us-to-see-oursels-as-others-see-us-it-wad-frae-monie-a-blunder-free-us-and-foolish-notion%25e2%2580%259d%2F That quote from Robbie Burns. For such a long time it seems that pain research has focused only on the person having pain and less on the social context where the person is experiencing it. Pain is subjective, personal and private, and the only way I can determine whether someone is in pain is if they’re exhibiting pain behaviours. Some of these behaviours, it’s true, are automatic reflex-driven responses (nocifensive, to be pedantic) – but usually only once the brain determines that the input received is a threat.  And what the brain determines to be threatening depends on a whole lot of things, including what else is going on in the environment. We have numerous pen and paper measures of pain behaviour, but far fewer tools to capture what is one of the most important e... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4997843 Mon, 04 Jul 2011 04:41:12 +0100 4997843 http://www.medworm.com/index.php?rid=4992831&cid=t_102545_129_f&fid=36035&url=http%3A%2F%2Fwww.everydayhealth.com%2Fblog%2Flife-with-chronic-pain%2Fsometimes-life-just-sucks-2%2F Aw come on, you know it’s true. We all have our rotten days and have our own way of getting through the bad times. Life has many hammers, hatchets and boiling oil and can use it all on us; a bad marriage, auto accidents out of the blue and children who screw up their lives and break our hearts. Unfortunately, life is imperfect and yet, we’re always surprised when it whams us in the face. That should tell us hope lives deep within our hearts, whether we’re aware of it or not. Today the particular rotten I would like to talk about is the very personal double whammy of daily pain and disease. We take pills, some of us drink too much alcohol, others become very wretched to be with and sometimes, we just cry. I don’t do all of those but am guilty of most of them. I don’t drink because... Life with Chronic Pain blogs http://www.medworm.com/rss/comments.php?id=4992831 Sat, 02 Jul 2011 02:07:53 +0100 4992831 http://www.medworm.com/index.php?rid=4993017&cid=t_102545_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F07%2F01%2Fwhat-is-this-thing-called-pain%2F As I’m busy writing up research papers for publications to “count” towards my research productivity, I’m reminded of one reason I keep on blogging – and it’s this: blogs are open to anyone.  People can comment on what I write.  When someone comments, whether they agree, disagree, or simply pose a question, it’s an opportunity for dialogue and reflection. That’s not nearly as easy to do in a peer-reviewed journal! As a result of comments from my post yesterday, I’m musing on ways to explain the distinction between acute and chronic pain that will make sense to someone who experiences fluctuations in pain intensity. I think I’m clear in my own mind between the two, but perhaps things are not as distinct as I’ve made them &#8... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4993017 Thu, 30 Jun 2011 21:04:56 +0100 4993017 http://www.medworm.com/index.php?rid=4976238&cid=t_102545_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F06%2F29%2Fblack-and-white-thinking-must-be-abolished%2F Black and white thinking, for those readers unfamiliar with cognitive distortions, refers to the tendency to reduce complex ideas and situations into simple, dichotomous, and mutually exclusive categories. Think of good or bad, yes or no, all correct or all wrong, acute pain or chronic pain, neuromatrix or peripheral mechanisms, cure the pain or manage the pain. It’s a way of simplifying arguments or decisions that can work well when the situation requires very fast decision-making, or where the options are very limited. It doesn’t work at all in the messy and complicated worlds of clinical reasoning, theory development, or in discussions to broaden understanding. I’m pondering this because of the way various aspects of pain management and the science of pain are misrepre... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4976238 Tue, 28 Jun 2011 19:15:22 +0100 4976238 http://www.medworm.com/index.php?rid=4968705&cid=t_102545_129_f&fid=36035&url=http%3A%2F%2Fwww.everydayhealth.com%2Fblog%2Flife-with-chronic-pain%2Fwhere-do-you-find-true-grit%2F It’s often inspiring how life leads us along, licking our wounds which it also inflicted upon us; we love it, we hate it. These last few weeks I have been immersed in the past. I live in a home that is 120 years old and often wonder about those who lived here before we did. Did they love? Did they find joy and survival, together or individually? Did they have physical pain? Surely, they must have because they were without NSAIDs, biologics, acid inhibitors, a local drug store, or a supermarket. I often run across some little remnant of the past presence of one who lived here, like finding an oyster shell working its way out of the foundation outdoors or the aqua blue marine paint that dripped from the brush of an “ancient” mariner who used to live here, many years ago, still trailing... Life with Chronic Pain blogs http://www.medworm.com/rss/comments.php?id=4968705 Fri, 24 Jun 2011 13:08:46 +0100 4968705 http://www.medworm.com/index.php?rid=4945248&cid=t_102545_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F06%2F17%2Fwhat-to-do-about-catastrophising-even-when-youre-not-a-psychologist%2F In this study, 25.9% of those reporting acute pain, and 51.3% of those reporting chronic pain endorsed catastrophising beliefs.  And this group of people were not seeking treatment (as an aside, this is one of few studies to look at non-treatment-seeking people)!  The study also found that in those with high levels of catastrophising, mental health problems were more prevalent, and that catastrophising explained a good proportion of work disability.  In other words, even in this very healthy group of people, catastrophising was associated with greater vulnerability to having difficult managing pain and keeping mentally healthy.  If this finding is identified in other non-treatment-seeking people, I think we can confidently draw the conclusion that catastrophising may be one of the more... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4945248 Thu, 16 Jun 2011 23:24:01 +0100 4945248 http://www.medworm.com/index.php?rid=4934586&cid=t_102545_129_f&fid=36035&url=http%3A%2F%2Fwww.everydayhealth.com%2Fblog%2Flife-with-chronic-pain%2Fsues-patient-rights-responsibilities-and-opportunities%2F You have the right to life as long as you realize it might not be quite as you planned. You have the opportunity to change what you can and accept that which you cannot change. Just remember the word impossible is a relative term. You have the responsibility to seek options, be they health care, marital status or parenthood. All three require early action rather than late. You have the responsibility to judge each situation you face with candor, good judgment, and valor. If you choose not to do the above, you have the right to screw things up. It is your life, after all. You have the responsibility to maintain your body even though it appears to not give a fig about you. Disloyal lot these physical shells. You have the responsibility to remember your brain and your heart are in charg... Life with Chronic Pain blogs http://www.medworm.com/rss/comments.php?id=4934586 Thu, 16 Jun 2011 22:46:43 +0100 4934586 http://www.medworm.com/index.php?rid=4945249&cid=t_102545_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F06%2F15%2Fquick-update-from-earthquake-city%2F The aftershocks seem to have slowed a little, and they are not as powerful so hopefully things will settle down a bit. We still don’t have water, so we’re having to use our emergency stash (60 litres!) and boil it to wash, do dishes etc. Even when the water comes back on, we’ve been advised to boil the water again because there’s damage to the sewers. I feel OK in myself, in that I’m not fearful of the quakes (a bit fatalistic really, but there is so little time to react when a quake hits, there seems little point in being afraid – you can’t do anything!), but I am very tired and not sleeping all that well. I think the difference for people in Christchurch now, compared with the previous two big earthquakes is that the adrenaline rush that was ther... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4945249 Tue, 14 Jun 2011 19:24:23 +0100 4945249 http://www.medworm.com/index.php?rid=4921623&cid=t_102545_129_f&fid=36035&url=http%3A%2F%2Fwww.everydayhealth.com%2Fblog%2Flife-with-chronic-pain%2Fa-life-with-chronic-pain-dont-panic%2F When we are struck with a life of chronic pain, we are terrified, feel forsaken and usually panic. Those who don’t panic are usually in denial and get around to panic later when the fear of the unknown sweeps over them. Today, as usual, I searched my heart and mind to find the helpful ideas which have and do help me everyday of my life. Please, let me list them for you in the hope that you will also find courage, calm and control in your life if you are also facing this monster each day. Gain Control. I know, you feel like your body has betrayed you and after all the great things you did for it, too. Stop asking yourself why this happened to you and look forward. Of course, it might help you to know if it’s genetic, for the sake of your children, but for now, you have to deal with eac... Life with Chronic Pain blogs http://www.medworm.com/rss/comments.php?id=4921623 Fri, 10 Jun 2011 13:20:44 +0100 4921623 http://www.medworm.com/index.php?rid=4911844&cid=t_102545_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F06%2F08%2Fa-brief-review-of-cognitive-behavioural-approaches-for-pain-management%2F Cognitive behavioural approaches for pain management are not exactly the same as cognitive behavioural therapy for mental health problems.  While there are some underlying concepts that are the same, cognitive behavioural approaches for pain management include a wider range of strategies, and are far less readily defined than the very structured approach used in mental health.  In fact it has only been in the last few years that research into the process of change in pain management have been conducted. What defines a cognitive behavioural approach? The assumption that people can learn to accept their chronic pain That people can broaden their self-concept beyond being “a patient” into being “a person with pain” That people can learn or re-explore skills to deal ... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4911844 Wed, 08 Jun 2011 00:39:00 +0100 4911844 http://www.medworm.com/index.php?rid=4893703&cid=t_102545_129_f&fid=36035&url=http%3A%2F%2Fwww.everydayhealth.com%2Fblog%2Flife-with-chronic-pain%2Feveryday-life-with-chronic-back-pain%2F As many of you who have been reading this blog for some time know, I live with sacroiliac joint pain and have for more than twenty years. Those particular joints are the two upon which you place your derriere, hold your two lower cheeks together and keep your legs from falling off. The pain from them often extends into the pubic area, the hips, and the lumbar spine and down the legs. Pain in these regions can have an affect on your bowel and bladder habits as well. Recently, the inflammation of those large joints has, for me, been worse than ever. I share this with you to explain why I have low back pain on the brain today, as well as on my backside. Since I have a brain that tickles easily, I have been remembering an event of many years ago when I was in nursing school. One of my nursing ... Life with Chronic Pain blogs http://www.medworm.com/rss/comments.php?id=4893703 Thu, 02 Jun 2011 22:12:47 +0100 4893703 http://www.medworm.com/index.php?rid=4893948&cid=t_102545_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F06%2F02%2Fcatastrophising-and-pain-ii%2F What are some of the indications that someone tends to catastrophise about their pain? How do we know? Do we have to use a questionnaire? Is it really my job to know about this if I’m not a psychologist – and what do I do about it? These are the kinds of questions that have been posed to me as I’ve explored the topic of catastrophising, and I propose to answer the last question in my next post (sorry to keep stringing you along like this – I think many may know my take on that already!). I work in a wonderful interdisciplinary team setting, in a centre where everyone who attends the Centre gets to complete a set of psychometrically sound questionnaires that all of the team are encouraged to use and interpret, so any of the team can be confident about identifying and... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4893948 Thu, 02 Jun 2011 08:26:50 +0100 4893948 http://www.medworm.com/index.php?rid=4893949&cid=t_102545_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F06%2F01%2Fpain-behaviours-persist%2F In this study by Martel, Thibault and Sullivan (2010), people with back pain were recorded on two separate occasions (on averge 22 days apart) while carrying out two lifting tasks designed to elicit pain behaviours.  These recordings were reviewed by trained observers who recorded the number of pain behaviours in each segment of film using a standardised coding scheme (developed by Keefe and Block, 1982).  Participants in the lifting tasks also completed a range of questionnaires – the Tampa Scale for Kinesiophobia, the McGill Pain Questionnaire, and the Pain Catastrophising Scale. Before I describe the findings, in this study two different forms of pain behaviour were identified – communicative behaviours are things like grimacing, speaking, sighing, moaning and so on; while... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4893949 Wed, 01 Jun 2011 05:26:00 +0100 4893949 http://www.medworm.com/index.php?rid=4883910&cid=t_102545_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2Fiz1T5XSIZzU%2F On May 27th, 2011, actor Jeff Conaway died from complications of opioid dependence. His death has been attributed to several causes—sepsis, pneumonia, and aspiration among them— but there is little debate over the ultimate cause of his death at the age of 60 years, that being addiction to opioid pain medications. Mr. Conaway reportedly struggled with chronic pain and addiction to pain medications for a number of years. His situation was particularly tragic—living with severe pain that was relieved by nothing save for a substance with the power to destroy him. Such situations are, unfortunately, not uncommon. It is easy to take the position that Mr. Conaway should have avoided pain pills; that his addiction essentially disqualified him from even considering them. I will take that atti... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=4883910 Tue, 31 May 2011 15:57:00 +0100 4883910 http://www.medworm.com/index.php?rid=4883925&cid=t_102545_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F05%2F31%2Fcatastrophising-and-pain-i%2F One reason I love blogging is the discussion between me and readers. I wrote about the language of pain recently, and out of that discussion I’ve spent a few days digging around the literature to look at what is known about the relationship between language, pain and catastrophising. I’d argued in my post that metaphoric language can reflect distress both in the communicator and the listener, and that this is supported by fMRI studies in which various parts of the brain are activated when emotion-laden communication about pain is being carried out, while one of my readers thought I might be taking this interpretation too far. Pain behaviour My reason for being interested in how we communicate about pain is that talking about pain (including describing it) is a pain behaviour. P... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4883925 Mon, 30 May 2011 19:15:07 +0100 4883925 http://www.medworm.com/index.php?rid=4872282&cid=t_102545_129_f&fid=36035&url=http%3A%2F%2Fwww.everydayhealth.com%2Fblog%2Flife-with-chronic-pain%2Fdilapidated-me-and-learning-to-rejoice%2F My body is a wreck. My condition, never “mint;” Sometime, when I was gone My body came and went. If I was a horse Irregardless how I cope, I’m certain that by now I’d be a bar of soap. Each time I stand or move I fear parts of me will escape. Since it might be parts I need, Guess I’ll use more tape. I often feel confused How can I look so good? I belong in a dumpster, After all I’ve withstood. If I was a goose, I’d be stark naked A pillow stuffed with down. If I was a waddling white duck My tail would rub the ground. I admit I’m partially in ruins But the part of me that’s left Should shut up, be quiet and Stop feeling so bereft. As long as I draw breath and My heart beats within my breast, I thank God for insurance To restock my medicine chest. It’s easy... Life with Chronic Pain blogs http://www.medworm.com/rss/comments.php?id=4872282 Thu, 26 May 2011 22:13:41 +0100 4872282 http://www.medworm.com/index.php?rid=4847964&cid=t_102545_88_f&fid=38129&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2Flifeinthefastlane%2FWZHV%2F%7E3%2FFNQVKM-g3iQ%2F The mystery of chronic pain highlights an inspiring TED talk by paediatric anaesthesiologist and chronic pain specialist Elliot Krane. (Source: Life in the Fast Lane) Life in the Fast Lane blogs http://www.medworm.com/rss/comments.php?id=4847964 Fri, 20 May 2011 02:52:32 +0100 4847964 http://www.medworm.com/index.php?rid=4821007&cid=t_102545_129_f&fid=36035&url=http%3A%2F%2Fwww.everydayhealth.com%2Fblog%2Flife-with-chronic-pain%2Fchoices-for-good-or-choices-for-evil-its-up-to-you%2F Each day, as mere mortals, we have decisions to make. Choices surround us 24 hours a day. We are assaulted by choices even when we’re asleep. For instance, during the night, are we cold, are we hot, do we get up to urinate or is it worth the effort? Do we feel enough pain to check the clock and see if it’s time for a pain pill or perhaps, a muscle relaxant? Does that mean we have to get up or did we plan ahead and put some water or juice at the bedside, trying to avoid that long, long hobbling walk to the bathroom in the middle of the night? When we try to get back to sleep we wonder about life, decide we need a new mattress, or in my case, think of ways to get my spouse to stop snoring. I hate to bother the poor, tired man so I try not to wake him but I have found he will stop snoring... Life with Chronic Pain blogs http://www.medworm.com/rss/comments.php?id=4821007 Thu, 12 May 2011 19:23:27 +0100 4821007 http://www.medworm.com/index.php?rid=4813690&cid=t_102545_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F05%2F11%2Fthe-language-of-pain%2F Have you ever wondered about the ways we communicate our pain? Pain behaviour doesn’t just include nonverbal communication – one of the main ways we communicate our pain is through speech. Words are an incredibly powerful aspect of pain behaviour that strikes me as something we haven’t really studied much. When I was searching for the article to refer to in this post, I looked in PsychInfo under the terms “linguistics” and “pain” – and out of the tens of thousands of articles under each term, and total of 16 included both words. Sixteen! The stimulus for this post comes from someone who said the term “catastrophising” is a misnomer – a way for health professionals to dismiss or minimise the suffering and distress someone who... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4813690 Wed, 11 May 2011 00:57:33 +0100 4813690 http://www.medworm.com/index.php?rid=4803558&cid=t_102545_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F05%2F10%2Fcatastrophising-and-maybe-what-to-do-about-it-for-subacutechronic-pain%2F This study is also an excellent one for looking at process, or how people change over time using a daily diary method. The finding in this paper suggests that one way for helping people be more resilient and modify their tendency towards catastrophising might be to help them identify and then pursue positive experiences during each day.  Scheduling pleasant or enjoyable events as part of a daily routine is certainly something any clinician can do, and often those pleasant events can be physical, such as going for a walk, playing with the kids, or even doing some stretches. Finally (but not the final word!), a study by McKnight and colleagues looked at the mediating effect of self efficacy on the relationship between catastrophising and disability.  In this study, participants with early ... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4803558 Tue, 10 May 2011 02:18:40 +0100 4803558 http://www.medworm.com/index.php?rid=4803184&cid=t_102545_106_f&fid=34805&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FAwfulPlasticSurgery%2F%7E3%2F3krMfF0uwp0%2F eClinicMD is revolutionizing... [[ This is a content summary only. Visit MyWebsite.com for full links, other content, and more! ]] (Source: Awful Plastic Surgery) Awful Plastic Surgery blogs http://www.medworm.com/rss/comments.php?id=4803184 Mon, 09 May 2011 17:42:43 +0100 4803184 http://www.medworm.com/index.php?rid=4794953&cid=t_102545_129_f&fid=36035&url=http%3A%2F%2Fwww.everydayhealth.com%2Fblog%2Flife-with-chronic-pain%2Fgreed-grief-and-the-choices-of-a-lifetime%2F As most of you already know, my daughter, Beth and I have just returned from a working trip to the high desert region of California. My sweet mother-in-law passed away last May and due to other family matters it has taken us a year to make it down there to clean out her home. The weather is also a factor because I cannot tolerate heat or sun. When we left home it was drizzling here in beautiful, green yet soggy Oregon. The contrast to the high desert is startling. Yucca trees, a few evergreens and lots of brown greeted us. It was also 90 degrees. I got out the sunscreen but still have many fever blisters. You all know I have trouble sitting, and had to go to the hotel and just lie down after the trip. We had drawn row 12 on our small commuter plane and got stuck right in front of the emerg... Life with Chronic Pain blogs http://www.medworm.com/rss/comments.php?id=4794953 Fri, 06 May 2011 20:36:00 +0100 4794953 http://www.medworm.com/index.php?rid=4780495&cid=t_102545_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F05%2F04%2Fmore-psychological-stuff-isnt-in-my-scope-of-practice-so-what-can-i-do%2F I promised there would be more on this topic – it’s a popular one and full of vexing questions.  I left off yesterday, after making four points that IMHO might help incorporate some of the psychosocial management to a nonpsychological practice.  They were: Give precise advice about what to do. Give reasons for your advice. Ask the person about their understanding of their pain. Make sure you give clear timeframes for any activity restrictions. The underlying rationale for each of these is to counter two main problems that appear to underpin the development of longterm disability associated with pain: catastrophising, or ‘thinking the worst’, and avoidance. This point is really important, so listen up! It’s not the presence of pain alone that is the problem.�... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4780495 Tue, 03 May 2011 19:32:40 +0100 4780495 http://www.medworm.com/index.php?rid=4762858&cid=t_102545_129_f&fid=36035&url=http%3A%2F%2Fwww.everydayhealth.com%2Fblog%2Flife-with-chronic-pain%2Fthe-assologist-is-evolving%2F After writing this blog for almost five years, I find I have few secrets. My life is an open book. I’m one of those irritating women who talk to you in line at the market, have total strangers pick me out of a crowd to ask directions and always pet friendly, furry dogs at street fairs. I’ve always had a tongue that had a life of it’s own but now I’m far worse. My life changed about half-way through when, over a period of a few months, I developed two strange symptoms. Those two irritating and eventually painful problems changed my life forever. When I look back on the last 20+ years, I no longer recognize the woman I used to be. There is something about having chronic pain everyday of your life that causes you to evolve. I decided long ago it was up to me to decide if that evolutio... Life with Chronic Pain blogs http://www.medworm.com/rss/comments.php?id=4762858 Thu, 28 Apr 2011 21:08:12 +0100 4762858 http://www.medworm.com/index.php?rid=4753984&cid=t_102545_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F04%2F27%2Fworking-inside-the-envelope-or-pushing-the-boundaries%2F This study examines four different treatments carried out in parallel, it’s an unblinded/masked randomised trial designed to establish the effectiveness of these treatments as well as the adverse events associated with each treatment, and reviews the outcomes up to one year after treatment ended. Participants were carefully selected to meet the criteria for a diagnosis of chronic fatigue syndrome, and it’s interesting to see that only 28% of the people initially recruited actually met these criteria, and of this group, only 71% or 641 people actually progressed through to treatment.  Thankfully the CONSORT trial profile included in the paper shows very clearly who was ‘in’ and who was ‘out’ – and why! Clinicians were carefully trained, supervised ... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4753984 Tue, 26 Apr 2011 19:35:40 +0100 4753984 http://www.medworm.com/index.php?rid=4753985&cid=t_102545_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F04%2F26%2Fa-new-way-of-looking-at-coping-maybe%2F One half of knowing what you want is knowing what you must give up before you get it. ~Sidney Howard Many are stubborn in pursuit of the path they have chosen, few in pursuit of the goal. ~Friedrich Wilhelm Nietzsche There are few topics closer to my heart than goals.  This is partly because of my background in occupational therapy, where goals are seen as part of how we live purposeful, meaningful lives – but it’s also because they’re incredibly difficult to help others to do, yet goal setting is seen as integral to therapy. I’ve also been considering the whole topic of coping recently.  What is coping? Which coping strategies are helpful? Is it possible to view coping efforts without also looking at the context in which they’re being used? My current concl... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4753985 Mon, 25 Apr 2011 19:33:35 +0100 4753985 http://www.medworm.com/index.php?rid=4742544&cid=t_102545_129_f&fid=36035&url=http%3A%2F%2Fwww.everydayhealth.com%2Fblog%2Flife-with-chronic-pain%2Fsues-official-rules-for-whining%2F When you’ve had chronic pain for many years whining becomes an art form, a sacred ritual while also becoming a bit repetitive. That’s why you have to jazz it a bit by coming up with new ways to whine. Sure, it sounds easy. If you’re new to all this you might think all you have to do is be the victim, I mean patient, then spot another victim, also known as the listener and you’re all set to go. It’s much more complex than that. Let me see if I can sum it up for you. You know I love a list so let’s try, shall we? Never whine when you’re with someone sicker than you are. They don’t give a rat’s ass and you will find it very unfulfilling. Whining is not a contest but if it were, you’d have to find someone without any problems of their own. Good luck with that. You might a... Life with Chronic Pain blogs http://www.medworm.com/rss/comments.php?id=4742544 Thu, 21 Apr 2011 21:36:19 +0100 4742544 http://www.medworm.com/index.php?rid=4734699&cid=t_102545_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F04%2F20%2Festablishing-routines-and-baselines-recording-daily-schedules%2F I don’t know about you, but I’m not the world’s best at noting down every activity I do during a day.  I get engrossed in the thing I’m doing and I often get interrupted, so it’s not very easy to record my activity moment-by-moment.  Yet, for many of us, this is something we ask for from the people we’re working with. Luckily, there is some research on daily diary methods.  Unluckily for most of us, the best ones (ie most accurate and least intrusive) are electronic!  Useful if you’re funded for some research, less helpful if you’re trying to do this in your everyday clinical setting!  Basically, the research findings show that an electronic, automated and usually random alarm that reminds the participant to record their activity (and us... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4734699 Tue, 19 Apr 2011 19:23:47 +0100 4734699 http://www.medworm.com/index.php?rid=4734700&cid=t_102545_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F04%2F19%2Festablishing-routines-and-baselines-baseline-recording%2F One of the problems novice clinicians often complain about is that journals and research papers rarely examine or provide practical approaches to daily problems that are encountered when working with people who have chronic pain. It can take a lot of work to locate suitable approaches to things like: ways to help a person who is not accepting that a cure for chronic pain is unavailable ‘motivating’ a person to engage in activities that are anticipated to increase pain how to develop a baseline and establish an appropriate rate of progression how to establish a daily routine It’s tempting to think that in the absence of evidence-based approaches, the clinical skills are artistic rather than scientific, but I’m not so sure about that.  Maybe it’s more a case ... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4734700 Tue, 19 Apr 2011 06:11:03 +0100 4734700 http://www.medworm.com/index.php?rid=4719986&cid=t_102545_129_f&fid=36035&url=http%3A%2F%2Fwww.everydayhealth.com%2Fblog%2Flife-with-chronic-pain%2Fgone%2F Life is filled with constant change As we grow, mature and learn Unfortunately it’s not all mental as Our bodies sometime take a turn. Yet, each of us is amazed Because life doesn’t stay the same; Relationships, jobs and health In a flash can rearrange. Each time the hand of fate comes down We face surprise and shock Because we want it all to stay the same We learn early how to pitch a squawk. Accidents, bad planning and stupidity Can throw us into a spin; It seems we’re always trying to cope, To adjust, never dreaming we could win. As we struggle to adjust our Rubik’s cube We blame ourselves when struck by fate, And we face fear, self-blame and loathing And try to give up, “That’s it, it’s just too late.” Yet, deep within us, after the initial surprise Is this glim... Life with Chronic Pain blogs http://www.medworm.com/rss/comments.php?id=4719986 Fri, 15 Apr 2011 15:15:00 +0100 4719986 http://www.medworm.com/index.php?rid=4715032&cid=t_102545_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F04%2F15%2Ffriday-funnies-48%2F It’s been a while since I posted a Friday Funnies – my apologies. I’m happy to say that despite this lack, my sense of humour has remained intact, fed by regular dollops of my favourite cartoons from The Oatmeal (who can resist the call of “15-ish Things Worth Knowing About Coffee“, or “Ten Words You Need To Stop Misspelling“, or even “Cat vs Internet“?), and XKCD – the authors who announce the site to be A webcomic of romance, sarcasm, math, and language. - and who add this warning: Warning: this comic occasionally contains strong language (which may be unsuitable for children), unusual humor (which may be unsuitable for adults), and advanced mathematics (which may be unsuitable for liberal-arts majors). I mean – how could ... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4715032 Thu, 14 Apr 2011 22:06:50 +0100 4715032 http://www.medworm.com/index.php?rid=4709469&cid=t_102545_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F04%2F14%2Fdaily-routines-a-framework-for-healthy-living%2F I’m working with a couple of people who are having a good deal of trouble maintaining a routine.  Things like having a reasonably regular bedtime and wakeup time, eating regularly, having periods of energising activity, and periods of rest and relaxation.  While some of our normal routines have been disrupted by the earthquake in Christchurch, and things like getting to a supermarket or petrol station or even to see a doctor can mean travelling further than normal, for these people, routines have not ever really been a strong point. As someone who likes a bit of routine, I personally struggle to understand how people can miss out a meal or go to bed at wildly different times of the night (or early morning!).  Although I have to say I’m not averse to the occasional lie-in!  ... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4709469 Wed, 13 Apr 2011 19:24:15 +0100 4709469 http://www.medworm.com/index.php?rid=4704983&cid=t_102545_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F04%2F12%2Ftalking-about-it-is-it-worth-encouraging-emotional-disclosure-for-people-with-pain%2F One of the more common coping strategies for people with chronic pain is talking about stressful experiences. It’s thought to be healthy to be open and express feelings, while the very idea of repressing or avoiding emotional content seems almost Victorian. And there are various talk therapies in which emotional disclosure is encouraged – in fact, one popular approach suggests that people risk developing chronic pain if they don’t discuss ‘trauma’ (Sarno). So, does it work? Some studies of emotional disclosure have found that it has ‘moderate’ effects – people can feel emotionally better, and their general health status can also improve.  Other studies are more equivocal, with less positive outcomes.  Even in meta-analyses, outcomes have be... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4704983 Mon, 11 Apr 2011 18:56:57 +0100 4704983 http://www.medworm.com/index.php?rid=4693398&cid=t_102545_129_f&fid=36035&url=http%3A%2F%2Fwww.everydayhealth.com%2Fblog%2Flife-with-chronic-pain%2Flearning-to-live-with-the-gremlins-called-fear-and-guilt%2F There are two little gremlins that sit on my shoulder each day and night. I swat at them like pesky flies, but they continue to stick. It’s as if they had glue on their feet, sharp little claws, and such extreme staying power that I would admire them under different circumstances. Their names are fear and guilt. These persistent little buggers came to me many years ago — or maybe I was born with them, as most of us are who are full of the normal human foibles. Fear of heights, fear of failure, fear of the next unknown event flying at you — list goes on and on. When you suffer disease and chronic pain, there is much to be afraid of. You can’t dispel fear. You have to confront it and look it squarely in the eyes. Fear is normal under many circumstances. Many actors always hav... Life with Chronic Pain blogs http://www.medworm.com/rss/comments.php?id=4693398 Fri, 08 Apr 2011 14:04:59 +0100 4693398 http://www.medworm.com/index.php?rid=4677137&cid=t_102545_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F04%2F05%2Fwhat-is-coping%2F When we use the word ‘coping’, what do we mean? Recently, I’ve been reviewing the whole concept of coping in chronic pain.  I’m trying to establish how people with chronic pain view this term, and what they include in their repertoire of ways to cope.  My research is looking at the ways that people who cope well with their pain, and never need input from a chronic pain management team, do so.  And in doing this research, I’m hitting some conceptual snags. The thing is, coping as a concept isn’t defined all that well.  Some definitions refer to the outcome of coping: “he coped well with that” meaning “he managed that stressor in a positive way and the outcome was good”; some definitions refer to the process of coping and don&#8... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4677137 Tue, 05 Apr 2011 06:55:06 +0100 4677137 http://www.medworm.com/index.php?rid=4664361&cid=t_102545_129_f&fid=36035&url=http%3A%2F%2Fwww.everydayhealth.com%2Fblog%2Flife-with-chronic-pain%2Fsharp-retorts-for-dull-people-in-a-life-of-chronic-pain%2F Each of us who lives a life of compromised health doesn’t do it on an island. Neither do we live in a gilded cage, whatever the heck that is. No, we live in a larger cage without any adornments as we struggle to make it through each day — each of us in different circumstances and conditions. Some of us are seriously disabled while others live with different degrees of equally serious pain. There is definitely one aspect of life we experience as we live in flocks, groups or herds. Yes, herds. Have you been to a large city lately? The only thing missing is the mooing. There is a certain insensitivity that has crept into our society as we bump up against others, going through life in our limited capacity or attempting full speed ahead. Most people do not understand what a life of chr... Life with Chronic Pain blogs http://www.medworm.com/rss/comments.php?id=4664361 Fri, 01 Apr 2011 14:53:31 +0100 4664361 http://www.medworm.com/index.php?rid=4653616&cid=t_102545_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F03%2F30%2Fwhat-do-people-expect-when-they-get-referred-to-a-pain-management-centre%2F This study also found that many people didn’t feel they had been heard, or taken seriously prior to being referred. Participants in their study “needed to feel legitimated in the sick role, and part of the reason for wanting to know the cause of the pain was a desire to seek legitimacy in the eyes of others.” They made an interesting observation in that participants ranked the statement “I would like to have a better understanding of my pain” fifth on the list of 10 statements, and in the focus group discussion, identified having a diagnostic label as something different from having a better understanding. Allcock, Elkan and Williams suggest that “It was not so much personal understanding of their pain that they needed to legitimise it, as a diagnostic l... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4653616 Tue, 29 Mar 2011 18:25:34 +0100 4653616 http://www.medworm.com/index.php?rid=4631568&cid=t_102545_129_f&fid=36035&url=http%3A%2F%2Fwww.everydayhealth.com%2Fblog%2Flife-with-chronic-pain%2Fattitude-is-everything-in-a-life-of-chronic-pain%2F I frequently run into individuals — as I did in my past as an RN — who thought they were the only ones who were suffering. What is this whole living with pain business, some morbid contest to see who’s suffered the most? It’s far too easy to slide down into that hole of depression and self-pity and think you’re the most unfortunate, the most tortured, and the most miserable of them all. If that’s your approach you’ll get a prize for certain; all you have to do is win. Your prize is a life of darkness engulfed in pain and suffering. Your attitude will stink. Your friends and family will eventually resent you and remember, it can get awfully dark down in that hole. I have many goals and hopes for this blog, but the big one is to avoid the whole contest idea. I know as ... Life with Chronic Pain blogs http://www.medworm.com/rss/comments.php?id=4631568 Thu, 24 Mar 2011 20:32:34 +0100 4631568 http://www.medworm.com/index.php?rid=4622515&cid=t_102545_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F03%2F23%2Fits-there-and-im-stuck-with-it-chronic-knee-pain-after-knee-joint-replacement%2F I share an office with an Emeritus Professor of Orthopaedic Surgery.  He snorted at me one day, and showed me the stats from our national joint register database where I saw that while the main reason given for revision of a total hip joint was dislocation, and pain was the sixth most common reason given; in the case of revision of knee joint replacements, persistent pain was the most common reason given. Some studies have shown between 6 – 30% of people receiving total knee joint replacements have ongoing pain months after their immediate post-surgical recovery.  With knee joint replacement such a common surgery for osteoarthritic knees, and some reports of up to 33% of the adult population having OA of the knee, that’s a lot of people who continue to have pain! It’s n... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4622515 Tue, 22 Mar 2011 18:22:40 +0100 4622515 http://www.medworm.com/index.php?rid=4615450&cid=t_102545_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F03%2F21%2Fmaking-self-help-more-helpful%2F In this study, Varley, Webb and Sheeran contacted (via email) the students and staff at a university in the UK.  People who were already being treated for anxiety were excluded, and the remaining participants (251 of them) were randomised into three groups.  All of them completed baseline Hospital Anxiety and Depression Scale (HADS, developed by Zigmond and Snaith, 1983) and the state version of the State-Trait Anxiety Inventory (STAI; Spielberger, Gorsuch, Lushene, Vagg, and Jacobs, 1983). One group received no input, while the other two groups were asked to go to a web page where they downloaded a self-help booklet.  Both of the booklets were the same eight-page booklet containing psychoeducation, diary sheets for self-monitoring triggers and feelings, and two relaxation techniques &#... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4615450 Sun, 20 Mar 2011 19:20:16 +0100 4615450 http://www.medworm.com/index.php?rid=4605937&cid=t_102545_129_f&fid=36035&url=http%3A%2F%2Fwww.everydayhealth.com%2Fblog%2Flife-with-chronic-pain%2Fwaiting-for-the-big-one-while-living-with-chronic-pain%2F Out here on the west coast we are all too familiar with the ever-menacing threat of the “big one.” Growing up in California, the San Andreas Fault was part of our history. Every few years the earth would lunge, sometimes separate and create a chasm and always shake. As a child I was always terrified of earthquakes and truthfully, I still am. Watching the tragedy that is unfolding in Japan is heartbreaking for the entire world but for those whose lives have been totally disrupted it has proven to be an ongoing sorrow with no end in sight. Everyday something seems to make it worse. One is once again reminded of the inequality in life as Mother Nature randomly reaches out her hand and slaps us around. We ask ourselves many questions about what we can do to help those who are suffering and... Life with Chronic Pain blogs http://www.medworm.com/rss/comments.php?id=4605937 Fri, 18 Mar 2011 03:04:51 +0100 4605937 http://www.medworm.com/index.php?rid=4577905&cid=t_102545_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fchronic-pain-chocolate-and-vicodin%2F2011.03.12 Chocolate and vicodin? No, it’s not the latest Ben & Jerry’s flavor. “Chocolate & Vicodin: My Quest For Relief From the Headache That Wouldn’t Go Away” is the latest book by author, blogger, web designer, and busy woman Jennette Fulda. I became acquainted with Jennette’s blog during BlogHer 2008, where I had purchased her first book, “Half-Assed: A Weight-Loss Memoir.” When she asked if I would like a copy of “Chocolate & Vicodin” to review, I jumped at the chance. In “Half-Assed,” Jennette chronicled her journey to a near-200 pound weight loss. Just prior to that book’s release, she began another journey — one whose goal proved elusive. On February 17, 2008, Jennette went to bed with a headache. She still ... Better Health blogs http://www.medworm.com/rss/comments.php?id=4577905 Sat, 12 Mar 2011 18:00:18 +0100 4577905 http://www.medworm.com/index.php?rid=4570657&cid=t_102545_129_f&fid=36035&url=http%3A%2F%2Fwww.everydayhealth.com%2Fblog%2Flife-with-chronic-pain%2Fhow-to-train-your-dragon-of-chronic-pain%2F As most of you already know, I love children’s movies. Their plots are simple, their characters clearly evil or good, and they’re usually humorous. They are clever, beautifully colorful, and entertaining. There’s another reason I like them so much and often prefer them to adult films — they’re usually less depressing. Sure, I know Bambi’s mother gets killed, someone is always orphaned, and evil doers cause trouble, but in the end, all is made right. Adult movies have, over the past few years, become very dark, morbid, and frankly, gruesome. You might as well watch the news if you want to be that depressed. I cannot figure out what’s entertaining about hatchets splitting skulls, guts spilling onto the floor, love betrayed, and the smarmy side of the drug world. If I wante... Life with Chronic Pain blogs http://www.medworm.com/rss/comments.php?id=4570657 Thu, 10 Mar 2011 21:49:15 +0100 4570657 http://www.medworm.com/index.php?rid=4549834&cid=t_102545_129_f&fid=36035&url=http%3A%2F%2Fwww.everydayhealth.com%2Fblog%2Flife-with-chronic-pain%2Fyou-can-still-count-in-a-life-with-chronic-pain%2F As many of you, I have those days when my thinking is fuzzy. That’s a kind and understated way of saying I feel my years of this compromised life, am distracted by daily pain and have done something to confuse myself. That something is often forgetting to eat, resulting in low blood sugar. Other days I run around in a fog for no reason at all, because I’m trying to do too much too fast or haven’t slept well the night before. Today, as I was refilling my medicine containers into those weekly plastic containers I realized how often I use basic counting to prevent mistakes and to promote many of the other forms of therapy I use in my life of chronic pain. I’m certain many of us have tricks, gimmicks and reminders as we find our way through this strange life we have been given. We writ... Life with Chronic Pain blogs http://www.medworm.com/rss/comments.php?id=4549834 Fri, 04 Mar 2011 21:57:12 +0100 4549834 http://www.medworm.com/index.php?rid=4536519&cid=t_102545_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F03%2F02%2Fliving-well-with-chronic-pain-a-grounded-theory-study%2F While ‘coping’ with chronic pain has been studied extensively, the people usually studied have been those seeking treatment, and because of this, little is known about how people cope well despite their pain.  A large group of people experiencing ongoing pain do not seek treatment, and while there is speculation that factors such as personality or social support may be associated with this, there is very little known about how this group of people have developed coping skills, or the strategies they employ. Consequently there is a lack of theory to explain how some people with chronic pain continue with important activities despite their pain. My PhD study is intended to develop a theoretical understanding (using a grounded theory methodology) of how people cope well despite their pai... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4536519 Wed, 02 Mar 2011 03:19:00 +0100 4536519 http://www.medworm.com/index.php?rid=4522193&cid=t_102545_129_f&fid=36035&url=http%3A%2F%2Fwww.everydayhealth.com%2Fblog%2Flife-with-chronic-pain%2Fpotholes-in-the-road-of-chronic-pain%2F We have often shared how rough the road of chronic pain can be. It winds around many curves, jarring us for years as we seek to live as “normal” a life as possible. Along this ride we call life, there are often potholes strewn along the way. Some are small and easily traversed but others are huge and appear to swallow up our lives leaving us in a sunken, dark state of stickiness of being. Attitude and state of mind. It’s difficult to put enough emphasis on this one particular point without overdoing it. Little ruts along the way can jar us and shake us up a bit. They can hurt our outlook on life which is already in a compromised state due to our pain. It’s impossible to merrily skip along the road of life when you hurt everyday. First of all, many of us find it impossible to skip a... Life with Chronic Pain blogs http://www.medworm.com/rss/comments.php?id=4522193 Fri, 25 Feb 2011 18:52:26 +0100 4522193 http://www.medworm.com/index.php?rid=4489832&cid=t_102545_129_f&fid=36035&url=http%3A%2F%2Fwww.everydayhealth.com%2Fblog%2Flife-with-chronic-pain%2Fode-to-my-ass%2F Thus you’ve always been, Following me around Changing with each age and phase Once so firm and round. I used to be quite fond of you When we both were young and perky, That was very long ago Now you look like turkey jerky. I know gravity takes its toll I see it mirrored day by day But I must confess I do resent you, Do you consider this fair play? All those years you came last Letting me go first Then behind my back you fell apart As if a balloon had burst. I once had a shape to be envied And loved to shake my booty. At least you still hold up my pants And they don’t fall down around my footy. You were designed to sit, To hold my legs and back To help me get from place to place So what if you were cracked? When sacroiliitis struck my tush, Pain came to live with me Infesting everything... Life with Chronic Pain blogs http://www.medworm.com/rss/comments.php?id=4489832 Thu, 17 Feb 2011 22:53:35 +0100 4489832 http://www.medworm.com/index.php?rid=4464607&cid=t_102545_129_f&fid=36035&url=http%3A%2F%2Fwww.everydayhealth.com%2Fblog%2Flife-with-chronic-pain%2Fis-life-with-chronic-pain-a-reality-or-a-cartoon%2F As most of you already know I have been having a terrible time with some funky new virus this year. I feel like a turtle that got tipped and can’t get upright again. That could explain why the room keeps spinning. Some spirit with a sense of humor keeps rocking my shell and occasionally gives it a spin. On Saturday, I went into urgent care. It was cold and slow. The people were very kind but I had to wear my gloves and jacket to keep from shaking my teeth out of my mouth while shivering. I had a chest X-ray, was given an antibiotic and left there being told I would eventually be okay. The diagnosis was viral with bronchitis. Since, like many of you, I already had a satchel full of problems, all things were complicated. We got out into the parking lot and I could hardly wait to get home a... Life with Chronic Pain blogs http://www.medworm.com/rss/comments.php?id=4464607 Sat, 12 Feb 2011 00:46:51 +0100 4464607 http://www.medworm.com/index.php?rid=4460063&cid=t_102545_129_f&fid=36035&url=http%3A%2F%2Fwww.everydayhealth.com%2Fblog%2Flife-with-chronic-pain%2Fis-life-with-chronic-pain-a-reality-or-a-cartoon%2F As most of you already know I have been having a terrible time with some funky new virus this year. I feel like a turtle that got tipped and can’t get upright again. That could explain why the room keeps spinning. Some spirit with a sense of humor keeps rocking my shell and occasionally gives it a spin. On Saturday, I went into urgent care. It was cold and slow. The people were very kind but I had to wear my gloves and jacket to keep from shaking my teeth out of my mouth while shivering. I had a chest X-ray, was given an antibiotic and left there being told I would eventually be okay. The diagnosis was viral with bronchitis. Since, like many of you, I already had a satchel full of problems, all things were complicated. We got out into the parking lot and I could hardly wait to get home a... Life with Chronic Pain blogs http://www.medworm.com/rss/comments.php?id=4460063 Thu, 10 Feb 2011 22:13:54 +0100 4460063 http://www.medworm.com/index.php?rid=4455498&cid=t_102545_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F02%2F09%2Fmore-on-choosing-chronic-pain-questionnaires%2F Mood and anxiety - depression, anxiety and pain-specific anxiety were chosen because of their importance to outcomes, and the need to treat psychopathology Catastrophising – because this is thought to be one of the most important aspects of cognition that needs to be addressed Pain-related anxiety and avoidance – because this appears to be one of the strongest predictors of ongoing disability Acceptance – this domain has been emerging as an increasingly important treatment process variable, and may be a target for intervention Pain location and intensity - yes, we do ask, just in case you wondered! Pain self efficacy – again, this seems to be an important process variable, and a target for treatment.  It’s also associated with higher levels of disability. Pain-related disability... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4455498 Wed, 09 Feb 2011 08:56:40 +0100 4455498 http://www.medworm.com/index.php?rid=4450530&cid=t_102545_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F02%2F09%2Fchoosing-chronic-pain-questionnaires-2%2F In my last post I started to discuss the questionnaire domains that can be used in a battery of questionnaires for chronic pain.  Today it’s time to turn to the specific measures that we’ve chosen as part of a set that a group working across the public health system in New Zealand have selected.  It’s hoped that eventually the responses from these questionnaires will be as available within the national DHB patient information system as the results from radiology and lab tests.  Imagine that! Below are the domains as I indicated yesterday. Mood and anxiety - depression, anxiety and pain-specific anxiety were chosen because of their importance to outcomes, and the need to treat psychopathology Catastrophising – because this is thought to be one of the most important as... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4450530 Tue, 08 Feb 2011 18:31:33 +0100 4450530 http://www.medworm.com/index.php?rid=4446048&cid=t_102545_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F02%2F07%2Fchoosing-chronic-pain-questionnaires%2F Choosing a set of questionnaires for an assessment battery can be a task fraught with all kinds of traps, because if there is one thing bound to get clinical tongues flapping, it’s the idea that their favourite questionnaire will be left out of the mix! And to complicate matters for us Southern Hemispherians, most of the research into normative data for questionnaires is North American, so it can be a long, quite tedious and epic job to arrive at a set that covers all the basic domains, doesn’t give the client questionnaire-fatigue, and uses psychometrically-sound  instruments. At the Centre where I work, the set of questionnaires has just been reviewed and, working with a number of clinicians from around the country, we have arrived at a set that seems to be a reasonably work... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4446048 Mon, 07 Feb 2011 05:53:13 +0100 4446048 http://www.medworm.com/index.php?rid=4436850&cid=t_102545_129_f&fid=36035&url=http%3A%2F%2Fwww.everydayhealth.com%2Fblog%2Flife-with-chronic-pain%2Fare-you-an-accident-waiting-to-happen%2F During my nursing career, I saw many fruitful and productive lives changed in an instant. A fall, a trip, or a slip of any kind of accident can cause injury and change a life. Sometimes, that change is forever. Prevention of falling or injury is the best treatment. Most recently, I have a good friend in California who simply twisted her body in her driveway while attempting to lift a wet and heavy garage door. She went down in a heap with a fractured femur, the long leg bone, cracked right in the middle. Thankfully, she has alert neighbors who came to her rescue and called 911. Because she also suffers from osteoporosis the mending is slow and discouraging. She can’t bear weight on the fractured leg and they have her on strict bedrest. No walker, not even a potty chair. Dignity pretty we... Life with Chronic Pain blogs http://www.medworm.com/rss/comments.php?id=4436850 Fri, 04 Feb 2011 21:04:51 +0100 4436850 http://www.medworm.com/index.php?rid=4419467&cid=t_102545_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F02%2F01%2Foccupational-therapy-the-cognitive-behavioural-approach-for-pain-management-ii%2F In the first post on my commentary of Robinson, Kennedy and Harmon’s review of occupational therapy for chronic pain, I argued that they have misinterpreted the cognitive behavioural approach to pain management, and in particular, that they appear to hold an outmoded view of pain as either biological/organic or psychological, and refute the place of psychosocial models in occupational therapy practice. Yesterday I distinguished between cognitive behavioural therapy and a cognitive behavioural approach - while the therapy is often primarily concerned with ‘talk’ therapy followed by behavioural changes to improve mood for example, a cognitive behavioural approach is a broader concept that is based upon the assumption that people are able to make changes in the way they unde... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4419467 Mon, 31 Jan 2011 17:46:19 +0100 4419467 http://www.medworm.com/index.php?rid=4405902&cid=t_102545_129_f&fid=36035&url=http%3A%2F%2Fwww.everydayhealth.com%2Fblog%2Flife-with-chronic-pain%2Fi-hate-the-word-stress-in-a-life-of-chronic-pain%2F Actually, I’ve disliked that word — stress — for a very long time, long before I faced chronic pain every day. “Stress” is overly applied, misused, and has become the universal bandaid for too many areas of life. Doctors seem to use it for any physical condition they can’t explain. Well-meaning friends and relatives coo it to us as if we’re not to be taken seriously and think just by saying, “Oh, you’re stressed,” that we will automatically feel better. There’s an excellent physiological definition for true stress in the current issue of Natural Health magazine, Dec/Jan 2011. The author, Dorothy Foltz-Gray, goes into minute detail regarding the hormones that are triggered by the hypothalamus after it receives messages from the brain. The stress hormones cortisol a... Life with Chronic Pain blogs http://www.medworm.com/rss/comments.php?id=4405902 Thu, 27 Jan 2011 22:22:02 +0100 4405902 http://www.medworm.com/index.php?rid=4405957&cid=t_102545_131_f&fid=34989&url=http%3A%2F%2Ffeeds.b5media.com%2F%7Er%2Fb5media%2FGeneticsHealth%2F%7E3%2FLIutwp9L_3k%2F I’ve had such positive health experiences with acupuncture over the years, that it makes me sad when I hear people dismiss the idea that this ancient Chinese practice actually has powerful healing properties. After all, you skeptics, Eastern medicine has been around a lot longer than Western medicine. (And I’ve been able to manage my genetic skin disease called Hailey-Hailey, thanks in large part to regular acupuncture treatments.) So I asked my acupuncturist, Anne Mok, Doctor of Acupuncture and Oriental Medicine and co-owner of Cornerstone Healing in New York City, to debunk these ten common myths about acupuncture and your health: 1. The needles are so damn long! Actually, acupuncture needles have different thicknesses and lengths. Most needles are inserted into the skin less... Genetics and Health blogs http://www.medworm.com/rss/comments.php?id=4405957 Thu, 27 Jan 2011 17:32:44 +0100 4405957 http://www.medworm.com/index.php?rid=4399841&cid=t_102545_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F01%2F26%2Fpulling-it-all-together-biopsychosocial-assessment%2F Over the past little while I’ve been writing about how a comprehensive pain assessment can be carried out.  Today it’s time to pull that information together to develop a formulation, or set of possible explanations for why this person presents in this way at this time – at least for one or two aspects of his presentation. For example, if the person’s pain is low back pain, where surgery has failed to improve the person’s pain, but he has maintained working in a teaching job where physical demands are reasonably light, but is having trouble with sleep, feels irritable, can’t manage things like mowing lawns, and is very careful not to bend because he was advised after surgery to avoid bending because it may affect healing.   Limited forward flexion, si... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4399841 Wed, 26 Jan 2011 01:00:45 +0100 4399841 http://www.medworm.com/index.php?rid=4389378&cid=t_102545_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F01%2F24%2Fpulling-the-biopsychosocial-assessment-together%2F Over the past couple of posts I’ve described one way to assess a person’s chronic pain presentation from a medical, psychosocial and functional perspective.  I don’t think there is much difficulty in seeing how these three perspectives can help us develop a biopsychosocial explanation, or formulation, for why this person is presenting in this way at this time – and that’s what assessment is about, when it comes to chronic pain. A quick note on why explanations or formulations are useful when working in chronic pain.  Acute pain is, as most people know, usually directly related to some sort of tissue damage, potential or actual.  The usual rule for helping someone with acute pain is to diagnose the underlying cause of the pain, remediate that causal factor,... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4389378 Mon, 24 Jan 2011 01:25:20 +0100 4389378 http://www.medworm.com/index.php?rid=4377681&cid=t_102545_129_f&fid=36035&url=http%3A%2F%2Fwww.everydayhealth.com%2Fblog%2Flife-with-chronic-pain%2Fthe-circle-of-life-and-the-grieving-process%2F I realize I may sound like a cartoon or Elton John, but the Circle of Life is very real for all of us mere mortals. The simplistic approach may offend many self-proclaimed sophisticated adults, but life is truly just that simple. We’re born, we live, we wear out or run into trouble, and then we die. If you have not been touched by this circle, experiencing birth and death within the last year, then you are probably overdue. The joys of birth, the gut-wrenching pain of death, and all that happens in between represent this experience called life. Like the filling in a sandwich cookie, that “in between” is the most important part. I’ve never known anyone to scrape out the filling of an Oreo and toss it out just to eat the crispy cookie, have you? We are each of stuck with the whole co... Life with Chronic Pain blogs http://www.medworm.com/rss/comments.php?id=4377681 Thu, 20 Jan 2011 21:44:28 +0100 4377681 http://www.medworm.com/index.php?rid=4372260&cid=t_102545_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F01%2F20%2Fa-comprehensive-pain-assessment-continued%2F One of the hallmarks of chronic pain is the effect on functional performance.  It’s for this reason alone that an assessment of function needs to be a major part of any comprehensive pain assessment.  This, however, is probably where agreement begins – and ends. Function is all about doing, and in this kind of pain assessment, what I’m interested in is how the person with pain goes about engaging in activities that are important and necessary to him or her.  Like any measure, the sum weight a person can shift in a manual handling task means very little without some sort of context.  I’m more interested in how the person planned the movements; the quality of his or her movements; the pace the person moved; the thoughts or images that went through the person&#8217... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4372260 Wed, 19 Jan 2011 18:41:54 +0100 4372260 http://www.medworm.com/index.php?rid=4361321&cid=t_102545_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F01%2F19%2Fa-comprehensive-pain-assessment%2F What makes up a comprehensive pain assessment?  I could begin and never end this particular topic, I know, so I’ll try to confine myself to some of the major themes as I see it.  While this is my opinion, and readers should always remember this, there are some very good researchers and clinicians who hold this view as well – and I’ll cite one or two at least! The first aspect to determine in any assessment is its purpose.  I’ll explore this much further in future posts – the process I’ll describe is to guide initial case formulation and broad direction for pain management.  That is, it’s to identify any medical strategies required, to ascertain the basic coping ability (and thus the need for self management), and finally, to gauge the general f... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4361321 Tue, 18 Jan 2011 18:15:38 +0100 4361321 http://www.medworm.com/index.php?rid=4349516&cid=t_102545_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Ffda-restricts-acetaminophen-in-popular-pain-medications%2F2011.01.14 This is a guest post from Dr. Mary Lynn McPherson. ********** FDA Restricts Acetaminophen In Popular Pain Medications The Food and Drug Administration (FDA) made an announcement yesterday that affects one of the most common pain medications on the market, and as a consequence may affect countless numbers of the 75 million Americans who experience chronic pain (for perspective, that’s more than the number of people suffering from cancer, heart disease and diabetes combined.) The FDA has asked manufacturers of popular prescription pain medications like Vicodin or Percocet to limit the amount of acetaminophen (also known as Tylenol, or APAP) used in these drugs to no more than 325 milligrams per tablet — the equivalent of one regular-strength Tylenol tablet. The move came because rese... Better Health blogs http://www.medworm.com/rss/comments.php?id=4349516 Fri, 14 Jan 2011 13:00:05 +0100 4349516 http://www.medworm.com/index.php?rid=4343245&cid=t_102545_129_f&fid=36035&url=http%3A%2F%2Fwww.everydayhealth.com%2Fblog%2Flife-with-chronic-pain%2Flet-a-child-teach-you-about-a-life-of-chronic-pain%2F The children in our lives bring us many gifts throughout all seasons. They may be your children, your grandchildren, or a friend or neighbor’s child; all seem capable of performing this fete. They bring us the gift of laughter, the gift of acceptance and most of all, the gift of insight. Today, I would like to share with you some of the gifts the children in my life have taught me over the years, if I may? Anything is possible. Unless someone tells you otherwise, there is nothing you cannot accomplish. Just do it. You may not always succeed in doing something well, but you must try. Giving up is not an option. With all of life’s possibilities, why should it be? Santa, as well as Mary Poppins, has a bag that holds anything you want to be in it. Size and weight are not issues; but y... Life with Chronic Pain blogs http://www.medworm.com/rss/comments.php?id=4343245 Thu, 13 Jan 2011 21:13:25 +0100 4343245 http://www.medworm.com/index.php?rid=4338291&cid=t_102545_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F01%2F12%2Fworking-out-who-does-what-teamwork-at-its-best%2F I work in a large team of clinicians.  We have clinicians from occupational therapy, physiotherapy, nursing, social work, clinical psychology and specialist medics with anaesthetic, musculoskeletal and occupational backgrounds.  Teamwork is absolutely vital to our work. When we start to work with an individual, we work in much smaller teams of two or three: someone with a psychosocial flavour, another with a functional flavour, and (often) someone with an applied focus. While scouting around in my office I found an old book chapter from a book called “Pain Management. A Handbook of Psychological Treatment Approaches” edited by A. D. Holzman and D. C. Turk. It’s an old book, published by Pergamon Press in 1986, but don’t let that fool you – a couple of the ch... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4338291 Tue, 11 Jan 2011 23:17:08 +0100 4338291 http://www.medworm.com/index.php?rid=4331265&cid=t_102545_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F01%2F11%2Fbrain-training-it-happens-all-the-time%2F At the risk of seeming untrendy, the trend to rave on about neuroplasticity can be a bit overdone.  Not, I add quickly, because it doesn’t happen, or it’s not important – in fact, quite the opposite – but because it happens all the time.  And at the back of our minds, I think we’ve known this for quite a while.  How else do you think we manage to learn new things even in our elder years? The reason I’m raising this today is, after yesterday’s post on phantom limb pain and the parts of the brain that are active when we have pain and when hypnosis is used for pain relief, I started to mull over the range of treatments that are used in managing chronic pain.  Now, we don’t have fMRI studies for all the treatments available.  I don’t t... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4331265 Mon, 10 Jan 2011 21:40:09 +0100 4331265 http://www.medworm.com/index.php?rid=4327074&cid=t_102545_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F01%2F10%2Fits-really-all-about-the-brain%2F Neuroscience is such a geeky area to study. And I have to say I didn’t really study the brain all that well in my undergraduate training all those years ago – but oh, how the worm has turned! It’s so exciting to see how basic science directly influences treatments that we can use for people who don’t have many pharmacologic options for their pain. While I don’t have really up-to-date papers today, I think the 2008 paper by Herta Flor presages some of the approaches we’re starting to use in clinical settings now, a scant three years later. Flor’s work has always been impressive – she has often looked at what happens when brains are deprived of their normal feedback because of trauma or amputation, and (really exciting!) she is coming to Austra... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4327074 Mon, 10 Jan 2011 03:02:46 +0100 4327074 http://www.medworm.com/index.php?rid=4322507&cid=t_102545_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fpain-contracts-do-they-threaten-the-doctor-patient-relationship%2F2011.01.07 Doctors today are wary about treating chronic pain. One of the main worries is precipitating fatal opioid overdoses. Indeed, according to the CDC, and reported by American Medical News, “fatal opioid overdoses tripled to nearly 14,000 from 1999 to 2006 … [and] emergency department visits involving opioids more than doubled to nearly 306,000 between 2004 and 2008.” Requiring chronic pain patients to sign pain contracts is a way to mitigate this risk. But how does that affect the doctor-patient relationship? Indeed, a contract is an adversarial tool. Essentially, it states that a patient must comply with a strict set of rules in order to receive medications, including where and how often they obtain controlled substances, and may involve random drug testing. Break the contract and the ... Better Health blogs http://www.medworm.com/rss/comments.php?id=4322507 Fri, 07 Jan 2011 20:00:11 +0100 4322507 http://www.medworm.com/index.php?rid=4318443&cid=t_102545_129_f&fid=36035&url=http%3A%2F%2Fwww.everydayhealth.com%2Fblog%2Flife-with-chronic-pain%2Fpromises-to-myself-for-the-new-year%2F First of all, I need to get organized. I’ll get out all my random notes, including my exercise notebook I’ve kept for several years with all of my favorite and most helpful stretches and exercise moves diagrammed. I will make my best effort to perform stretches each day or at least every other day to keep limber and to alleviate some of my pain. If I don’t, I may end up looking like a human question mark. It might be time to buy a couple of new stretchy bands. Scares the beans out of me when the old ones pop. I will continue to clutter up my small home with a giant red exercise ball because it is ideal for maintaining balance and strength. Sitting on it while lifting my small weights, I will do my best not to fall off. Balance is so important. All I need is a fall. Then I’d be “t... Life with Chronic Pain blogs http://www.medworm.com/rss/comments.php?id=4318443 Thu, 06 Jan 2011 20:26:44 +0100 4318443 http://www.medworm.com/index.php?rid=4314228&cid=t_102545_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F01%2F06%2Fsleep-posts-from-2010%2F Sleep is so important for wellbeing (ask any young parent!), and yet many people with chronic pain have really poor and unrefreshing sleep, and very poor sleep habits.  Some pain conditions show changes to the quality of the sleep stages (such as fibromyalgia for example), to the point where these changes can almost be diagnostic, while many people with chronic pain also have low mood in which sleep disruption is a common feature. I’ve written about sleep several times over the past year, and today I provide links to some of these posts for your education and enjoyment. Sleep problems in chronic pain and what helps – Pain can be associated with a sense of poorer quality sleep, and could well have been a factor influencing the onset of insomnia, it’s often other factors that ... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4314228 Wed, 05 Jan 2011 18:13:48 +0100 4314228 http://www.medworm.com/index.php?rid=4305126&cid=t_102545_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F01%2F03%2Fall-about-you-and-me-how-health-professionals-influence-pain-management%2F This study looks at the use of the Pain Attitudes and Beliefs Scale with GP’s, or primary care providers. How long does it take to get there? – no, not kids in cars, but a look at the delays in referral for chronic pain management. Rules for doctors – and probably other health professionals – A repost of a wonderful set of instructions written by a doctor! Are these posts with links to my other posts helpful? Let me know – I love comments, and almost always respond.  Don’t forget too, you can bookmark my blog, or you can subscribe via RSS or even email.  Introduce yourself on my ‘About’ page – I’d love to get to know you and what you’re looking for. Filed under: Chronic pain, Clinical reasoning, Education/CME, Research, Therap... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4305126 Sun, 02 Jan 2011 20:18:51 +0100 4305126 http://www.medworm.com/index.php?rid=4300628&cid=t_102545_129_f&fid=36035&url=http%3A%2F%2Fwww.everydayhealth.com%2Fblog%2Flife-with-chronic-pain%2Fready-or-not-a-new-year-is-on-the-way%2F Click your seat belt, gird your loins (don’t know what it means but it sounds good), open your mind and heart, expect your panties to get ruffled — just don’t let them get in a wad — and go for it. The New Year is coming at you whether you’re ready for it or not. The good part of celebrating an annual New Year’s Day is: You get an innovative fresh start. Of course, you are still hauling around the same old painful shell on the outside but inside, you can be a new you. You can be new even if you’re old. You figure it out. That’s your challenge for the year. You get to take everything you learned with you into the New Year but only if you remember it or it really doesn’t suck. You can choose to be smart and use all you’ve learned in this past year or you can repeat w... Life with Chronic Pain blogs http://www.medworm.com/rss/comments.php?id=4300628 Thu, 30 Dec 2010 17:58:12 +0100 4300628 http://www.medworm.com/index.php?rid=4298821&cid=t_102545_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F12%2F30%2Fskills-strategies-resources-in-2010%2F Part of the reason for this blog is to introduce clinicians to some of the research and application of coping strategies for people with chronic pain.  While I can summarise the year’s developments in (almost) a single sentence (see below!), it’s also true that I’ve posted a lot of really interesting findings about coping over the year.  Today’s summary links to the goodies I’ve found in 2010. Oh, my summary? There is nothing especially new under the sun in self managing pain – it’s about goals, acceptance, exercise, engaging in important activities and roles, gratitude, connecting with people…oh and mirrorbox for some lucky people for whom it works well! Cognitive behavioural approaches to pain management Before I post the links, a quick w... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4298821 Wed, 29 Dec 2010 22:04:49 +0100 4298821 http://www.medworm.com/index.php?rid=4295018&cid=t_102545_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F12%2F27%2Ftopic-index%2F After writing for three years, and starting with very limited knowledge of how things like categories and tags worked, there are a lot of posts hidden in my backfiles that might be just what you’re looking for.  So my project is to organise my posts into a topic index!  Here are the first two. ACT – posts about Acceptance and Commitment Therapy, and mindfulness, acceptance and committed action This section is about aspects of acceptance, mindfulness, values, committed action, and ACT, the therapy.  I am no expert in ACT, although I am slowly learning more about the approach.  Several aspects of this therapy appeal to me – firstly the adherence to a research base for it’s effectiveness; the way in which personal values are honoured; the recognition that to achiev... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4295018 Sun, 26 Dec 2010 21:35:55 +0100 4295018 http://www.medworm.com/index.php?rid=4281413&cid=t_102545_129_f&fid=36035&url=http%3A%2F%2Fwww.everydayhealth.com%2Fblog%2Flife-with-chronic-pain%2Fmy-christmas-wish-for-those-who-live-with-chronic-pain%2F I wish you the blessings of less pain or enough joy to displace it from the center of your life. I wish you the ability of fresh eyesight to enjoy Christmas lights, the twinkle in a child’s eye, and the glitter of ice from fresh fallen snow. I wish you the warmth of family love, the hug of a small child, or a wet lick in the face from a beloved dog. I wish you the soft purr of a beloved furry cat as he/she cuddles and gently plays the “piano” in your lap. I wish for you the insight to embrace others who also suffer, as we do; therefore I wish you the blessings of empathy toward others. Let us all be especially aware and show gratitude to the young wounded warriors in our midst. I wish for you the gift of laughter, the joy of song, and the hum of life as you embrace this season. I wis... Life with Chronic Pain blogs http://www.medworm.com/rss/comments.php?id=4281413 Wed, 22 Dec 2010 18:01:35 +0100 4281413 http://www.medworm.com/index.php?rid=4277832&cid=t_102545_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fchronic-illness-and-%25e2%2580%259cthe-spoon-theory%25e2%2580%259d%2F2010.12.21 If you don’t truly understand how draining it can be to live with chronic illness, including chronic pain, go read The Spoon Theory right now. In five minutes it forever changed my own awareness of my wife’s arthritis and bone pain. On Twitter I saw “spoonies” raving about this months ago, but I finally took time to read it: 2,100 words and worth every second. Also, on Twitter follow @bydls – “But you don’t look sick!” – and explore their smart website, where they’re wisely selling posters of the story for doctors’ waiting rooms, and everything else imaginable in modern outreach through social media. These are smart people, and this is a powerful piece of writing. *This blog post was originally published at e-Patients.net* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=4277832 Tue, 21 Dec 2010 20:00:16 +0100 4277832 http://www.medworm.com/index.php?rid=4272660&cid=t_102545_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F12%2F20%2Fa-year-in-review%2F This is the third year I’ve written this blog.  As the year ends, numerous people will be reviewing the year, reflecting on the good, the bad and the indifferent, and like them, I will too. What has been the same this year is the endless need to repeat to all and sundry the following: All chronic pain starts with acute pain – maybe if we were able to effectively manage risk factors for developing chronic pain in people when they first present for help with their pain, my job would be less in demand. All pain, whether acute or chronic, is a psychological experience – and can’t be understood without an appreciation of the biopsychosocial model. Because pain is a psychological experience means that we can’t divide pain into nociception and the psychological res... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4272660 Mon, 20 Dec 2010 07:22:22 +0100 4272660 http://www.medworm.com/index.php?rid=4266031&cid=t_102545_129_f&fid=36035&url=http%3A%2F%2Fwww.everydayhealth.com%2Fblog%2Flife-with-chronic-pain%2Ftwas-the-week-before-christmas%2F Twas the week before Christmas, so much to be done My body was laggin’ while my spirit cried “RUN!” So hard to do when your whole body hurts And your energy comes in bits and in spurts. There’s truly a magic that now fills the air With wreaths and seraphims with soft angel hair. All creatures were stirring, even the mice Children and grown-ups, all “extra nice.” The gifts were arriving, thanks to the ‘net How could I do it and stay out of debt? Aw heck, this is Christmas, forget about that. In January we’ll all eat like Jack Sprat. The pup dogs were snuggled all warm in our bed They hadn’t a clue as to my week ahead. How could I do it, so much to be done? My energy left with the rise of each sun. It was years ago, when my health fell apart, But I feel just the same, a... Life with Chronic Pain blogs http://www.medworm.com/rss/comments.php?id=4266031 Thu, 16 Dec 2010 21:57:49 +0100 4266031 http://www.medworm.com/index.php?rid=4259227&cid=t_102545_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F12%2F15%2Flooking-at-you-looking-at-me-the-effect-of-clinical-encounters%2F I’ve been browsing the databases for information on clinical encounters. I do this because while I’m well aware of many papers produced on the topic of patient-related predictors of outcome, the swing towards considering clinician characteristics as predictors of outcome means I hope to see more published on this incredibly important topic. A wee while I ago I wrote about patient self-report measures of chronic pain clinical encounters (Stomski, MacKintosh & Stanley, 2010), in which I discussed the lack of reliable, valid measurement tools in which people with pain are asked about their clinical encounters – and worse still, the glaring omission in any of the reviewed measures of actually asking people with chronic pain whether the constructs being assessed actually m... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4259227 Tue, 14 Dec 2010 20:53:00 +0100 4259227 http://www.medworm.com/index.php?rid=4253468&cid=t_102545_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F12%2F14%2Fknowing-how-is-not-equal-to-doing%2F There have been several attempts to develop a standardised approach to self management – one of the most popular in New Zealand is the Flinders Program (TM). This is a programme developed in Australia from the 1990 Australian Coordinated Care Trials. It’s based on cognitive behavioural therapy, includes problem solving and motivational interviewing techniques, and provides a set of tools and processes that clinicians can use to help people assess and then develop self management plans. The aim, as for any self management programme, is to shift the ‘balance of power’ so to speak from clinician-centred to patient or client-centred partnership, so that shared decision-making about health occurs. It has been used in New Zealand for some years: the Arthritis New Zealand ... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4253468 Mon, 13 Dec 2010 18:31:21 +0100 4253468 http://www.medworm.com/index.php?rid=4253469&cid=t_102545_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F12%2F13%2Fthe-pain-system-is-so-complicated%2F There are a couple of ways to approach the problem of pain – the one I grew up with is the medical one: diagnose the problem, fix the problem, life returns to normal.  The person’s role in this is to be open about what is wrong, let the treatment provider know the information (and only the information) relevant to the problem, follow the medical instructions, and all will be well. Of course the majority of readers of this blog can see some short-comings in this model.  It forgets that people choose when to seek treatment and that they make decisions about this based on ‘common knowledge’ (or what the community around them says they should do), family history, current stressors and activities, degree of distress, and how much the symptoms get in the way of living l... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4253469 Sun, 12 Dec 2010 19:17:10 +0100 4253469 http://www.medworm.com/index.php?rid=4245431&cid=t_102545_129_f&fid=36035&url=http%3A%2F%2Fwww.everydayhealth.com%2Fblog%2Flife-with-chronic-pain%2Fdo-you-feel-more-like-scrooge-or-santa%2F This grandma feels like she got run over by a reindeer. I realize that isn’t possible because they’re all at the North Pole, or grazing in Lapland, but that’s what it feels like and I think I saw a hoof print on my forehead late last night. It might be payback for eating reindeer meat when we were in Finland about ten years ago. I did swallow, but I didn’t like it. Doesn’t that count? I do hope Santa forgives me and all those Finns and Laps who eat it all the time. I’m pretty sure it wasn’t Rudolph or anyone we know. It’s a funny thing about the holidays how they run all over us, like reindeer run amok, whether we enjoy them or not so why not try to get into the spirit of the season? This year is a difficult one for my family because of a family member who is direly ill but... Life with Chronic Pain blogs http://www.medworm.com/rss/comments.php?id=4245431 Thu, 09 Dec 2010 22:10:37 +0100 4245431 http://www.medworm.com/index.php?rid=4225468&cid=t_102545_129_f&fid=36035&url=http%3A%2F%2Fwww.everydayhealth.com%2Fblog%2Flife-with-chronic-pain%2Fcan-you-find-happiness-while-living-with-chronic-pain%2F We just had a Happy Thanksgiving. We are annually wished a Happy Birthday. We will be expected to have a Happy New Year but apparently we’re supposed to have a Merry Christmas. We can be slap happy, trigger happy and “so happy for you.” I’m not certain who creates these labels but most of them have to be jolly, merry, and bright. I have often wondered how important it is to be happy. Do you think you can be happy if you live with chronic pain each day of your life? Should we strive for happiness? Does it matter? Is happiness important compared to being healthy? So many questions come to mind when you open this jolly, sparkly box such as: Can another person make you happy or do you have to do that all by yourself? Are we happier when we’re in love or when we&#8... Life with Chronic Pain blogs http://www.medworm.com/rss/comments.php?id=4225468 Thu, 02 Dec 2010 22:12:15 +0100 4225468 http://www.medworm.com/index.php?rid=4214520&cid=t_102545_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F12%2F01%2Fevidence-into-practice-but-wait-theres-more%2F I pondered a bit about writing this post today. Yesterday I discussed some of the challenges of transferring research into daily practice, and maybe I’ve done enough on the topic – then again, there are some issues that can take a long time to explore. One of them for me is how to integrate client-centred practice with research evidence – how do I use the data gathered in strict research conditions, where grouped data is the outcome when I come face-to-face with a person who is unique in presentation, outlook, values, hopes and dreams?  Do I have answers that will help this person make changes so that he or she can be and do what they hope to, despite their persistent pain? My take on this problem is to spend time working with the person to develop a set of clinical hypo... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4214520 Tue, 30 Nov 2010 21:49:52 +0100 4214520 http://www.medworm.com/index.php?rid=4214521&cid=t_102545_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F11%2F30%2Fhow-to-transfer-research-into-practice-more-questions-than-answers%2F With a background in a health profession not known for its love of science, I suppose when I came across evidence based health care I felt a strong sense of relief. Here, at last, was a way to work out what to do when faced with the task of helping people with pain.  I was therefore a bit taken aback when I read a blog post on Science-Based Medicine here challenging my assumptions about the place of randomised controlled trials at the top of the evidence hierarchy (well, actually second from top – meta-analysis of RCT’s is at the top!).  It took a moment or two of serious pondering to come to terms with David Gorski’s critique of EBHC, and to accept that he has a point.  His point is that if RCT is at the top of the heap in evidence terms, it shouldn’t do so at t... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4214521 Mon, 29 Nov 2010 18:31:43 +0100 4214521 http://www.medworm.com/index.php?rid=4207517&cid=t_102545_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F11%2F29%2Fcan-psychological-management-of-fibromyalgia-affect-pain%2F When I’m working with someone who has chronic pain, from the outset I’m pretty straight-up that the treatments I offer don’t directly affect pain intensity.  It’s not my focus, and very often after the first session, I don’t even discuss pain – I’m more interested in what the person is doing! And for this focus, I sometimes get some reasonably snippy comments, none more so than a doctor (who shall remain nameless) who said to some of my students that psychological and functional approaches to pain management are, in effect, useless because they ‘can’t directly address the pain’. Well, I beg to differ, kind sir. While pain intensity isn’t the focus of treatment, it very often is affected by the treatments offered using a cog... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4207517 Sun, 28 Nov 2010 21:06:30 +0100 4207517 http://www.medworm.com/index.php?rid=4200743&cid=t_102545_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F11%2F25%2Fi-dont-know-three-words-we-might-not-be-saying-enough%2F New Zealanders are reeling today after the deaths of 29 miners trapped in a coal mine on the rugged West Coast of New Zealand.  We have watched this drama unfold over the past five days.  We have seen media conferences and we have watched TV footage.  And one of the more frustrating aspects for families has been the refrain “It’s too dangerous to enter the mine.”  The key player in the public face of this disaster has been Peter Whittall, CEO of Pike River Coal Mine.  His ability to answer questions honestly, calmly and with dignity has been a constant source of wonder.  What he must be feeling now can’t be put into words. Throughout this tragedy, the words ‘I don’t know’ have been spoken often.  I think these are some of the bravest words a... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4200743 Wed, 24 Nov 2010 19:58:26 +0100 4200743 http://www.medworm.com/index.php?rid=4197387&cid=t_102545_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F11%2F24%2Fdeveloping-a-set-back-plan-in-pain-management%2F In this study, access to this support was maintained for four months. What this research found was that across a wide range of outcome measures including pain intensity, mental health, physical activity and disability, participants maintained their changes.  Not only did they maintain these changes during the four months of telephone support, they also maintained changes over a subsequent four months – to a greater extent than those who didn’t have access to this kind of support. I think this approach is promising.  Ongoing support groups have some negative effects, particularly if they rely on volunteer or lay leaders (who may have their own issues to manage), and they can foster a degree of ongoing identification with the ‘patient’ role.  Similarly, providing i... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4197387 Tue, 23 Nov 2010 18:30:46 +0100 4197387 http://www.medworm.com/index.php?rid=4190545&cid=t_102545_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F11%2F23%2Fflare-ups-breakthrough-pain-or-set-backs-self-managing-exacerbations-of-pain%2F A couple of days ago I wrote about medication and managing flare-ups, and out of that post there was a bit of discussion about what exactly I meant by flare-up, and whether it might be better defined as break-through pain.  I’ve found that there is not a lot of agreement in the literature – nor with clinicians! – in terms of distinctions between flare-up or breakthrough, so I’ve decided to redefine the problem completely. Not that I’m the first to do so, as you’ll see from the paper I’ve referred to today.  I have to admit that I like Turk’s approach to chronic pain, as it’s the way I have been trained to approach pain management.  Turk is also the author of a self-help book for chronic pain management that I still think is one of th... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4190545 Mon, 22 Nov 2010 21:34:13 +0100 4190545 http://www.medworm.com/index.php?rid=4190546&cid=t_102545_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F11%2F22%2Ftaking-a-closer-look-at-health-encounters-for-people-with-chronic-pain%2F A theme of comments made by people I’ve seen clinically is that certain health care encounters they’ve had have not been especially helpful. Some people feel belittled, some patronised, some bamboozled, some dismissed – and yet in most surveys of health care satisfaction, the rating is pretty high (Jenkinson, Coulter, Bruster, Richards & Chandola, 2002). What is an effective way to measure how well we do what we do? One method is to look at repeat customers – but in chronic pain management this could indicate that something is wrong! After all, if we’re working to help people who have a chronic condition to self manage their pain, coming back for more is most likely going to end up in an enormous number of patients to see!  Chronic conditions, by definiti... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4190546 Sun, 21 Nov 2010 18:41:11 +0100 4190546 http://www.medworm.com/index.php?rid=4179412&cid=t_102545_129_f&fid=36035&url=http%3A%2F%2Fwww.everydayhealth.com%2Fblog%2Flife-with-chronic-pain%2Fsearching-for-thanksgiving%2F As children we’re taught the basics. We’re told to say, “Thank you,” when someone gives us a gift, whether or not we like it. We’re taught the magic word, “Please.” We also learn when we’re young not to wander into the street without looking both ways. Oh my, childhood is so full of dos and don’ts, as we are taught to become civil individuals, isn’t it? We learn so much about life that is basic to our knowledge to survive in this world. Day-to-day life was full of routine, learning, discipline, and friendships. The times that shine the brightest, however, are the holidays. Families dressed in their finest, the odors of fine food, and the joys of seeing faces you didn’t often see. The feeling of family love was and is wonderful. I know we all have many memories of Than... Life with Chronic Pain blogs http://www.medworm.com/rss/comments.php?id=4179412 Thu, 18 Nov 2010 21:53:55 +0100 4179412 http://www.medworm.com/index.php?rid=4175986&cid=t_102545_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F11%2F18%2Fmedication-and-self-managing-chronic-pain-iii%2F When discussing medication and pain reduction for chronic pain, it’s not surprising there are some very strong opinions and emotions.  After all, having pain is universally known to be unpleasant, very few people really want to have pain (except those who like the rush of acute pain – vis a vis body suspension!), and the first person many people go to discuss their pain is a medical practitioner. The way the centre in which I work views medication is that it forms part of a toolkit for managing pain, alongside all the self management strategies that we also endorse.  So, by and large, most of the people we see are on a stable regime of medication targeting the underlying mechanisms thought to be influencing the nervous system’s sensitivity to stimuli. A reader suggested... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4175986 Wed, 17 Nov 2010 20:03:55 +0100 4175986 http://www.medworm.com/index.php?rid=4172341&cid=t_102545_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F11%2F17%2Fmedication-and-self-managing-chronic-pain-ii%2F If medication is to be part of a toolkit for self managing chronic pain, then it seems to me that it’s important to know as much about the medication and how it should be used as possible.  Once again, today I’m not directly referring to the literature because I haven’t found an awful lot discussing this integration approach, so please bear this in mind when you read what I’ve written.  I’m also not a medical doctor, I don’t prescribe, I don’t want to have prescribing rights, and I must advise any reader NOT to change, reduce or increase medications without having a good discussion with your own medical practitioner first. There are two main paths in pain management – one focuses on pain reduction, and this is where I think medication (and surgery and... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4172341 Tue, 16 Nov 2010 18:37:08 +0100 4172341 http://www.medworm.com/index.php?rid=4168224&cid=t_102545_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F11%2F16%2Fmedication-and-self-management-for-chronic-pain%2F Last week a reader asked me for my take on using medications for chronic pain, so today I’m going to take a stab at this rather emotive and certainly very complex topic.  Before I do so, a word of warning – this is mainly my opinion and experience!  I’m also not a medical doctor, I don’t prescribe, I don’t want to have prescribing rights, and I must advise any reader NOT to change, reduce or increase medications without having a good discussion with your own medical practitioner first. Strangely, I had trouble locating journal articles on combining medication and self management, so I either need to refine my search terms – or there may not be an awful lot of information out there about it. Despite the lack of information that I could find, more peopl... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4168224 Mon, 15 Nov 2010 18:26:29 +0100 4168224 http://www.medworm.com/index.php?rid=4159357&cid=t_102545_129_f&fid=36035&url=http%3A%2F%2Fwww.everydayhealth.com%2Fblog%2Flife-with-chronic-pain%2Fget-to-know-the-new-you-in-a-life-of-chronic-pain%2F I’m a different person now than the one I used to be. The effect of disease and daily pain has a tendency to bring about change. I know that dreaded word, change. It seems to be all around us as life progresses. “Going through the change” is a phrase we hear uttered so often about women and menopause. For the guys we say, “Oh, he’s going through a mid-life crisis.” For many of us, male and female, change is thrown at us from many arenas of life. “The change” can mean the loss of health, a job, a loved one, or a calamity that has taken away a beloved home. Change can also mean growth, blossoming, and renewal. It can be shown in learning something we previously didn’t know, sharing some knowledge with a friend, or getting to know someone old or new to us whom we did not rea... Life with Chronic Pain blogs http://www.medworm.com/rss/comments.php?id=4159357 Thu, 11 Nov 2010 20:03:01 +0100 4159357 http://www.medworm.com/index.php?rid=4152302&cid=t_102545_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F11%2F11%2Fchronic-pain-in-the-interweb%2F It’s not very often that I’m moved to respond to other blogposts about chronic pain.  When I go onto Google and search for chronic pain SO many awful, quacky, misleading sites come up, promising this and that with so little evidence to support their claims, I’ve tended to avoid looking.  Today, however, thanks to the Neuroscience and Pain Science for Manual Physical Therapists group on Facebook (go Diane!) I was lead to the ever-challenging Science-Based Medicine blog in which a review of the book The Pain Chronicles by Melanie Thernstrom is posted. Now I have not read The Pain Chronicles (by all accounts it looks like a fascinating read), but one of the statements cited in SBM’s review is one of the more profound comments about the management of chronic pain that... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4152302 Wed, 10 Nov 2010 18:43:40 +0100 4152302 http://www.medworm.com/index.php?rid=4152303&cid=t_102545_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F11%2F10%2Frebuilding-work-identity%2F I love helping people return to work.  It’s got to be one of the most rewarding parts of pain management for me because not only is work important for health, it’s a major part of our day, and it’s a whole lot about individual identity.  So helping people reconstruct their sense of self to the point where they can go to an employer and say ‘I can do this for you’ with confidence is an enormous challenge. To feel confident enough to put yourself on the line to an employer despite chronic pain is a challenge.  It involves at least some of the following (and yes, this is mostly from my experience on this post!): Good self efficacy for managing pain - to the point where fluctuations in pain intensity can be taken with equanimity Strong knowledge of what you ca... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4152303 Wed, 10 Nov 2010 01:28:00 +0100 4152303 http://www.medworm.com/index.php?rid=4152304&cid=t_102545_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F11%2F09%2Fbroaden-and-build%2F Readers may be wondering why I’ve come over all happy clappy and jolly joy germ – well, I realised I’d been writing a lot about experimental and theoretical factors found to influence vulnerability to chronic pain, but I had been writing less about ways to help people cope more effectively with chronic pain. I do have a soft spot for positive psychology because, as we can see in most of the major journals, psychological studies have primarily been interested in what goes wrong, why people may struggle to cope with their pain, and other aspects of vulnerability. Yet more people than not live well with their chronic pain, and rarely seek help for their pain – maybe we can learn something from how these people cope, and in doing so, help people who do need treatment de... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4152304 Mon, 08 Nov 2010 18:40:11 +0100 4152304 http://www.medworm.com/index.php?rid=4143033&cid=t_102545_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F11%2F08%2Fhappy-happy-joy-joy-increasing-positive-experiences-to-improve-mood%2F I am sure there will be people who read today’s post who will feel like giving me a bit of a slapping. “How”, they will say, “Are you supposed to get happy when you’re feeling bad?” And I would have been one of these people a few years ago too, given my history of low mood and love of whining. Seriously, it’s completely counter-intuitive to think that when you’re feeling flat and low, all you need to do is get out and enjoy yourself! It goes a bit like this, I think. When someone is feeling a bit flat, maybe having done too much and started to feel fatigued, it’s normal to stop doing quite so much and rest up. But if resting fails to increase energy – maybe because of a chronic condition like fibromyalgia, or really any of the chr... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4143033 Sun, 07 Nov 2010 18:37:39 +0100 4143033 http://www.medworm.com/index.php?rid=4139496&cid=t_102545_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F11%2F05%2Ffirday-funnies%2F Something we can all be reminded of now and again – work does come to an end.  So if these are true – what happens to physiotherapists, nurses, occupational therapists, psychologists and social workers?  Contributions more than welcome! Lawyers are disbarred. Ministers are defrocked. Electricians are delighted. Far Eastern diplomats are disoriented. Drunks are distilled. Alpine climbers are dismounted. Piano tuners are unstrung. Orchestra leaders are disbanded. Artists’ models are deposed. Cooks are deranged. Dressmakers are unbiased. Nudists are redressed. Office clerks are defiled. Mediums are dispirited. Programmers are decoded. Accountants are discredited. Holy people are disgraced. Pastry chefs are deserted. Perfume makers are dissented. Butterfly collectors are de... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4139496 Fri, 05 Nov 2010 03:42:15 +0100 4139496 http://www.medworm.com/index.php?rid=4134030&cid=t_102545_129_f&fid=36035&url=http%3A%2F%2Fwww.everydayhealth.com%2Fblog%2Flife-with-chronic-pain%2Funderstanding-death-while-we-live-with-chronic-pain%2F Today, dear friends, for some unknown reason, I feel compelled to share a story with you. Perhaps, it is because we are going through a loss in our family with the terminal cancer of the other grandma and I have final days on my mind and heart. Grab your tissues and let me tell you about a very special woman I took care of many years ago. As I opened the door to her hospital room, I wasn’t sure what to expect. Having reviewed her chart, I knew she was only 39 years old and she was dying of cancer. Breast cancer, diagnosed and discovered two years before, had metastasized to many other areas of her body; she had tumors behind her corneas in both eyes, partially affecting her eyesight. She was in the hospital when I first met her to have those tumors irradiated. She was also receiving chem... Life with Chronic Pain blogs http://www.medworm.com/rss/comments.php?id=4134030 Thu, 04 Nov 2010 22:10:47 +0100 4134030 http://www.medworm.com/index.php?rid=4134291&cid=t_102545_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F11%2F02%2Fresilience-catastrophising-and-positive-emotions%2F Catastrophising, or thinking the worst, is one of those psychological factors that we know influences distress and disability in people with chronic pain. It’s quite a common phenomenon, and sometimes can stand us in good stead – after all, if we can think of the worst things that can happen, then plan to avert those possible disasters, then life will be sweet, yes? ermmmm – no, as a matter of fact.  Catastrophising can actually function to narrow our thinking down, reducing the range of options we can come up with to manage situations, and it can also function to focus us on things that haven’t worked out while at the same time minimising our appreciation of things that are working well. In chronic pain, catastrophising is often an outcome to measure – the t... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4134291 Tue, 02 Nov 2010 08:49:36 +0100 4134291 http://www.medworm.com/index.php?rid=4125302&cid=t_102545_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F11%2F01%2Fwords-on-the-value-of-data%2F I’m not known for my immaculate office or my attention to detail – I’m the sort of big picture or conceptual person in a team.  I care about values and finding a way to achieve an end result, but I’m less fascinated by detail.  There is, however, a time when record-keeping and data comes into its own, and I am very grateful to those people who do look after the nuts and bolts.  And today’s post is about why. I work in a tertiary pain management centre in a teaching hospital in a large health organisation with multiple layers of administration and management all wanting a piece of the fiscal pie allocated to us from central government.  Throughout my years in health care, I can’t ever recall being told ‘we have lots of money, let’s go shop... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4125302 Mon, 01 Nov 2010 07:31:47 +0100 4125302 http://www.medworm.com/index.php?rid=4119411&cid=t_102545_129_f&fid=36035&url=http%3A%2F%2Fwww.everydayhealth.com%2Fblog%2Flife-with-chronic-pain%2Fchronic-pain-shakes-up-your-life%2F When life turns around for us and our world seems upside down, we’re not sure which part is wearing out first. Are we losing our minds, too, as well as our bodies? It’s a strange thing about choice when you live a life of chronic pain or deal with some awful illness every day. At first, when we become ill or are struck by pain, we are shaken to the core. It’s as if someone has set fire to our plans, our credentials and our futures. We are forced to re-think our direction in life. When our life changes direction, each part of us gets sucked into the morass and the quagmire. It’s as if our plane has crashed and all the debris fell into a whirlpool and while we’re in the midst of pain and suffering, we still have to sort out finances, family and just getting through each day. We wou... Life with Chronic Pain blogs http://www.medworm.com/rss/comments.php?id=4119411 Thu, 28 Oct 2010 21:43:14 +0100 4119411 http://www.medworm.com/index.php?rid=4119760&cid=t_102545_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F10%2F28%2Fwhats-missing-from-pain-assessment%2F I am stumped. Here is a common clinical quandary – one of the most important outcomes from pain management is to increase participation in daily activity (occupation), yet the measures we use just don’t quite cut it for me. Here’s a couple of examples: in the IMMPACT recommendations from 2008 (in the paper I’ve cited below and from the one I cited earlier this week) two ‘disability’ measures are suggested as a way to assess disability.  One is the ‘Interference’ subscale from the Multidimensional Pain Inventory, and the other is the Pain Disability Index.  Both of these have sound psychometric properties, have been used for a long time in pain management research and clinical use – but both of them have problems. The problems are abou... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4119760 Wed, 27 Oct 2010 18:39:19 +0100 4119760 http://www.medworm.com/index.php?rid=4119761&cid=t_102545_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F10%2F27%2Fpsychological-therapy-works-for-fibromyalgia%2F An ‘enigmatic’ disorder – this is what Perry Nicassio calls fibromyalgia. I hadn’t thought of it that way, because so many chronic pain problems seem to be equally ‘enigmatic’! It’s a common disorder, affects many more women than men, has a multiplicity of effects on people ranging from fatigue, poor sleep, widespread aching, other pain sensations such as stabbing or needle-like pains that can appear anywhere in the body, often with low mood and loss of function.  There are few medications that seem to help, and many people never seek treatment for their pain.  If people do look for treatment, they can be faced with skepticism from some health providers, despair from others, and offered a multiplicity of treatments that don’t seem to do an ... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4119761 Tue, 26 Oct 2010 18:37:56 +0100 4119761 http://www.medworm.com/index.php?rid=4106087&cid=t_102545_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F10%2F26%2Fwhat-matters-to-people-with-persistent-pain%2F I’ve read many written expectations of people coming for pain management – and without a doubt, the majority of people want to get on with life, go back to doing what they enjoy, and feel better in themselves. The only problem with that? Most of them preface their goals with ‘reduce my pain so I can…’, or words to that effect. And the reality is that for many of them, that particular goal is frustratingly difficult to achieve. I would think that most clinicians working in pain management want to practice patient-centred care – but what is it that patients really want when pain can’t be completely eliminated? Luckily for us (maybe), the team developing the IMMPACT (Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials) recommend... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4106087 Mon, 25 Oct 2010 18:29:08 +0100 4106087 http://www.medworm.com/index.php?rid=4106088&cid=t_102545_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F10%2F25%2Fessential-skills-for-pain-clinicians%2F Strangely enough I don’t have a specific reading or paper for my post today – only my experience over a long time working in pain management. Now I know anecdotes are not strong evidence, yet at the same time there are some things that have yet to be well researched, so this is an attempt maybe to put something out there that someone will pick up and run with! What are some of the essential skills for pain clinicians? Whether they’re working in acute pain or chronic pain, I think the first and sot essential skill is the ability to listen and be empathic towards the peson with pain. To me, listening with the whole mind and heart is a clinical imperative. It means really hearing what the person is saying with words and body. Why would I put this skill at the top of the list... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4106088 Sun, 24 Oct 2010 21:01:05 +0100 4106088 http://www.medworm.com/index.php?rid=4098230&cid=t_102545_129_f&fid=36035&url=http%3A%2F%2Fwww.everydayhealth.com%2Fblog%2Flife-with-chronic-pain%2Fthe-karate-kid-and-a-life-of-chronic-pain%2F Several times over the course of the last few years and our chats together, I have mentioned the films with various reincarnations of the character the Karate Kid. The late Pat Morita starred in three of them and was such a perfect Mr. Miyagi in example and his sparsely spoken words. Anyone who has seen those films was imprinted with the importance of consistency of movement exemplified in such statements as “Wax on, wax off.” Consistency of movement builds muscle mass and keeps us strong and our bodies usable. The conscious movement using both sides of our bodies, particularly our hands, arms, and legs, is our way of putting up a valiant fight against the hostile takeover of disease. Some of us with pain in other areas have, with the help of physical therapy, learned ways to keep thos... Life with Chronic Pain blogs http://www.medworm.com/rss/comments.php?id=4098230 Fri, 22 Oct 2010 14:24:32 +0100 4098230 http://www.medworm.com/index.php?rid=4098493&cid=t_102545_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F10%2F21%2Fhow-to-translate-research-into-practice%2F Well, maybe that’s a misnomer for today’s post, but it does strike to the very heart of some of the more heated debates that I see when I browse the interweb. With all the conflicting research reports into all the various interventions for chronic pain (well, for anything really), how does a clinician decide when the time is right to start incorporating a new practice (such as working with acceptance or mirror therapy or laterality), or begin to phase out an old practice (like distraction or core stability or muscle imbalance)? This paper, one of a series of excellent papers in Best Practice & Research Clinical Rheumatology on the management of low back pain, discusses in a really accessible way, the various problems that face an earnest clinician who wants to ‘do the... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4098493 Wed, 20 Oct 2010 18:38:45 +0100 4098493 http://www.medworm.com/index.php?rid=4086533&cid=t_102545_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F10%2F21%2Fhow-to-translate-research-into-practice%2F Well, maybe that’s a misnomer for today’s post, but it does strike to the very heart of some of the more heated debates that I see when I browse the interweb. With all the conflicting research reports into all the various interventions for chronic pain (well, for anything really), how does a clinician decide when the time is right to start incorporating a new practice (such as working with acceptance or mirror therapy or laterality), or begin to phase out an old practice (like distraction or core stability or muscle imbalance)? This paper, one of a series of excellent papers in Best Practice & Research Clinical Rheumatology on the management of low back pain, discusses in a really accessible way, the various problems that face an earnest clinician who wants to ‘do the... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4086533 Wed, 20 Oct 2010 18:38:45 +0100 4086533 http://www.medworm.com/index.php?rid=4082343&cid=t_102545_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F10%2F19%2Fhow-did-that-happen-stories-of-returning-to-work%2F Yesterday I started to talk about returning to work with chronic pain. I mentioned that it’s often not the degree of importance an individual places on returning to work that engenders resistance – it’s more likely the lack of confidence the person has towards the process, the fear that this won’t work out and they will fail… A story or two might help detail some of the issues that people I work with encounter when they’re returning to work. Now I recognize that the people I see are possibly at the more complex end of the spectrum than many, so these stories might well be more extreme than what many clinicians see, but at the same time they illustrate where things go wrong. A note: vignettes used in this blog are composites of people I’ve worked wi... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4082343 Tue, 19 Oct 2010 05:21:29 +0100 4082343 http://www.medworm.com/index.php?rid=4082344&cid=t_102545_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F10%2F19%2Fworking-and-chronic-pain%2F If there is one aspect of chronic pain management that has received more attention than returning to work, I don’t know it! In 1995 when I started working at my current workplace, work was almost a dirty word. I was accused at one time of being a ‘Siberian workcamp’ Commandante because some people thought it was cruel to ‘force’ people with chronic pain into the workplace. Thankfully this attitude has changed over the years, and most people recognise that working when you have chronic pain, while difficult, is achievable and good for health. At the same time, returning to work with pain has never been especially easy and there are numerous issues to work through. Today is the first day I will discuss the practical aspects of returning to work with the current ... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4082344 Mon, 18 Oct 2010 18:37:07 +0100 4082344 http://www.medworm.com/index.php?rid=4077624&cid=t_102545_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F10%2F17%2Fworkability%2F There can sometimes be a delicate balance in therapy, between challenging people to try something new and step away from ways of coping that are easy because they’re habits, and at the same time respecting that people have different ways of doing things, different values and beliefs, and in the end have to choose what works for them. In a recent discussion, someone asked me why Psychology is so quick to judge treatments and why ‘evidence’ is restricted to therapy that has been subject to things like randomized controlled trials and so on. After all, lots of people come to see this person after ‘conventional’ treatment has failed, and they feel very happy with the treatment he gives them. To answer that question, and at the same time give due regard to individ... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4077624 Sun, 17 Oct 2010 05:37:29 +0100 4077624 http://www.medworm.com/index.php?rid=4074261&cid=t_102545_129_f&fid=36035&url=http%3A%2F%2Fwww.everydayhealth.com%2Fblog%2Flife-with-chronic-pain%2Fgoblins-and-ghoulies-in-a-life-with-chronic-pain%2F Somehow, celebrating Halloween seems a bit redundant when you live each day with chronic pain. Strangely, all of the popular figures associated with this holiday are all too familiar to us. In my humble opinion, they should not be allowed to have their own holiday; but as I recall, no one asked me. Ghoulies: We visit them often as they stab our veins and take our blood. For many of us this happens every month or two. I can only thank a lifetime of maturation for changing my manners and yours when it comes to this blood-letting. What if all the adults who were sitting in the outpatient lab behaved like 2-year-olds and screamed loudly enough to be heard on the third floor? Now, that’s a sight I’d pay to see and hear. Could I be one of the screamers? Goblins: Many of us are unfortunate ex... Life with Chronic Pain blogs http://www.medworm.com/rss/comments.php?id=4074261 Thu, 14 Oct 2010 20:29:23 +0100 4074261 http://www.medworm.com/index.php?rid=4061090&cid=t_102545_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F10%2F13%2Fflexibility-of-the-psychological-kind%2F More holiday reading to ponder… One of the fascinating developments in psychology over the past 50 years is the ongoing study into what constitutes psychological health. It’s been known by many names – ego-resilience, executive control and self-regulation – but the work on these areas hasn’t been pulled together into a coherent whole until recently. The authors of this paper suggest that this is partly because of the nature of defining this particular beast – what is health after all? Their argument, and one that I find rather appealing, is that a main feature of health is to be able to apply the right kind of response to the many different situations in which we find ourselves. In other words, flexibility. Occupational therapists in particular will rejo... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4061090 Tue, 12 Oct 2010 18:38:39 +0100 4061090 http://www.medworm.com/index.php?rid=4055968&cid=t_102545_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F10%2F12%2Fcounting-your-blessings-or-looking-on-the-bright-side-of-life-whistles%2F My family were big on the Andrews Sisters. One of my strong memories as a child is listening to the song ‘count your blessings, name them one by one…’ [no, I will not sing it ok?!]. And I remember the book Pollyanna (you can read it for free here!) and the ‘Glad game’ where she looked for the positive in her rather dire situation when she went to live with her strict Aunt Polly. And guess what?  There is something in this approach to coping that makes a difference! While on holiday, sad person that I am, I did spend one or two days reading journal articles.  Several of them were related to the theme of positive psychology in a special issue of Clinical Psychology Review. While research into optimism, positive affect and even psychological flexibility has bee... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4055968 Mon, 11 Oct 2010 18:36:40 +0100 4055968 http://www.medworm.com/index.php?rid=4040676&cid=t_102545_129_f&fid=36035&url=http%3A%2F%2Fwww.everydayhealth.com%2Fblog%2Flife-with-chronic-pain%2Fkeeping-it-simple-in-a-life-with-chronic-pain%2F There are many names for it when life becomes complicated. We can spin out of control, “lose it,” and become so entangled you’d think life was a game of Twister. For most of us that wouldn’t literally be possible but you get the idea. When you already feel like a human pretzel, can it get any worse? The answer to that is, of course, “Well, sure, life can always get worse.” Reassuring, isn’t it? Best not go there because we need to remind ourselves life can also get better. These are not simple times for anyone. There is much to worry about on the news 24 hours each day; in our personal lives and in the lives of others. Financial times are scary, terrorists want to kill us, and neighbor to neighbor we disagree about the solutions to all of these complex problems. I haven’t e... Life with Chronic Pain blogs http://www.medworm.com/rss/comments.php?id=4040676 Thu, 07 Oct 2010 21:37:33 +0100 4040676 http://www.medworm.com/index.php?rid=4031368&cid=t_102545_122_f&fid=36582&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSharpBrains%2F%7E3%2FB6qLbobY-Ng%2F Welcome to Grand Rounds, the weekly col­lec­tion of best health and med­ical blog posts. This week we invite you to enjoy a broad range of insights, tips, and first-hand stories, presented as a Q&A conversation with bloggers willing to answer, below, a total of 22 good questions. On Health and Medicine What can one-word prescriptions deliver How does food processing change food´s nutritional value Can diet Increases Risk of ADHD Is alcoholism an illness What´s better: steady dete­ri­o­ra­tion over 10 years, or symp­tom-free life for 9 years fol­lowed by rapid dete­ri­o­ra­tion in year 10 On Patient Life As we talk about wellness…what about developing self-compassion Can patients with chronic pain still live a full life What is the patient-doctor etiquette for usin... SharpBrains blogs http://www.medworm.com/rss/comments.php?id=4031368 Tue, 05 Oct 2010 11:19:13 +0100 4031368 http://www.medworm.com/index.php?rid=4018300&cid=t_102545_129_f&fid=36035&url=http%3A%2F%2Fwww.everydayhealth.com%2Fblog%2Flife-with-chronic-pain%2Fthe-power-of-expectation-in-a-life-with-chronic-pain%2F When we are plunged, thrown, or gradually swallowed by a life of chronic pain, it’s only human to feel despair. We say things like, “Well, I’m just not going to let this get me down,” or “I’m trying to stay positive about this.” I’m not certain why we do that. I think we fear thinking about the worse scenario of whatever is happening in our lives and bodies. I believe, also, we are trying to put on a happy face for our family members and friends. We don’t like to embrace the fact we may be causing anxiety, pain, and worry for those we love as well as for ourselves. To have your life shattered takes more than glue to put it back together again. I don’t know anyone who went through life, particularly the early years and said, “Oh let’s see. When I’m 40 years old I t... Life with Chronic Pain blogs http://www.medworm.com/rss/comments.php?id=4018300 Thu, 30 Sep 2010 19:21:22 +0100 4018300 http://www.medworm.com/index.php?rid=4018454&cid=t_102545_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F09%2F30%2Fclinicians-and-graded-exposure%2F Some people do, and some people don’t, some of us will, and some of us won’t! Graded exposure can be an uncomfortable experience for both the person who is learning to approach activities that don’t feel very good – and for the clinician! It goes against the grain for some of us to elicit anxiety and see distress as we work with people, after all, our job is to help people feel better isn’t it? There are some consistent findings about clinician anxiety vs patient anxiety when it comes to pain. It seems that clinicians can often be more conservative with regard to what is OK for a person to do than the person can be. This conservatism can be related to clinician’s beliefs about hurt vs harm, clinician’s orientation to a biopsychosocial model –... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4018454 Wed, 29 Sep 2010 17:35:42 +0100 4018454 http://www.medworm.com/index.php?rid=4013604&cid=t_102545_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F09%2F29%2Fgo-on-expose-yourself%2F …er, maybe not that way OK?! Graded exposure in vivo (with response prevention) is a specific treatment for pain-related anxiety/fear and avoidance.  More specifically, it’s for people who are avoiding activities that are not going to harm them, but may increase their pain.  Their beliefs as to why they ‘shouldn’t do’ these activities or movements differ widely – some people recognise that while they’re not going to harm themselves, they don’t want to or feel overwhelmed when they experience increases in pain, while others are definitely concerned that their pain means some damage is likely to occur, or more often, ‘might’ occur. Simple reassurance doesn’t help people in this situation.  Just telling someone that ’... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4013604 Wed, 29 Sep 2010 03:56:33 +0100 4013604 http://www.medworm.com/index.php?rid=4003454&cid=t_102545_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F09%2F28%2Ffearanxietyavoidance-%25e2%2580%2593-treatments-review%2F For years, clinicians working in pain management have mixed together a rich assortment of strategies to help people function better.  But to identify the ‘active ingredients’ of multidisciplinary pain management using a cognitive behavioural approach, it’s been important to tease each element apart.  One size does not fit all – and just as a physician chooses the most effective medication for a disorder, in time I hope we will be able to choose the most effective strategy for the problems each individual experiences rather than applying our current ‘scatter-gun’ approach. Yesterday I gave a brief overview of the three main treatments to helping people who are fearful/anxious of their pain (or harm) and avoid activities as a result. They are: Graded ex... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4003454 Mon, 27 Sep 2010 18:25:26 +0100 4003454 http://www.medworm.com/index.php?rid=4003101&cid=t_102545_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F09%2F27%2Ffearanxietyavoidance-and-some-treatments%2F I’ve been pondering the post by Neil O’Connell on Body in Mind in which he comments on a paper by Foster, Thomas, Bishop, Dunne and Main (2010) in which he makes the point that “There is a huge emphasis on psychological variables in research and current care for low back pain. My experience (the usual biased, unreliable, non-replicable shambles) tells me that this is justifiably so. But in this rigorous study the four psychological variables found to have a unique influence individually explained just 2.5% of the variance or less. The big players were the level of disability when the patient arrived at the GP and demographic factors which together explained 50%.” Now this flies in the face of the general trend towards emphasising psychosocial variables associated wi... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4003101 Mon, 27 Sep 2010 05:35:16 +0100 4003101 http://www.medworm.com/index.php?rid=3999132&cid=t_102545_129_f&fid=36035&url=http%3A%2F%2Fwww.everydayhealth.com%2Fblog%2Flife-with-chronic-pain%2Fthrough-the-looking-glass-of-chronic-pain%2F For some of us, life has totally changed. Like Alice in Wonderland, you wake up one day and you find you have slid into a new world, when you live with chronic pain. The shapes, the appearance, and the order of life have been altered. We find ourselves asking questions like the following: Can I be this tired and still be alive? At first, we try extra vitamins, visit the health food store, and think we need more sleep. We read books on fatigue, pollution, and the influences of chemicals on everyday life. We visit doctor after doctor until one of them comes up with a reasonable, acceptable, logical diagnosis. Gradually, we assimilate this new-found fatigue as part of our everyday lives. We never fully accept it; just live with it. What else can we do? Fatigue that accompanies rheumatoid dis... Life with Chronic Pain blogs http://www.medworm.com/rss/comments.php?id=3999132 Thu, 23 Sep 2010 19:12:10 +0100 3999132 http://www.medworm.com/index.php?rid=3994369&cid=t_102545_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F09%2F23%2Fworking-with-thoughts-habits-take-time-to-change%2F If only there was a magic wand. I could make millions out of a ‘quick fix’ to changing habits! Unfortunately my magic wand is red and glittery – and plastic. I call it my ‘self management’ wand because it reminds me that self management is no quick fix, and a good deal of the work we need to do is about helping people recognize unhelpful thoughts and behaviors that might work in the short term, but not so in the long term. Changing patterns for sleeping well despite chronic pain is no different – what might have been going on for years isn’t likely to change overnight. Some of the thoughts that people have when embarking on cognitive behavioral therapy for insomnia can be quite unhelpful. One woman I worked with became despondent and eventually gav... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3994369 Wed, 22 Sep 2010 18:35:51 +0100 3994369 http://www.medworm.com/index.php?rid=3987247&cid=t_102545_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F09%2F21%2Fthinking-about-sleep-or-not%2F It’s 3.00 in the morning.  You haven’t slept since you got into bed at 11.00, and the last time you had a full night’s sleep was some months ago.  Every morning you wake up feeling as though you haven’t really slept yet – and every day is just the same. I can understand why people who have sleeping problems (and yes, I’m one of them!) often have quite strong reactions when they’re introduced to some of the concepts that are most successful for restoring a normal sleep pattern.  While the basic principles of sleep hygiene are well-known and reasonably simple, putting them – and other more challenging strategies in place – can be quite a difficult process. It’s what goes through a person’s mind that makes it difficult &#821... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3987247 Tue, 21 Sep 2010 09:06:04 +0100 3987247