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 'coping skills.'. Tue, 04 May 2010 18:34:55 +0100 http://www.medworm.com/index.php?rid=3530051&cid=t_324180_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F05%2F04%2Frelaxation-how-why-the-evidence%2F Over the weekend a discussion about relaxation and the how’s and why’s came up in a discussion group I belong to. Several members of the group, including me, contributed our ‘list of do’s and don’ts’, much of it based on years of clinical experience – until I thought (as I do!) what about the literature? What does research tell us about precautions and effectiveness of relaxation? I have to say that my searches in the literature so far have failed to consider many of the practical tips that the group came up with, but I have found some really helpful reviews of relaxation that support its use in pain management.  One of those more recent references is the one I’m focusing on today. At the same time as wanting to briefly look at the evidence ... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3530051 Mon, 03 May 2010 19:28:35 +0100 3530051 http://www.medworm.com/index.php?rid=3483154&cid=t_324180_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F04%2F19%2Fwho-will-do-well-who-will-not%2F If I had a crystal ball, and could decide who would do well in self managing their pain, and who would not, what would I do? A holy grail for insurance companies and health economists and yes, clinicians, is to find some precise way to decide who needs the most help with their pain, and who will manage well without as much assistance – with the ultimate aim to reduce disabilty and therefore costs (both human and fiscal). The problem is that so far, the experience of pain can’t be objectively measured, and ultimately, it’s the person experiencing the pain who will do or not do, and we have no way of deciding whether the person ’should’ or ’should not’ be expected to function well. This poses an enormous problem in health and insurance. How on earth ... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3483154 Sun, 18 Apr 2010 20:45:48 +0100 3483154 http://www.medworm.com/index.php?rid=3463878&cid=t_324180_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F04%2F13%2Fjust-doing-it-behavioural-activation%2F This post is sparked by a pre-print paper I read yesterday, but follows a long time cogitating about the use and value of “just doing it”. Behavioural reactivation is a set of techniques often used for mood management.  It usually incorporates activity monitoring, assessment of life goals and values, activity scheduling, skills training and problem solving, effective communication training, relaxation training, contingency management, and managing things like avoidance. Fellow occupational therapists will probably feel a tad superior here because these are core aspects of the ways in which occupational therapists work with people, but beware troops! The research from psychology is vast, and it’s rapidly gaining recognition as a psychological approach to reactivation. Beh... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3463878 Mon, 12 Apr 2010 19:31:38 +0100 3463878 http://www.medworm.com/index.php?rid=3444004&cid=t_324180_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F04%2F07%2Fpain-and-health-anxiety-working-with-beliefs%2F Over the past few posts I’ve been looking at pain and health anxiety, and how anxiety about body symptoms can be misinterpreted to represent something sinister when it may be a reflection of the level of physiological arousal in the individual. In fact, one definition of anxiety is ‘over-estimating the threat’ while ‘under-estimating the resources to cope with the threat’. I really like Salkovskis statement ‘People suffer from anxiety because they think situations as more dangerous than they really are’, and ‘Treatment helps the person to consider alternative, less threatening explanations of their problem’. These explanations have to fit with past experiences of the person – and work when they’re tested out. The process of ... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3444004 Tue, 06 Apr 2010 21:13:41 +0100 3444004 http://www.medworm.com/index.php?rid=3370706&cid=t_324180_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F03%2F17%2Fsetbacks%2F A couple of days ago I mentioned the satisfaction I feel when a person I’ve been working with faces a setback and manages it successfully on their own for the first time.   Someone replied saying that we all face pain setbacks alone, so what did I mean really – and I thought today I’d quickly expand on what I did mean! Chronic pain persists (goes without saying) but its pattern is to fluctuate from time to time and often without clear provocation – so it’s not very helpful to try and look at what ’caused’ the pain to change.  Yet this is so often what we as clinicians ask about, and more often what the person experiencing the pain tries to do.  Flare-ups happen irrespective of how hard we try to avoid them, so it’s useful IMHO to group fla... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3370706 Tue, 16 Mar 2010 18:23:08 +0100 3370706 http://www.medworm.com/index.php?rid=3366452&cid=t_324180_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F03%2F15%2Fmaintaining-change%2F This study by Christiansen, Oettingen, Dahme and Klinger, shows an extension of the motivational approaches based on Motivational Interviewing, integrates it with traditional problem solving, drags in a bit of goal achievement theory and ties it all together in two half hour sessions – and produces a significant change in functional outcome.  How so? Importance and confidence The two important drivers of action seem to be how important an activity is and how confident a person is to achieve it.  In this study, a group of patients was asked to rate the importance and confidence to ‘improve physical capacity’.  They were then asked to list four positive aspects associated with making this change – eg getting in shape, having fun, distraction from pain.  They were ... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3366452 Sun, 14 Mar 2010 18:20:24 +0100 3366452 http://www.medworm.com/index.php?rid=3298633&cid=t_324180_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F02%2F23%2Fbridging-the-self-management-gap%2F Recently I ran an online survey on this blog asking the question ‘Should self management include:’ and then I listed a number of options such as ‘injection therapy’, ‘medications’, ‘intermittent hands-on therapy’, ‘intermittent hands-off therapy’ and so on. My thoughts were that while the term ’self-management’ is bandied about a lot, there isn’t really a consensus on what self-management should look like. I was right. The three most popular choices were: - having intermittent hands-on therapy as needed – 31% - nonmedical coping strategies with no ongoing contact with a self-management therapist – 26% - regular hands-off reviews with a self-management therapist – 26% Following quite closely behi... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3298633 Mon, 22 Feb 2010 18:36:35 +0100 3298633 http://www.medworm.com/index.php?rid=3292035&cid=t_324180_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F02%2F21%2Fwhy-do-i-spend-so-much-energy-time-on-chronic-pain%2F Someone said recently that they’d like a job where they come in, do the job, then go home and have a life.  Later that day I spent an hour or so after work talking to another clinician who, like me, has occasionally been accused of ‘not having a life’ – oh and breaking a few rules to get a good outcome for someone.  We both thought that in health care, at least in New Zealand, there are more people who live and breathe their passion for their work than those who don’t, and that our work is more enjoyable and more exciting than when we’ve ever been working in a job that needs less energy.  I can also say that I’d rather be seen by someone who loves their job than someone who is simply waiting to go home… There’s a saying I put on the ... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3292035 Sat, 20 Feb 2010 23:01:34 +0100 3292035 http://www.medworm.com/index.php?rid=3259300&cid=t_324180_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F02%2F10%2Fbalance-control-passion%2F Yesterday a couple of colleagues were talking about balance in life, and making it plain that they think people who spend a lot of time and energy on their work are sad.  Their opinion? Work is the means to pay for your ‘real’ life, to spend more on working means less on what is really important to them. And musing on this, as I do, I thought about values and what we bring in to pain management and how this influences our practice.  It also started me thinking about the goals and values of the people we see with chronic pain and disability. One way of looking at the distress and disability associated with chronic pain might be to think of it as a result of conflict between what can be done (resources) and both values (what is important) and goals (how I want to express my val... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3259300 Tue, 09 Feb 2010 18:46:08 +0100 3259300 http://www.medworm.com/index.php?rid=3189415&cid=t_324180_151_f&fid=35818&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FRecoveryIsSexycom%2F%7E3%2Fd1nSuXbFK9Q%2F Clues about alcohol related brain damage can be gathered by observing the person’s mood, behaviour, daily functioning and coping skills. Here are some examples of common indicators: Mood changes – anxiety, agitation or depression Behavioural changes – difficult behaviour, acting out, suspicious or paranoid behaviour, withdrawal, inappropriate behaviour Confusion and disorientation Talking excessively about, and living in, the past Problems carrying through with plans and getting around to chores Disconnection of gas, electricity or the phone Missed appointments Repetitious conversation Problems staying focused in conversation Resistance to change Confabulation Irrational reasoning Inability to change even when the person desires to These symptoms of brain impairment wil... Recovery Is Sexy.com blogs http://www.medworm.com/rss/comments.php?id=3189415 Tue, 19 Jan 2010 04:02:00 +0100 3189415 http://www.medworm.com/index.php?rid=3185629&cid=t_324180_151_f&fid=35818&url=http%3A%2F%2Frecoveryissexy.com%2Fsymptoms-of-alcohol-related-brain-damage%2F Clues about alcohol related brain damage can be gathered by observing the person’s mood, behaviour, daily functioning and coping skills. Here are some examples of common indicators: Mood changes – anxiety, agitation or depression Behavioural changes – difficult behaviour, acting out, suspicious or paranoid behaviour, withdrawal, inappropriate behaviour Confusion and disorientation Talking excessively about, and living in, the past Problems carrying through with plans and getting around to chores Disconnection of gas, electricity or the phone Missed appointments Repetitious conversation Problems staying focused in conversation Resistance to change Confabulation Irrational reasoning Inability to change even when the person desires to These symptoms of brain impairment wil... Recovery Is Sexy.com blogs http://www.medworm.com/rss/comments.php?id=3185629 Tue, 19 Jan 2010 04:02:00 +0100 3185629 http://www.medworm.com/index.php?rid=3185659&cid=t_324180_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F01%2F19%2Fwhen-in-danger-when-in-doubt-just-remember-deep-breath-in-deep-breath-out%2F It was a physio who first chanted that wee slogan at me some ten years ago… for a physio, he wasn’t bad at all! Come to think of it, I have worked with some great physiotherapists (please don’t let them know!).  Anyway, it’s been one of those sayings that I’ve carried with me ever since he taught me, and it actually works. One of the simplest, easiest and least intrusive coping strategies for pain has to be diaphragmatic breathing. I’ve always thought it work partially because it buys a little time – a bit like ‘counting to ten’ to stop you losing your temper! And I’ve often used breathing techniques because it works so quickly on physiological arousal…it’s one of the few aspects of arousal level that we can conscious... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3185659 Mon, 18 Jan 2010 19:41:37 +0100 3185659 http://www.medworm.com/index.php?rid=3180265&cid=t_324180_109_f&fid=34750&url=http%3A%2F%2Fpsychcentral.com%2Fblog%2Farchives%2F2010%2F01%2F17%2F5-ways-to-build-and-sustain-hope-an-interview-with-anthony-scioli%2F Today I have the pleasure of interviewing the coauthor of Hope in the Age of Anxiety, Anthony Scioli. I excerpted his 9 Kinds of Hopelessness and How You Can Overcome Them awhile back, and now I wanted to focus on what you can do to find and sustain hope. Dr. Scioli is professor of Clinical Psychology at Keene State College and a member of the graduate faculty at the University of Rhode Island. Question: What is the biggest thread to hope? Anthony: If I had to pick one resource it would be surrounding oneself with good “hope providers”. I view hope in terms of four dimensions: mastery or goal strivings, attachments, survival or coping skills, and spirituality. Good relationships can serve as catalyst for the development of all four of these resources. We need a powerful presenc... World of Psychology blogs http://www.medworm.com/rss/comments.php?id=3180265 Sun, 17 Jan 2010 13:32:01 +0100 3180265 http://www.medworm.com/index.php?rid=3172224&cid=t_324180_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F01%2F14%2Fdo-people-use-the-same-ways-of-coping-over-the-lifetime-of-their-pain%2F This is a bit of an unanswered question – do people use the same coping strategies at the beginning of their experience with chronic pain, or are there shifts in coping as time goes on? I’ve been pondering, as I do when writing my PhD, about the ways we have studied ‘coping’ in chronic pain.  It’s like researchers have conceptualised coping as a static trait rather than a developmental journey, and this is something I’m struggling to accept. Definitions of coping have emphasised that coping consists of ‘purposeful efforts to manage the negative impacts of stress’ (Lazarus & Folkman), and my guess is that many factors influence the choice of specific strategy.  Some that spring to mind are: how the event is construed – is it &#821... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3172224 Wed, 13 Jan 2010 19:36:26 +0100 3172224 http://www.medworm.com/index.php?rid=3167479&cid=t_324180_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F01%2F13%2Fattention-please-attention-management-for-chronic-pain%2F A debate that’s been going on for some time is the role of ‘distraction’ in pain management. So many of the people I see have told me they ‘just ignore’ the pain, or ‘I try to distract myself’, or similar, that there isn’t much doubt to me that people habitually use attention management as a coping strategy – yet the research findings have been quite mixed, especially with respect to ‘distraction’ and ‘ignoring’ pain. Pain is naturally an attention-grabber. That’s one of the main purposes of acute pain, IMHO, to attract attention and direct the person to DO something in response. Of course in chronic pain, there is little to DO, so the person needs to redirect attention away from pain and back into the task... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3167479 Tue, 12 Jan 2010 19:51:04 +0100 3167479 http://www.medworm.com/index.php?rid=3108563&cid=t_324180_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F12%2F21%2Fgetting-through-it%2F This study is a qualitative study of women’s experiences after cardiac surgery – some points to note right off.  Firstly, more women than men complain of post-operative pain than men – curious but not unexpected.  More women than men complain of pain at all ages from puberty until menopause.  Secondly, pain experiences depended on what women’s expectations of pain after cardiac surgery were.   Thirdly, early discharge requires increased patient participation in pain management.  It’s that one that I think could be much more emphasised! The findings indicated that women described four aspects of the pain experience – location, quality, consequences and cognitive aspects – the latter dealing with ‘expected pain’, ‘unexpected pain&... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3108563 Mon, 21 Dec 2009 01:01:10 +0100 3108563 http://www.medworm.com/index.php?rid=3089600&cid=t_324180_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F12%2F15%2Fbut-im-not-ready-to-stop-looking-for-a-cure%2F People come to pain management with a wide range of attitudes and expectations.  Over the past few months I’ve been reviewing the ‘goals’ that people write in their pre-appointment psychometric questionnaires, and almost without exception people write ‘Reduce my pain’ or ‘Fix my pain’.  While they’ll also write down ‘do more’, ‘return to work’, ‘get a life back’ – these things are all ‘provided that…my pain is gone’. I spent a half hour talking to a man yesterday who has spent seven years searching for firstly ‘the reason’ for his pain, and now ‘the cure’ for his pain.  He told me he’s not yet ready to accept that his pain might be permanent.  His li... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3089600 Mon, 14 Dec 2009 18:33:10 +0100 3089600 http://www.medworm.com/index.php?rid=3084999&cid=t_324180_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F12%2F14%2Fi-want-my-epidural%2F I’ve had two children – now 19 and 16, and wonderful. At the time of their delivery I can remember both times thinking ‘as long as they’re healthy’ and being not at all worried about having medical intervention if it was needed. My eldest was born with epidural anaesthesia, and my youngest was born completely naturally. And I am one of those people who ended up with an exacerbation of my chronic pain after delivery, in fact quite specific chronic pain in the area where the epidural was inserted. I recall asking my GP about 12 months later how long the pain was supposed to last, and she was quite surprised I had any pain at all! But now I’ve been reviewing some of the literature around childbirth, and I realise how common having persistent pain can be in ... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3084999 Sun, 13 Dec 2009 18:19:14 +0100 3084999 http://www.medworm.com/index.php?rid=3075782&cid=t_324180_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F12%2F10%2Frecovering-from-a-wrist-or-ankle-fracture-pain-related-fear-catastrophising-and-pain-influences-outcome%2F I have no idea how many wrist and ankle fractures occur every year, but I can bet it’s not a small number by any imagination. For most of us, I’m guessing we’d expect to have a fracture, wield a wonderfully-autographed cast, get it removed and go on our merry way – but after reading this article, and having seen some very sad people over the years, perhaps my expectations of speedy return to normal might be over-inflated! This paper by Linton and colleagues from Orebro, Sweden, is a novel one in that most of our knowledge about chronic pain comes from observing people recovering from low back pain. After all, low back pain is one of the most common pains, it’s the one that produces the most long-term work disability, and treatments for it eat up health budgets... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3075782 Thu, 10 Dec 2009 05:50:57 +0100 3075782 http://www.medworm.com/index.php?rid=3008418&cid=t_324180_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F11%2F19%2Fa-model-of-executive-functioning-and-stress-regulation%2F I’m a visual kind of girl, I need to see a diagram to help me conceptualise how the things I’ve been writing about recently all fit together. I’ve been looking at the various aspects of self regulation, emotions and executive functions and how this affects and is affected by stressors, of which chronic pain is certainly one. Drawing again from Williams, Suchy and Rau, i’m going to try to describe how I think their model of executive functioning might influence the way I look at stress regulation in people with chronic pain. This diagram is sort of upside down to me, but anyway, this is how I interpret it. Initially we all have a genetic inheritance, or the genotype we were born with. This influences the way our neurotransmitter systems, brain circuitry, physiology ... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3008418 Thu, 19 Nov 2009 08:58:09 +0100 3008418 http://www.medworm.com/index.php?rid=3008419&cid=t_324180_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F11%2F19%2Fstress-the-final-frontier-executive-functions%2F It’s visceral. Stress – hits you in the guts. Some of us cope well, some of us don’t – some of our stress lingers, sometimes it’s just the little things, those ‘daily hassles’ that end up tripping the switch. And I don’t think anyone would disagree that chronic pain is an enormous stressor. Regulating that stress level, or managing it effectively, has to be the main challenge in learning to live alongside chronic pain. Today’s post discusses executive functions (the parts of the brain that carry out self regulation) and stress. Executive function is ‘… a multifaceted construct comprising a number of basic neurocognitive processes, including working memory, cognitive flexibility, response selection, inhibition, initiation, se... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3008419 Wed, 18 Nov 2009 18:02:18 +0100 3008419 http://www.medworm.com/index.php?rid=2999879&cid=t_324180_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F11%2F17%2Fgoing-with-the-flow-emotion-regulation-and-coping%2F I’m in two minds about attempting to regulate emotions. From ACT, and in particular, mindfulness, I’m learning that trying to control emotions and thoughts is darned near impossible – and unhelpful. From the research on the effect of pain on emotions and subsequently on self regulation, goals and coping, it seems that pain strongly influences emotion and that negative emotions in particular, influence the range of coping strategies and goals we choose – and success or failure in turn generates further emotion, and so on. As Hamilton, Karoly and Kitzman say ‘the primary function of pain is to disrupt other ongoing activities and to direct attention toward the cause of injury or the extent of tissue damage’ – of course, in chronic pain, there may no ... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2999879 Mon, 16 Nov 2009 18:29:34 +0100 2999879 http://www.medworm.com/index.php?rid=2985057&cid=t_324180_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F11%2F12%2Fchronic-pain-management-is-not-just-like-any-other-chronic-disease%2F The other day someone said to me that managing chronic pain was just the same as managing something like diabetes, hypertension, asthma or any other chronic disease.  It irked me at the time and I couldn’t put my finger on just what it was that bothered me, but after a couple of days thinking about it I’ve got a few thoughts to share. Chronic pain comes with a whole lot of misinformation that most other illnesses don’t have. Unlike diabetes or emphysema, people with chronic pain have usually spent a long time searching for a diagnosis, and have usually seen multiple health providers all with various names for what the person has, and promising some sort of cure.  Even for something as clear-cut as ankylosing spondylitis, it takes around 4 years from initial symptoms to... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2985057 Wed, 11 Nov 2009 18:33:02 +0100 2985057 http://www.medworm.com/index.php?rid=2981393&cid=t_324180_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F11%2F11%2Fwhat-do-i-do-when-ive-had-enough-the-effect-of-emotions-on-self-regulation-chronic-pain%2F As soon as read the first paragraph of the paper I’ve used as the basis for this post, I knew I was onto something that resonated with my original occupational therapy values. It says this: ‘Living with chronic pain is a balancing act. People with chronic pain are required to make daily decisions about how best to cope with illness-related demands while managing other role-related obligations. Although some people become overwhelmed by the demands of illness and daily life, many, if not most, remain focused and well-adjusted, and do not require the services of a mental health professional. … Why do some redouble their coping efforts following a health set back, whereas others become demoralised?’ I concur with the idea that ‘most remain focused and well-adjust... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2981393 Wed, 11 Nov 2009 06:15:44 +0100 2981393 http://www.medworm.com/index.php?rid=2977601&cid=t_324180_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F11%2F10%2Fself-regulation-what-it-is-and-what-to-do%2F So, if self regulation is about exerting control over thoughts, feelings, actions and physiology, how does it work? When I skipped through some Google references last night (o font of all knowledge!) I found a good number of sites referring to self regulation and children – but not nearly as many relating to adults, or the long-term results of limited self regulation. Curious in our world where kids get to ‘express themselves’ and are protected from disappointment, have few challenges set (especially those where they have to persist with difficult tasks), and don’t need to think about consequences for themselves because parents and teachers do it for them… Hmmmm When I got to reading though, self regulation really is what much of pain management is all about. ... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2977601 Mon, 09 Nov 2009 18:34:33 +0100 2977601 http://www.medworm.com/index.php?rid=2974233&cid=t_324180_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F11%2F09%2Fim-so-tired-of-coping-self-regulation-executive-functions-and-chronic-pain%2F Changes take energy – that’s nothing new, I know, but perhaps something as clinicians we might forget when we work with people who have chronic pain. I was thinking about this as I’ve had a week away from regular blogging so I could focus on writing and some self care.  Things are busy and as we enter the run up to Christmas, not likely to slow down any time soon – and yes, this takes energy! Adjusting to living with a chronic health problem is demanding, it’s complex and requires people to reflect on what is important to them, how to achieve important activities all the while maintaining a sense of self.  Self regulation is a term used to refer to the ability to alter thoughts, feelings, and behaviors.  In chronic pain ‘[the] demands cross biopsychos... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2974233 Sun, 08 Nov 2009 18:28:43 +0100 2974233 http://www.medworm.com/index.php?rid=2934969&cid=t_324180_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F10%2F28%2Fhypnosis-response-expectancies%2F Let’s explore the proposed mechanisms in hypnosis as I wander through the subject this week. According to some researchers, response expectancies, or ‘the expectation of one’s own non-volitional reactions to situational cues’ are thought to play a major part in both hypnosis and placebo responding. Let’s translate that: a person’s belief that they will respond to something may lead to them actually responding. Possibly the original ‘mind over matter’! Both hypnosis and placebo (or meaning response – see Dan Moerman for more details on this!) are complex effects that are not yet really understood, except to confound most RCT’s and to provide food for thought for philosophers and psychologists and lay people alike. In this paper, respon... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2934969 Tue, 27 Oct 2009 21:18:05 +0100 2934969 http://www.medworm.com/index.php?rid=2931310&cid=t_324180_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F10%2F27%2Fit-was-a-piece-of-cake-hypnosis-for-sleep-and-tummy-pain%2F After briefly looking at hypnosis yesterday, I found this lovely case study written by Leora Kuttner of an 11 year old girl with problems going off to sleep, including tummy pain and anxiety. The girl had been through CBT, and introduced to the idea that she had a ‘worry bug’, and that the way to rid herself of the ‘worry bug’ was to ‘climb the fear ladder’. The ‘fear ladder’ being a graded hierarchy where her mother would gradually ease away from her side when going off to sleep. The problem being that this little girl kept waking as her mother left the room – and would start to panic. At 11 years old, this wasn’t exactly the best thing for her, given that girls like to go to sleep-overs! Apparently this young girl had always bee... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2931310 Mon, 26 Oct 2009 18:33:51 +0100 2931310 http://www.medworm.com/index.php?rid=2927588&cid=t_324180_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F10%2F26%2Fhypnosis-for-chronic-pain-management-how-it-works-maybe%2F There are plenty of people who look at me as if I’m stepping right into woowoo when I start to talk about hypnosis for managing chronic pain. I’m happy to say that science has provided some good evidence that not only does hypnosis have a neurophysiological basis, but it also has some good effect. What exactly is hypnosis? Well, contrary to popular belief, it is NOT about a ‘hypnotist’ doing something to someone else – and most especially NOT about making people do things that they wouldn’t ordinarily consent to. This is the misconception that stage hypnotists perpetuate in an attempt to keep their mystique. Hypnosis is ‘an induction followed by a suggestion (or set of suggestions)’ - now that has a lot of mystique, doesn’t it?! ‘... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2927588 Sun, 25 Oct 2009 20:59:23 +0100 2927588 http://www.medworm.com/index.php?rid=2920505&cid=t_324180_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F10%2F23%2Fit-must-be-time-for-friday-funnies%2F I can heave a sigh of relief, because draft number two (hopefully final draft) of the PhD proposal is off to be reviewed…if I only didn’t ask so many questions of myself I’m sure it would be easier! So, time to chill out and bit and start the process of relaxing before Labour Weekend. (Source: HealthSkills Weblog) HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2920505 Thu, 22 Oct 2009 23:27:32 +0100 2920505 http://www.medworm.com/index.php?rid=2908915&cid=t_324180_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F10%2F20%2Fthat-old-mind-body-thing-again%2F I am not a philosopher.  Neither am I very conversant in the arguments around consciousness.  But working in pain management means the mind-body debate is something I run into now and again.  Is pain all about the body? Is pain all about the mind? Or is it both?  Which influences the other? This debate can often be pushed to one side in the day-to-day practicalities of helping people live well with their chronic pain, but it is often raised when we’re talking about whether it’s important to focus on reducing the underlying disease process (and hopefully reduce the pain) or whether it’s more important to help people live well despite their pain. IMHO it’s not about which is more important: it’s about when to focus on each aspect. Anyway, suffice to say that... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2908915 Mon, 19 Oct 2009 18:31:00 +0100 2908915 http://www.medworm.com/index.php?rid=2904926&cid=t_324180_109_f&fid=34750&url=http%3A%2F%2Fpsychcentral.com%2Fblog%2Farchives%2F2009%2F10%2F19%2Fwhat-is-a-nervous-breakdown%2F A nervous breakdown refers to a mainstream and often-used term to generically describe someone who experiences a bout of mental illness that is so severe, it directly impacts their ability to function in everyday life. The specific mental illness can be anything — depression, anxiety, bipolar disorder, schizophrenia, or something else. But the reference to a “nervous breakdown” usually refers to the fact that the person has basically stopped their daily routines — going to work, interacting with loved ones or friends, even just getting out of bed to eat or shower. A nervous breakdown can be seen as a sign that one’s ability to cope with life or a mental illness has been overwhelmed by stress, life events, work or relationship issues. By disconnecting from the... World of Psychology blogs http://www.medworm.com/rss/comments.php?id=2904926 Mon, 19 Oct 2009 14:55:47 +0100 2904926 http://www.medworm.com/index.php?rid=2905140&cid=t_324180_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F10%2F19%2Ffeeling-the-pain-distractionrelaxation-or-exposure%2F It’s not the pain, it’s the judgement of the pain that makes it so distressing – or at least, that’s how the cognitive behavioural model of pain views our experience of pain. As a result, most pain management therapies working to help people manage when their pain can’t be removed involves reviewing how people judge their pain. Of course, we’ve all had experience of pain since we were babies (at least, those of us with normal nervous systems), so we’ve all learned that pain is not something to enjoy and that it’s really something we should avoid. This works well when it’s short-term or acute pain, we learn not to do whatever caused the pain, and we carry on in life a little wiser. When pain persists, we usually bring this same judgement... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2905140 Sun, 18 Oct 2009 18:36:29 +0100 2905140 http://www.medworm.com/index.php?rid=2894786&cid=t_324180_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F10%2F15%2Faccepting-low-back-pain-is-it-related-to-a-good-quality-of-life-2%2F This study is another from the Bath University stable, this time from a PhD study carried out by Dr Victoria Mason and supported by Beth Mathias and Dr Suzanne Skevington. Mason’s PhD was around developing a chronic pain component/module to the World Health Organisation’s Quality of Life measure, the WHOQOL, and this study was a part of the larger programme. Quality of life is one of those terms that I’ve never really taken to – it’s always felt quite nebulous. The WHO definition of quality of life is ‘‘‘an individual’s perception of their position in life, in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns.’’ Hmmm, suitably broad, so reasonably difficult to me... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2894786 Wed, 14 Oct 2009 18:34:35 +0100 2894786 http://www.medworm.com/index.php?rid=2891024&cid=t_324180_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F10%2F14%2Fact-some-evidence-for-acceptance-commitment-therapy-in-chronic-pain%2F This study was carried out with a group of over 100 participants attending a pain management programme.  Two measurement times were used – at the time of screening for acceptance onto the programme and at the time participants started treatment, with a period of 18 weeks or so between them.  None of the participants in the study had active treatment, so this is simply a study of the relationship between one variable at one point in time, and another variable at another point in time without intervention.  Although you could argue that assessment is an interventions, and it’s certainly something we’ve observed at Pain Management Centre. While its a correlational analysis (remember, no conclusions about causation!), it’s notable that ‘acceptance of pain and v... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2891024 Wed, 14 Oct 2009 06:01:02 +0100 2891024 http://www.medworm.com/index.php?rid=2862760&cid=t_324180_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F10%2F05%2Fcoping-what-is-it%2F Some of you will know I’ve been striving to write my PhD proposal lately, ending up with loads more words than actually necessary! However, as part of it I’ve been reviewing some of the material I’ve collected over time on coping. Coping is one of those difficult words - one we all know, but don’t always define especially well. One definition of coping is ‘purposeful efforts to manage the negative impact of stress’ – this one’s by Lazarus & Folkman. This definition suggests that coping involves active choices about what to do in the face of stress. Wikipedia (o font of all knowledge) defines coping as ‘managing taxing circumstances, expending effort to solve personal and interpersonal problems, and seeking to master, minimize, reduce o... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2862760 Mon, 05 Oct 2009 07:15:49 +0100 2862760 http://www.medworm.com/index.php?rid=2842828&cid=t_324180_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F09%2F29%2Ffibromyalgia-an-overview%2F I didn’t intend to get into a theme this week, but this paper arrived in my inbox this morning, and given both the prevalence of fibromyalgia, and the often ‘fuzzy’ management that can be provided, I thought it might be worthwhile taking a look at it.  The paper itself is a pre-print, but has been revised earlier this year and is probably the final version. The outline of the paper covers diagnostic criteria, and briefly discusses the place of neuroimaging (if only we could get that done readily here!), but notes that many other conditions overlap or mimic FM such as hypothyroidism, tendonitis, ankylosing spondylitis, as well as chronic fatigue, suggesting some sort of common pathway in either the peripheral or central nervous system, raising the possibility of some comm... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2842828 Mon, 28 Sep 2009 20:26:02 +0100 2842828 http://www.medworm.com/index.php?rid=2828476&cid=t_324180_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F09%2F24%2Fmeaning-focused-coping-looking-for-the-good-things-in-dark-times%2F I’ve been reading about ways to increase resilience and help people develop strengths to cope with pain, and came across this blog post on Positive Psychology News where Kathryn Britton reviews several papers by Susan Folkman and others who look at ways of coping.  I’ve posted before on the Lazarus and Folkman model of coping here and here. Their original model described a path from Appraisal –> Coping –> Outcome –> Emotion, with two outcomes after a harmful or threatening event. The first outcome was simply to favorable resolution and positive emotion. The second outcome, led to an unfavorable resolution and distress, with a loop back to the appraisal process labeled negative emotion.  This model has been updated by Susan Folkman to include the imp... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2828476 Wed, 23 Sep 2009 19:20:53 +0100 2828476 http://www.medworm.com/index.php?rid=2772731&cid=t_324180_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F09%2F07%2Fpacing-and-avoidance-in-fibromyalgia%2F The recent emergence of study into ‘pacing’ or activity regulation in pain management is a welcome addition to our knowledge of this coping strategy. Although pacing has been described and included in many self-help books as well as clinical texts as an effective strategy for people with chronic pain to use, the research base for its use is pretty skinny (see Gill and Brown, 2009). McCracken and Samuels (2007) found that increased use of pacing was associated with higher disability and less acceptance, while Nielson and Jensen (2004) found that it was associated with lower disability in people with fibromyalgia. The study I’m looking at today, by Karsdorp and Vlaeyen, looked in whether pacing specifically was different from ‘other behavioural strategies assessed wit... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2772731 Sun, 06 Sep 2009 19:32:30 +0100 2772731 http://www.medworm.com/index.php?rid=2768835&cid=t_324180_151_f&fid=35822&url=http%3A%2F%2Fwww.whatwinnersdo.com%2Fdealing-with-negative-feelings-in-addiction-recovery%2F So, you know THOSE type of days. Everything that could go wrong does go wrong down to the tiny things like driving away from the drive through to realize that they gave you a flavored iced coffee instead of the coffee flavored iced coffee that you wanted and needed...desperately. So on a day when all those little things combined with a few big things start to pile up, how do you get through? That is, how do you get through with out the old standby solution of smoking or drinking or snorting your troubles away...for a little while.A while ago I had written about the lingering consequences of addiction that can show up in our recovery.  My particular lingering consequence has to do with me going to court because of some money that I owe. Not an outrageous amount but an amount big enough tha... What Winners Do blogs http://www.medworm.com/rss/comments.php?id=2768835 Mon, 31 Aug 2009 04:19:06 +0100 2768835 http://www.medworm.com/index.php?rid=2748146&cid=t_324180_151_f&fid=35822&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FWhatWinnersDo%2F%7E3%2FVmRU4ytw1H4%2F So, you know THOSE type of days. Everything that could go wrong does go wrong down to the tiny things like driving away from the drive through to realize that they gave you a flavored iced coffee instead of the coffee flavored iced coffee that you wanted and needed...desperately. So on a day when all those little things combined with a few big things start to pile up, how do you get through? That is, how do you get through with out the old standby solution of smoking or drinking or snorting your troubles away...for a little while.A while ago I had written about the lingering consequences of addiction that can show up in our recovery.  My particular lingering consequence has to do with me going to court because of some money that I owe. Not an outrageous amount but an amount big enough tha... What Winners Do blogs http://www.medworm.com/rss/comments.php?id=2748146 Mon, 31 Aug 2009 04:19:06 +0100 2748146 http://www.medworm.com/index.php?rid=2730383&cid=t_324180_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F08%2F25%2Freal-world-outcomes-still-matter-why-medical-and-psychological-is-not-enough-in-pain-management%2F NB: The following rant does not reflect the opinions of my employers, colleagues, family or pets! It is MY opinion! I feel rather weary today, having come to a realisation that although pain management as a field of work has become much more recognised, there are some serious differences of opinion around approach and priorities between various members of the health care team.  I could list my current gripes and take up more than one screen on this blog, but I’ll try and confine myself to whining about just one: the lack of recognition of  ‘real world’ functional outcomes. What I mean is this – we can have the widest range of self report questionnaires covering all the variables in the world from pain intensity, pain quality, pain location to self efficacy, depres... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2730383 Tue, 25 Aug 2009 06:03:48 +0100 2730383 http://www.medworm.com/index.php?rid=2730384&cid=t_324180_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F08%2F25%2Fsafety-behaviours-do-they-maintain-kinesiophobia%2F Let me start by saying this post is conjecture, but based both on observing patients, and after reading an interesting paper on ’subtle avoidance and safety behaviours relevant to social anxiety’. First some definitions: I hope you’re all familiar with the term ‘kinesiophobia’, or ‘fear of movement’ – it’s the fear and avoidance of movements that an individual believes will hurt or harm them. Safety behaviours: are strategies that may be used to reduce the anxiety of carrying out a behaviour – and are usually ‘logically’ linked to the underlying belief about the movement.  For example, using ’safe lifting techniques’ can be a safety behaviour in someone who is fearful of bending; taking a deep breath in an... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2730384 Mon, 24 Aug 2009 19:29:17 +0100 2730384 http://www.medworm.com/index.php?rid=2712166&cid=t_324180_109_f&fid=34750&url=http%3A%2F%2Fpsychcentral.com%2Fblog%2Farchives%2F2009%2F08%2F18%2Fmental-resiliency-training-planned-for-soldiers%2F Filed under the “better late than never” department, we have word via The New York Times today that the U.S. military is finally recognizing the importance of fitness. Not just physical fitness, mind you, but mental fitness training, in the form of improving one’s resiliency: The training, the first of its kind in the military, is meant to improve performance in combat and head off the mental health problems, including depression, post-traumatic stress disorder and suicide, that plague about one-fifth of troops returning from Afghanistan and Iraq. Psychologist Martin E. P. Seligman at the University of Pennsylvania has been consulting with the Pentagon on the innovative program. There’s no direct research that’s been conducted on soldiers to see if such a pr... World of Psychology blogs http://www.medworm.com/rss/comments.php?id=2712166 Tue, 18 Aug 2009 18:05:20 +0100 2712166 http://www.medworm.com/index.php?rid=2553260&cid=t_324180_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F06%2F29%2Fhealth-coaching-resources-and-worksheets%2F I thought I’d do a quick search through the internet to locate resources and worksheets for health coaching – and what a wealth there is! I’m not sure about the grammar of that last sentence, but I am sure of the amazing amount of material there is online. First up, a link back to Health Coaching Australia, with a very good series of worksheets in pdf format on topics like a healthy goal action plan, a weekly goal checklist, a ‘change your mind’ worksheet (decisional balance), and an ‘activity pyramid’ for the elderly.  All work looking at and perhaps modifying if you need to. University of Iowa provides a health coaching service – and has several worksheets that could be used as an initial screening or record tool, and one that I liked espe... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2553260 Mon, 29 Jun 2009 07:50:14 +0100 2553260 http://www.medworm.com/index.php?rid=2513400&cid=t_324180_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F06%2F23%2Fbouncing-back-resilience%2F After looking at positive coping in my post from yesterday, I hoped to bring an assessment to light – and lo and behold I found one! This brief assessment differs from other resilience measures in that it looks at recovery, resistance, growth and adaptation rather than simply the resources a person might bring into a stressful situation. Smith and colleagues from the University of New Mexico developed this assessment and tested it on four groups of people – those recovering from cardiac problems, a group of women with fibromyalgia, and as usual, two groups of university students. What’s nice about this scale is that it contains only six items: 1. I tend to bounce back quickly after hard times 2. I have a hard time making it through stressful events (R) 3. It does not take... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2513400 Mon, 22 Jun 2009 19:19:11 +0100 2513400 http://www.medworm.com/index.php?rid=2513403&cid=t_324180_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F06%2F19%2Frandom-daily-acts-of-a-pain-management-therapist%2F Our erstwhile hero, SuperTherapist (ST) is discovered in her work habitat… (Source: HealthSkills Weblog) HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2513403 Fri, 19 Jun 2009 01:14:14 +0100 2513403 http://www.medworm.com/index.php?rid=2470012&cid=t_324180_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F06%2F11%2Fwhen-to-start-self-management-for-chronic-pain%2F There’s no doubt that early self management for chronic pain is a good thing – but in our facility, we’ve always had a rather mixed feeling about introducing self management while people are still receiving medical treatment for their pain. Our experience has been that few patients are really committed to learning how to modify their lives when just around the corner there could be a procedure that will ‘fix’ the pain. So I was interested to read about this study, published last year, about a four-week programme self management programme for people who are still undergoing medical treatment. A couple of interesting points from this study:  participants were carefully selected; the programme was brief; and participants were involved in the programme from aroun... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2470012 Wed, 10 Jun 2009 19:10:45 +0100 2470012 http://www.medworm.com/index.php?rid=2470013&cid=t_324180_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F06%2F10%2Fchronic-disease-management-follow-up-and-support-needs-from-diabetes-is-this-a-model-for-pain%2F Self management for chronic pain is not the only area in which self management has been introduced. Heart disease, obesity and diabetes are all very commonly managed with a combination of biomedical and self management strategies. While reviewing different ways to provide support for people who have newly developed coping strategies, I have found a fairly limited number of studies directly examining varying options for providing follow-up. This paper by Fisher, Brownson, O’Toole and Anwuri (2007), while not an empirical study itself, does draw on the experiences of fourteen self management programmes for diabetes management that have been studied under the auspices of the Diabetes Initiative of the Robert Wood Johnson Foundation in St Louis, Missouri. I’m not suggesting that pa... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2470013 Wed, 10 Jun 2009 05:29:23 +0100 2470013 http://www.medworm.com/index.php?rid=2458163&cid=t_324180_109_f&fid=34750&url=http%3A%2F%2Fpsychcentral.com%2Fblog%2Farchives%2F2009%2F06%2F06%2Finpatient-psychiatric-questions-and-tips%2F Last week, PatientsLikeMe released a new report highlighting patient experiences and tips regarding how to make the most of inpatient psychiatric treatment. PatientsLikeMe.com is an online community for people with significant, life-changing conditions that emphasizes the sharing of health care data and information publicly. It is thought by sharing such information with one another and for research purposes, we can learn more about health and mental health concerns, more quickly and in a real population than could otherwise be done. Inpatient psychiatric treatment is not all that common (most people who get treatment for a mental health concern [or "mood condition," as they call it] do so in an outpatient setting). But because it’s fairly uncommon, there are a lot of misconceptions ... World of Psychology blogs http://www.medworm.com/rss/comments.php?id=2458163 Sat, 06 Jun 2009 16:30:44 +0100 2458163 http://www.medworm.com/index.php?rid=2453264&cid=t_324180_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F06%2F03%2Fsupported-self-management-new-but-old%2F I attended a workshop today on supported self management for chronic health conditions.  It’s something the New Zealand Ministry of Health are keen to support, it’s popular in the US and UK – hopefully will save money, because it’s all about what the person with the health condition does, it’s a bit of a buzz-word. Some of the other buzz words for the day: biopsychosocial model; health literacy; cognitive behavioural therapy; and patient-centred. I was pleased to see so many people from a diverse range of practice settings all keen to hear about new ways of delivering health.  It was exciting to see people given hard evidence that self management in a condition such as refractory angina actually works.  It does cost less to help someone do some daily exerci... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2453264 Wed, 03 Jun 2009 09:11:31 +0100 2453264 http://www.medworm.com/index.php?rid=2442922&cid=t_324180_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F05%2F26%2Fovercoming-pain-david-halls-new-book%2F Every now and then you run into someone who makes a real impact on you – Dave’s one of those people.  I met him in Sydney at the International Association for the Study of Pain World Congress in 2005 (take a look here at the information on the next one), and we’ve intermittently kept in touch by email ever since.  David is one of these almost relentlessly energetic people – he looks fit, healthy and balanced.  You’d never guess that he’s experienced chronic neck pain and has had to learn how to become ‘CAPABLE’ so he can live this good life. His book (and pain management programme by the same name) is called Overcoming Pain, and it’s available from his website at the very reasonable price of Aus$25 + postage.  It’s all about t... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2442922 Tue, 26 May 2009 08:14:51 +0100 2442922 http://www.medworm.com/index.php?rid=2424532&cid=t_324180_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F05%2F20%2Ftell-me-what-you-want-what-you-really-really-want%2F A theme in almost any reading about health is that treatment should be patient-focused, typically goal-directed and have some sort of measureable impact. Over the past few weeks I’ve been reading about the process of goal setting and motivation, finding that there can be quite some differences between what a therapist sees as a suitable goal for therapy, and what the patient/participant sees as ‘the goal’. Today I thought to ponder the types of goals we might see during pain management treatment. On the one hand, each therapist will identify several areas to target on the basis of clinical reasoning (in my case, using a case formulation). Usually these targets for therapy are derived from the application of theory to the specifics of the person in front of the therapist. ... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2424532 Tue, 19 May 2009 19:33:05 +0100 2424532 http://www.medworm.com/index.php?rid=2415871&cid=t_324180_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F05%2F18%2Fwhy-i-didnt-make-it-goals-and-reasons-for-nonachievement%2F Part of most therapy, especially in chronic pain, involves setting goals. A major part of moving from ‘patient’ to ‘person’ means refocusing life from a round of appointments ‘to get better’ to actually doing things that matter in life – being ‘better’. Some of the people we work with achieve these goals and feel more in control, start to focus on interesting things in life rather than pain, and hopefully won’t need to come back and see us again! Others find it much more difficult to achieve the goals they’ve set and need more intervention. This paper explores the reasons people gave for not achieving goals in various domains. The goals were set in the last week of an interdisciplinary pain management programme, and follow-u... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2415871 Sun, 17 May 2009 19:34:27 +0100 2415871 http://www.medworm.com/index.php?rid=2406266&cid=t_324180_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F05%2F14%2Fsome-awesome-cbt-worksheets-and-resources%2F If you’re like me, you probably want to be able to put your hands on some easy-to-use worksheets for use with clients.  While I’m happy to make up my own, it’s nice to find some resources on the web – so thanks to therapyworksheets I’m linking to some of the worksheets I like from this blogsite.  These are NOT pain-related ones, sorry, they’ll be on here later in the year. First up is Lynn Martin’s CBT worksheet page.  Lynn has a whole raft of professional qualifications, but her original training is as a registered nurse.  Her site also contains a couple of concise summaries on CBT, and links to resources.  To use her worksheets you’ll need to cut and paste (and then probably reformat) into another document – but that’s hard... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2406266 Thu, 14 May 2009 08:22:37 +0100 2406266 http://www.medworm.com/index.php?rid=2406272&cid=t_324180_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F05%2F11%2Fhabit-at-work%2F I don’t know how I managed to miss linking into this web-based resource all about the aches and pains we get while we work! Take a look at Habit at Work – and yes, it’s developed by ACC, but don’t hold that against it. It’s a nice, simple web design, with a choice of either office or industrial workplace to select. Once you’ve clicked into the workplace, you’re able to choose a quiz (with some surprising facts for some people!), how to work in comfort, how to assess yourself, and what to do if you’re feeling sore. I especially liked the interactive nature of the site, the lovely graphics – and it is written in language that is clear and easy to understand. My only quibble, and it is a tiny one, is the section called ‘get rid of ... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2406272 Mon, 11 May 2009 03:23:23 +0100 2406272 http://www.medworm.com/index.php?rid=2390473&cid=t_324180_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F05%2F06%2Fwhere-pain-management-meets-vocational-rehabilitation%2F I had a conversation with a case manager yesterday.  The pain management team had asked for the inclusion of several sessions with me to look at coping with pain at work, along with some anxiety management and some exercise extension for a chap who has been off work for about two years with chronic low back pain.  The case manager seemed mystified as to why I might need to work with this man, saying ‘but we’ve already got a vocational plan in place’. I asked about the plan they had - it involved developing a good working CV/resume, obtaining a work trial, supervising that work trial, helping him develop effective interview skills, and getting him used to the routine of working again.  A good plan for returning to work. Let me backtrack for a moment to take you throug... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2390473 Tue, 05 May 2009 20:59:49 +0100 2390473 http://www.medworm.com/index.php?rid=2381178&cid=t_324180_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F04%2F30%2Fabsolutely-positively-healthy%2F New Zealand readers will recognise the origins of the heading for this post - a few years ago, Wellington used that phrase to promote visiting that wild and windy place (don’t worry Wellingtonians, I’ve lived there for a few years - and among the wild and windy days are those gloriously balmy sunny days that take your breath away!). The theme for this week has been resilience, or taking a look at how people who are living ‘well’ with their pain manage to do so.  So a couple of links today to resources for those who would like to learn more about positive psychology. The first is a 2008 paper by Martin Seligman (my hero!) who reviews the concept of healthiness, returning to the origins of the WHO definition of health ‘not merely the absence of disease’&#... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2381178 Thu, 30 Apr 2009 08:57:09 +0100 2381178 http://www.medworm.com/index.php?rid=2376891&cid=t_324180_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F04%2F29%2Fpollyanna-may-have-been-right%2F Pollyanna - that relentlessy cheerful optimist from Eleanor Porter’s novel by the same name - may have been right. Pollyanna’s philosophy of life centers on what she calls “The Glad Game”, an optimistic attitude she learned from her father. The game consists of finding something to be glad about in every situation. It originated in an incident one Christmas when Pollyanna, who was hoping for a doll in the missionary barrel, found only a pair of crutches inside. Making the game up on the spot, Pollyanna’s father taught her to look at the good side of things—in this case, to be glad about the crutches because “we don’t need ‘em!”. Alez Zautra, Lisa Johnson and Mary Davis researched positive affect as a source of resilience in two groups... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2376891 Tue, 28 Apr 2009 19:20:59 +0100 2376891 http://www.medworm.com/index.php?rid=2376892&cid=t_324180_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F04%2F28%2Fsomeone-who-lives-well-with-chronic-pain%2F Pete (not his real name) has long-standing pain. He has ankylosing spondylitis involving especially his sacro-iliac joints, and often his intercostals, making it difficult to take a deep breath. He’s in his mid-40’s, and he’s had his diagnosis for just over 20 years. He takes a cocktail of anti-inflammatories, with omeprazole to counter the gastro-intestinal effects. He also takes paracetamol three times a day when his pain levels are increased. He’s also a keen walker, paddler (kayak), cyclist, and diver. Not someone who sits around! So, how does he do it? As part of my series on ‘resilience’, I want to spend some time considering how people who cope well with their pain go about doing things that are important to them. There is, not surprisingly very ... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2376892 Mon, 27 Apr 2009 18:25:43 +0100 2376892 http://www.medworm.com/index.php?rid=2368727&cid=t_324180_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F04%2F27%2Fresilience-and-chronic-pain%2F When you start to work in the field of chronic pain management, it doesn’t take long before your view of the prevalence, and severity, of chronic pain becomes somewhat skewed.  Of all the people who have chronic pain, only a small number actually ask for treatment.  This could be for many reasons - difficulty accessing treatment because of cost or hours of opening, fear of what the problem may indicate, or because the person has ‘given up’ on successful treatment. On the other hand, there are many people who have chronic pain and don’t ask for treatment - because they are successfully living their life as normally as anyone else.  Some people live extraordinary lives.  People like Fiona Crombie.  Fiona is a 24 year old athlete with arthritis.  She’s not ... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2368727 Sun, 26 Apr 2009 18:58:46 +0100 2368727 http://www.medworm.com/index.php?rid=2365487&cid=t_324180_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F04%2F23%2Fwhat-goes-into-a-pain-management-plan%2F Today’s post is a practical one.  The scientific evidence for interdisciplinary pain management using a cognitive behavioural approach is pretty strong now (e.g. Guzman, Esmail, Karjalainen et al. 2001; Guzman, Esmail, Karjalainen et al. 2002; van Geen, Edelaar, Janssen et al. 2007) although the components that make it effective are not yet known. One suggestion for why these programmes work is that they help people develop a new attitude towards their pain - it’s no longer a frightening, dominating experience that controls life, rather the person becomes more aware of their options, develops a sense of optimism and starts planning and taking steps towards the future. Part of this change of focus from ‘patient’ to ‘person’ involves developing a plan. Th... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2365487 Wed, 22 Apr 2009 19:32:17 +0100 2365487 http://www.medworm.com/index.php?rid=2349866&cid=t_324180_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F04%2F21%2Fthe-walking-accident-zone%2F Luke (not his real name - you know I disguise details to protect confidentiality) is a man in his mid-20’s who is a walking accident zone.  He tells me he’s broken ‘every bone’ in his body - and while it’s not exactly true, he has certainly broken a few of them!  The reason he came to see me was because he has neck and shoulder pain.  He describes it as burning, tingling, deep and aching pain over his neck and down the back of his arms to his elbow.  Sometimes he has tingling in his fingers, and sometimes he has headaches. The story is that he loves high risk sports - rock climbing, sky diving, mountain-biking, snow-boarding, the lot.  And the problem is that he falls down a lot.  And not slowly either!  He also seems to fall from heights - twice at lea... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2349866 Mon, 20 Apr 2009 19:22:00 +0100 2349866 http://www.medworm.com/index.php?rid=2302541&cid=t_324180_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F03%2F31%2Fattention-management-for-chronic-pain%2F In this study, it was great to see that a single element was the focus - but this could have reduced the overall effect size that could be achieved in a more common pain management setting where multiple modalities are used. I wonder what the results would have looked like had the participants also been undergoing exercise or activities of daily living reactivation at the same time - this would have combined both the cognitive and the behavioural components of most pain management programmes, and could have demonstrated a greater (and more realistic) effect.  However that would have reduced the purity of the study design, and now that we have a reasonable level of evidence for a cognitive behavioural approach to pain management, it is time to establish the specific elements that are helpf... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2302541 Mon, 30 Mar 2009 18:04:54 +0100 2302541 http://www.medworm.com/index.php?rid=2235676&cid=t_324180_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F03%2F04%2Fmy-pain-is-no-different-but-i-feel-differently-about-it%2F Anyone who works in pain management knows that sense of profound satisfaction when someone says ‘My pain is no different, but I feel differently about it’.  It’s a sign that something has shifted for the person, that they’ve started to move towards accepting it, taking charge of life again instead of waiting for, hoping for something to take it all away. After working for about 12 weeks with one man, yesterday was the last session.  We reviewed his formulation together - looking not so much at how his pain arose (it’s neuropathic post-surgical pain), but the influences on his experience of his pain.  We looked at the problems he was having with his pain - poor sleep, feeling unwell and nauseous when it spiked, trouble concentrating and managing work, feelin... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2235676 Tue, 03 Mar 2009 18:17:42 +0100 2235676 http://www.medworm.com/index.php?rid=2196244&cid=t_324180_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F02%2F18%2Fwhat-is-breakthrough-pain-and-what-about-using-medication-for-it%2F Everyone knows that chronic pain continues, and anyone who has chronic pain will tell you that it fluctuates.  Some days are ‘good’ (well…better), some days are …well… not so good. Some people think of this pain as ‘a new injury‘. Of course, the change in pain is rarely associated with tissue damage, calling it an ‘injury‘ is probably not especially accurate. Some people call the change in pain ‘acute on chronic‘ pain.  I’m not sure what the ‘acute‘ refers to - acute pain is usually defined as short-term, and is often associated with tissue changes. And some people call it ‘breakthrough‘ pain, probably drawn from the term used in cancer pain. In cancer pain the term ‘breakthrough‘ ... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2196244 Wed, 18 Feb 2009 07:40:47 +0100 2196244 http://www.medworm.com/index.php?rid=2178582&cid=t_324180_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F02%2F11%2Fsome-resources-for-act-acceptance-and-commitment-therapy%2F Well, I slipped up with posting some resources yesterday, so I’m getting in now to put together a few web resources on ACT for the curious.  I’m personally focusing on using ACT with people who have health problems - but ACT seems to be something that everyone could do with learning! The first and most extensive ACT resource on the internet has to be the Association for Contextual Behavioural Science. This site contains information for therapists and for the general public.  One of the resources for the general public that also happens to give a great explanation for anyone interested in ACT - try this link, which is a 22 minute video (takes a moment or two to load up) presented by Tom Lavin (go here for more information on his video’s). Go here for their extensive FAQ... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2178582 Wed, 11 Feb 2009 07:44:47 +0100 2178582 http://www.medworm.com/index.php?rid=2175150&cid=t_324180_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F02%2F11%2Fa-bit-more-about-acceptance%2F Because of time and energy limits, I have decided to change my post slightly today.  I was going to give some references and discuss values and goals a bit more, but that will need to wait until I have just a bit more time.  I’m sorry. I’m working with a new group of people in the three-week pain management programme.  We were discussing what they wanted from the programme, because one of the challenges I put to them is that if nothing has changed in their lives in six months time, then there is little point in staying - so what do they want? Often that challenge is met with stunned silence.  It’s like they have never thought about what they want for such a long time that it’s really hard to know what to say. It’s at this point someone will say ‘I wa... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2175150 Tue, 10 Feb 2009 18:15:53 +0100 2175150 http://www.medworm.com/index.php?rid=2170253&cid=t_324180_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F02%2F10%2Fthe-process-of-moving-towards-valued-actions%2F Another in a mini-series on values and actions, stimulated by reading about ACT, or Acceptance and Commitment Therapy. For many of the people I work with, remaining committed to a set of actions that lead towards a desired goal seems to be a very challenging thing. Often, at a one-month review, I find one group of people who are moving forward consistently, another group who are simply going through the motions because someone else is ‘making’ them do it (eg case managers or family members), and by far the largest group, those who are saying ‘I’d be on my way but …’ - and the ‘but’ can be so many things: my case manager hasn’t fronted up with the money for the course I wanted, so I can’t start my return to work plan I can’t... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2170253 Mon, 09 Feb 2009 18:25:38 +0100 2170253 http://www.medworm.com/index.php?rid=2122060&cid=t_324180_129_f&fid=36038&url=http%3A%2F%2Fblog.healthtalk.com%2Fmultiple-sclerosis%2Flife-with-ms%2Fmultiple-sclerosis-requires-routine%2F We’ve been nothing here at Life with MS if not totally and unabashedly up front, open and even personal.  In that vein, I’m going to get even more personal with you than I ever have been before; today I’ll talk about hygiene. I’ve come to realize that in certain things in my day, things that most people just don’t even think about doing, that my auto-pilot is broken.  You know the type of things I’m talking about; how many of us think about how we are brushing our teeth, for example? I’ve found over the past years that if I don’t do everything in an exact order in the morning, I just forget to do it. We’re used to our minds being on the day ahead when showering, for instance.  Now, however, if I let my mind wander to my day ahead, I ... Life with MS blogs http://www.medworm.com/rss/comments.php?id=2122060 Wed, 21 Jan 2009 22:24:28 +0100 2122060 http://www.medworm.com/index.php?rid=2117334&cid=t_324180_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F01%2F21%2Fintermittent-pain%2F I think intermittent pain must be one of the more challenging types of pain to have - one minute everything is going fine, then WHAMMO! out of the blue there is a bolt of electricity to hit the body.  The sort of pain I’m talking about here is primarily neuropathic pain, and I’m working with two people (and another one very soon) who have this pain.  One is an amputee with not only the WHAMMO type of electric shock pain, but also a nasty cramping phantom, and the other has intermittent noncardiac chest pain. There are lots of types of neuropathic pain - in the last year or so I’ve worked with a couple of people with postsurgical neuropathic pain (lower back pain with intermittent leg pain), a couple of people with CRPS pain, one with diabetic neuropathic pain in both fe... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2117334 Wed, 21 Jan 2009 09:23:35 +0100 2117334 http://www.medworm.com/index.php?rid=2117335&cid=t_324180_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F01%2F20%2Fwhats-getting-in-the-way-of-good-pain-management-in-rheumatoid-arthritis%2F This study by Fitzcharles, DaCosta, Ware and Shir really grabbed my attention because it made a couple of points I hadn’t considered - firstly, that many people with chronic conditions that have effective treatments continue to have high levels of pain (but often don’t get to see a pain management service, even though they are being treated in a specialist rheumatology clinic), and secondly, that there are many differing reasons for people’s reluctance to take medication for pain relief, but often it’s the only option offered. I won’t review the whole paper here, you’ll need to read the original (it’s worth it, because it has some good references and explores some interesting issues), but I do want to reflect on a couple of things that were identif... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2117335 Tue, 20 Jan 2009 07:25:27 +0100 2117335 http://www.medworm.com/index.php?rid=2111414&cid=t_324180_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F01%2F17%2Ffunny-maybe-just-quirky%2F Some wonderfully random, funny - but probably quirky sites to visit. If you’re a crafty sort of person - this website might attract you.  It’s all about mosaic supplies, based in New Zealand - so a local place at last! And for some quirky travel facts about New Zealanders - head over to here (they also have a whole lot of information on travel in New Zealand), worth a visit especially if you’re thinking about where to go and who to use as a travel agent in New Zealand. I love Cecily - genuine quirky New Zealand humour!  She’s created by Celia Allison, and her humour is soooo suited to kiwi women in the … erm… not 20’s! ‘Cecily is the creation of Celia Allison. Celia grew up in rural Canterbury, and after many itinerant years, now r... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2111414 Sat, 17 Jan 2009 06:50:29 +0100 2111414 http://www.medworm.com/index.php?rid=2102385&cid=t_324180_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F01%2F14%2Fbiofeedback-races-an-activity-to-develop-self-regulation%2F I’ve written once or twice on biofeedback as I’ve used it, but I thought today I’d share an exciting idea that one of my colleagues (you know who you are!) came up with to help participants on our pain management programme get practice using their skills in a fun sort of way. We’re a bit lucky in some ways, we have about 8 different portable biofeedback units - some monitoring EMG, and a couple of others monitoring heart rate and galvanic skin response. In the past we’ve taken our participants to the occupational therapy home unit to try out various household tasks while wearing the biofeedback units - but frankly, the men have switched off. Now I don’t know what this says about Kiwi males, but I do know it made the sessions really challenging. So as a t... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2102385 Wed, 14 Jan 2009 04:42:43 +0100 2102385 http://www.medworm.com/index.php?rid=2098682&cid=t_324180_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F01%2F13%2Fsetback-planning-worksheet-for-chronic-pain%2F We have all had them - moments when we know what we shoulda-coulda-oughta — but didn’t.  And it’s even more common when we’re trying to change a habit, or in the case of chronic pain management and healthy skills, develop a new way of responding.  We can call this ‘relapse’, which works for alcohol and drug use, but in chronic pain I think it’s more helpful to refer to ’setbacks’. A setback can be a time when things just don’t go as planned, perhaps when unexpected or out of the ordinary events happen (like Christmas!), or when pain intensity fluctuates.  Usually pain increases are called ‘flare-ups’ to avoid the possibility of people thinking they are ‘having another injury’.  The point of setback plan... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2098682 Tue, 13 Jan 2009 07:57:18 +0100 2098682 http://www.medworm.com/index.php?rid=2096209&cid=t_324180_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F01%2F12%2Freflections-on-act-case-formulation-in-chronic-pain%2F I’ve been reviewing ACT and contextual cognitive behavioural therapy in chronic pain management over the past year or so, and it’s really interesting reflecting on the different way in which I see people after being exposed to the ACT approach. Just to recap, some of the main precepts of ACT and CCBT are: people’s attempts to control their negative emotions lead them to avoid encountering these emotions but in doing so they often increase the intensity and frequency with which they experience them and their attempts to avoid the experiences also lead them away from pursuing activities that enable them to achieve things that are important to them (eg values) this becomes evident through ‘cognitive inflexibility’ or the difficulty to do things in different ways... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2096209 Mon, 12 Jan 2009 09:19:10 +0100 2096209 http://www.medworm.com/index.php?rid=2090789&cid=t_324180_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F01%2F09%2Ffive-ways-to-be-well-connect-be-active-take-notice-keep-learning-and-give%2F If you’re feeling a little jaded after the Christmas and New Year break, don’t worry, you’re among friends! It’s Friday in New Zealand, incredibly hot weather for us in Canterbury (we reached 35.7 degrees yesterday, 33 the day before, and it’s not expected to drop much today), and it’s my first week back at work since Christmas. Over Christmas I did have the chance to catch up on some reading, and I was delighted to find an editorial in the British Journal of Occupational Therapy about a project developed by the UK Government to promote ‘mental capital’ - or to improve the wellbeing of people. The project was developed because: An individual’s mental capital and mental wellbeing crucially affect their path through life. Moreover, they are v... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2090789 Thu, 08 Jan 2009 19:22:41 +0100 2090789 http://www.medworm.com/index.php?rid=2085009&cid=t_324180_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F01%2F07%2Fpractical-action-plans-and-a-worksheet-for-problem-solving-when-the-actions-get-stuck%2F The cognitive behavioural approach to pain management is marked by not just working through ‘education’ or ‘information’, not simply being about ‘psychotherapy’ and ‘cognitive therapy’ - but also about moving from being a patient to whom things are done to being a person who does things. This means goal setting and problem solving are almost compulsory components to a good cognitive behavioural pain management programme. The main problem I’ve had is finding suitably simple worksheets for the people I see who, by and large, are not ‘pen and paper’ people!  Not that they all have learning disorders, but many are just not conversant with written work, and they don’t respond well to screeds of paper and words (unlike me!)... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2085009 Wed, 07 Jan 2009 04:29:02 +0100 2085009 http://www.medworm.com/index.php?rid=2067683&cid=t_324180_133_f&fid=35129&url=http%3A%2F%2Fwhitterer-autism.blogspot.com%2F2008%2F12%2Ffailing-to-face-fall.html I watch his laborious progress from a distance, the kitchen, as he reassembles his nest at the bottom of the stairs at 5:25 a.m. on a Sunday. He reinserts his little body back into the neat fold, extends his arms and drags himself, the duvet and half a dozen furry friends towards the family room. His spindle arms tire every three or four pulls across the smooth hardwood floors, so he pauses. I do not offer assistance nor comment. I wait. The weather has turned chilly after dark but they both refuse nightwear. This is his version of self help, self initiated and without a murmour of protest.Their bedroom is the furthest distance away. A narrow corridor of hardwood floors, a U bend and a staircase. I wait until the whole caboodle reaches the edge of the carpet, where the resistance stops his... Whitterer on Autism blogs http://www.medworm.com/rss/comments.php?id=2067683 Sun, 28 Dec 2008 07:59:00 +0100 2067683 http://www.medworm.com/index.php?rid=2056688&cid=t_324180_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2008%2F12%2F22%2Fseven-things-that-made-me-go-gggrrrrrrrr-in-2008%2F It’s the time of year to reflect and review, so today I’m going to look at some of the stand-out events and issues that got me riled.  You might, after reading these, think that a kind of theme fits these things but as I write them I promise I’m not choosing them to fit any preconceived ideas!  They appear in no particular order, either… Health professionals ‘turf protecting’ - it could be occupational therapists holding out to be ‘the only ones who do goal-setting’; clinical psychologists saying ‘but we’re the only ones who can really do CBT’; physiotherapists proclaiming ‘but only we can do talk about posture’; anyone who says ‘but I don’t want to do generic case work because I’m special&#8... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2056688 Mon, 22 Dec 2008 08:42:40 +0100 2056688 http://www.medworm.com/index.php?rid=2056689&cid=t_324180_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2008%2F12%2F22%2Fpre-christmas-gratitude-5-things-im-grateful-for%2F In these couple of days before Christmas, it’s traditional to review some of the ‘best of’ 2008. It’s been just over a year since I started this blog, and the topic list and readership has grown a whole lot! What am I grateful for in 2008? Teamwork - the people I work with are fantastic. You can’t work alone in pain management IMHO,  a team of like-minded people to support you both professionally and personally just can’t be beaten.  I take my hat off to the team at Burwood Pain Management Centre who keep me honest, deflate my ego (gently), cushion my falls, keep me standing and give me inspiration to keep on caring about what I do. Motivation - using motivational approaches like motivational interviewing to help people make their own choices rather t... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2056689 Sun, 21 Dec 2008 18:14:48 +0100 2056689 http://www.medworm.com/index.php?rid=2042734&cid=t_324180_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2008%2F12%2F18%2Fcoping-strategies-survey-the-results-3%2F Today’s post completes the results from my coping strategies survey by identifying how important the skills are in the respondent’s view. Remember these are all health professionals who work in pain management, and the questionnaire was completed online and confidentially. What you can see there is that the most important skill, as identified in this survey, is ‘Working with realistic thoughts’. What’s surprising about this is that respondents were not ALL psychologists! In some ways, this is probably one of the most important components in pain management because it encompasses all the cognitive elements involved in reconceptualising chronic pain from something that represents alarm and harm, into something that is simply ‘noise in the system’. S... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2042734 Wed, 17 Dec 2008 18:18:52 +0100 2042734 http://www.medworm.com/index.php?rid=2042735&cid=t_324180_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2008%2F12%2F16%2Fcoping-strategies-survey-the-results-2%2F Yesterday I started reviewing the coping strategies survey I’ve been running. 33 participants, a mix of health professionals - and some interesting results. Today I’m looking at when to use pain management strategies, and why. Question 1 - Reducing pain behaviour has been recommended as a part of effective pain management. When do you think it should be encouraged? 24.1% When the person’s pain is at a ‘usual’ daily level 69.0% At all times, even during a flare-up of pain 6.9% When the person is around other people Further comments: As often as the person can sustain the focus without stressing out Interesting responses to this question - I’m curious because I don’t read much specific information about how therapists typically address reducing pain beh... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2042735 Tue, 16 Dec 2008 06:39:02 +0100 2042735 http://www.medworm.com/index.php?rid=2036208&cid=t_324180_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2008%2F12%2F15%2Fcoping-strategies-survey-the-results%2F Over the next couple of days I’m going to review the coping strategies survey I’ve been running.  I’ve had 33 participants, so it’s not a large sample, but it does represent some of the professions working in the field of chronic pain. Who responded? 12.5%   Social workers 4.2%     Nurse 29.2%  Occupational therapists 25%      Physiotherapists 12.5%  Medical practitioners 20.8% Psychologists (health or clinical) plus 4 ‘others’ - students mainly.  You’ll see the total is more than 100% - rounding, or so I understand from SurveyMonkey! The first set of questions related to defining three terms commonly used in pain management. I’ve just reviewed a paper about ‘pacing’, so it’s interesting to see how these participan... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2036208 Mon, 15 Dec 2008 08:05:05 +0100 2036208 http://www.medworm.com/index.php?rid=2036209&cid=t_324180_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2008%2F12%2F15%2Fresilient-or-simply-scared%2F In this study, the authors survey 5000 people living in Sweden, aged between 20 - 50 years.  The response rate, as you’d expect in a postal survey, was quite low (39%), but still numbered 1815 and over a thousand of these reported they had experienced nonspecific spinal pain in the previous 12 months. Using a large number of questionnaire measures, both validated and nonvalidated, and carrying out principle component analysis (take a look here at a great tutorial on PCA if you’re not certain of it), 22 items were analysed, resulting in 8 components with an eigenvalue greater than 1.0.  These were: (1) work satisfaction (2) pain vigilance (3) prevent/decrease pain (4) pain confrontation (5) physically demanding work (6) pain expectations (7) exercise and (8) everyday exercise.... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2036209 Sun, 14 Dec 2008 23:36:59 +0100 2036209 http://www.medworm.com/index.php?rid=2022738&cid=t_324180_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2008%2F12%2F08%2Fpain-intensity-does-not-correlate-with-life-satisfaction-in-people-with-long-term-pain%2F A hotly debated question in some pain management clinicians minds is whether to simply address pain intensity, or to focus on ‘other’ issues such as improved function, reduced distress, reduced fear, better mood and so on.  Well, to me it’s no debate, actually.  I can’t provide pain reduction strategies per se - I’m not a physiotherapist, I’m not a doctor, and although I care deeply about reducing suffering, I’m not especially bothered about reducing pain.  Why? Well, pain intensity fluctuates depending on a whole lot of things, including mood, distress (feeling fed up with the situation), fatigue, attention, the meaning of the pain, expectations, the degree of perceived control  -  as the King in ‘The King and I’ - etcetera, etcet... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2022738 Mon, 08 Dec 2008 05:13:21 +0100 2022738 http://www.medworm.com/index.php?rid=2008134&cid=t_324180_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2008%2F12%2F03%2Fwhat-happens-when-you-cant-do-what-you-want-to%2F Intendus interruptus, or ‘I want to but I can’t do it’ There is no doubt that having chronic pain stops many people from working towards things they want in their life.  At least for some of the time, especially during the early phases of their experience, people tend to focus on obtaining a diagnosis, then either a cure or some form of pain reduction.  Comments from people during this time are ‘I put my life on hold’, ‘I’m just focusing on getting through each day’. What we then see, as chronic pain persists, is a gradual reduction of engagement in firstly leisure activities, then work activities (however you construe this), and finally self care activities. Over time, as Paul Karoly puts it, they develop ‘… a self-defeating r... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2008134 Wed, 03 Dec 2008 05:20:39 +0100 2008134 http://www.medworm.com/index.php?rid=2000261&cid=t_324180_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2008%2F12%2F01%2Fgoals-and-goal-setting-in-pain-management%2F This is the first of a couple of posts about goals and goal setting in pain management. I’ve been curious about the use of goals in pain management, because although in New Zealand under ACC contracts, goals are required for every pain management programme, it’s not a direct requirement for treatments provided to non-ACC patients.  And I haven’t been sure of the literature about the use of goals and goal setting for people with chronic pain, and have wondered whether it’s something like the assumption that ‘doing activity is good’ or ‘pacing is good’ - thought to be ‘a good thing’ but not actually ever empirically tested. Well, I’m happy to report that there is some specific research on goals and goal setting in chronic pai... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2000261 Mon, 01 Dec 2008 07:59:12 +0100 2000261 http://www.medworm.com/index.php?rid=1997510&cid=t_324180_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2008%2F11%2F28%2Fthe-way-you-think-about-pain-is-related-to-the-way-you-cope%2F This study demonstrates that indeed, ‘cognitive appraisals of pain can indirectly predict the level of functioning, impairment, and pain intensity of pain’. If daily activity and impairment are considered as indicators of chronic pain patients’ health, adjustment, quality of life, and well-being, as suggested by many authors, then this study confirms that cognitive appraisals of pain, due to the mediating role of passive coping, influence the level of functioning and impairment. This of course, suggests that if we can help people reconceptualise their situation as a challenge rather than a threat or harmful, they may move from using passive coping strategies to active coping strategies. I’m not so sure - these were people who had no exposure to pain management strategi... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=1997510 Thu, 27 Nov 2008 19:17:43 +0100 1997510 http://www.medworm.com/index.php?rid=1985783&cid=t_324180_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2008%2F11%2F24%2Fpacing-whats-the-evidence-for-it%2F Pacing is one of those words: almost every person who has been through a pain management programme of any sort will roll their eyes and groan ‘pacing’ when asked about one of their least favourite strategies. I have long disliked the word because of the mixed ways in which therapists (and patients) interpret what it actually means, not to mention my own challenges to actually DO it when I’ve needed to! The term can mean anything from taking a break ‘before it hurts’, ‘breaking a task down into achievable chunks’, starting at ‘what you can do on a bad day, and increasing by 10%’, ‘working at 80%’ - well, you can see my point huh?! I was delighted to read some time ago, a paper by Birkholtz, Aylwin and Harman (2004) in which t... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=1985783 Mon, 24 Nov 2008 06:37:14 +0100 1985783 http://www.medworm.com/index.php?rid=1982188&cid=t_324180_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2008%2F11%2F23%2Fmaking-the-most-of-a-referral-for-pain-management%2F This is a post for people who may refer someone for pain management, or someone who is personally being referred. When I talk about pain management, I’m meaning a multidisciplinary or interdisciplinary pain management programme where participants learn about their pain, develop strategies to cope with life despite their pain, and get involved in reactivation. The contents of a cognitive behavioural pain management programme (eg INPUT, ADAPT, vary considerably - it’s essential that the approach includes these concepts: That clients can learn to accept the chronicity of their pain. That clients can change their relationship to their pain in a way that allows them to broaden their sense of identity/self beyond the pain to that of “a well person with pain”. That clients... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=1982188 Sun, 23 Nov 2008 06:57:25 +0100 1982188 http://www.medworm.com/index.php?rid=1977375&cid=t_324180_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2008%2F11%2F20%2Facceptance-musings%2F I asked the participants in the pain management group to think about the words ‘acceptance’ and ‘change‘ yesterday.  One person asked whether you had to ‘give up hope’ to accept chronic pain, and another said he could ‘never accept that things wouldn’t return to normal, I don’t want this change’. At the time I didn’t want to add my own thoughts about acceptance, but as I mulled over the words myself, I found myself trying to define acceptance - and kept coming up with phrases that included the word ‘change‘ every time. According to wikipedia (oh yes, the font of all wisdom!), ‘Acceptance usually refers to cases where a person experiences a situation or condition (often a negative or uncomfortable situation... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=1977375 Wed, 19 Nov 2008 18:28:07 +0100 1977375 http://www.medworm.com/index.php?rid=1970820&cid=t_324180_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2008%2F11%2F19%2Fcarrying-on-with-self-management-strategies-doesnt-make-a-difference%2F Continuing in the vein of yesterday’s post where I discussed a study showing no additional benefit from adding graded exposure or graded activity to treatment by classification, today I want to discuss a recent finding showing that all the hard work put into helping people develop and use self management may not make a difference to their recovery in the end.  It’s this study (doi:10.1016/j.ejpain.2008.06.009) by Charlotte Curran, Amanda C. de C. Williams, and Henry W.W. Potts - Cognitive-behavioral therapy for persistent pain: Does adherence after treatment affect outcome?  European Journal of Pain What?! Shock and panic around the world! Pain management skills are not used! The whole basis of self management lies with the idea that people develop practical skills they can... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=1970820 Tue, 18 Nov 2008 19:23:28 +0100 1970820 http://www.medworm.com/index.php?rid=1956521&cid=t_324180_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2008%2F11%2F13%2Fpain-related-anxiety-and-avoidance-a-practical-application-of-theory-and-research-to-clinical-practice%2F In 1995 I started work at the Burwood Pain Management Centre.  It wasn’t my first foray into pain management, but it was the first time I had worked in a fully integrated interdiscipinary team environment.  It was also significant because of the use of the words ‘fear-avoidance’, ‘guarding’ and ‘anticipatory anxiety’. What the team had observed was that there were a specific group of patients who were not just worried about experiencing pain, but were also showing the signs of increased physiological arousal, avoidance of specific activities, and firm beliefs about harm, reinjury, or doing further damage. At the time we used an operant conditioning model (based on Fordyce, 1971 & 1976), along with graded reactivation using a physical conditio... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=1956521 Thu, 13 Nov 2008 08:55:51 +0100 1956521 http://www.medworm.com/index.php?rid=1928159&cid=t_324180_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2008%2F11%2F04%2Fbasic-biofeedback-in-pain-management%2F I’m no techno-whizz in biofeedback - you have to speak to one of my colleagues (she knows who she is!) to get the technical data on things like heart rate variability - but I do use several modalities reasonably often. So today I thought I’d discuss some of the ways I use biofeedback with the people I work with. Biofeedback basically provides visual or auditory information about normally undetectable physiological processes. It ranges from temperature sensors through to skin conduction (galvanic skin response), and includes surface EMG, respiration, blood volume pulse and sometimes these are put together to provide feedback on heart rate variability. I’m not going into HRV yet, that’s for another day! The most common sensors I use everyday are GSR, which is a reaso... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=1928159 Mon, 03 Nov 2008 18:11:15 +0100 1928159 http://www.medworm.com/index.php?rid=1922130&cid=t_324180_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2008%2F10%2F31%2Fhow-to-help-if-youre-with-someone-dealing-with-hard-times%2F I loved this post from Musings of a Distractible Mind so I thought I’d link to it - what to do if you are dealing with hard times, and how to help someone who is…It’s a wonderful set of guides for us all.        (Source: HealthSkills Weblog) HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=1922130 Thu, 30 Oct 2008 20:35:23 +0100 1922130 http://www.medworm.com/index.php?rid=1922131&cid=t_324180_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2008%2F10%2F31%2Ffive-frivolous-friday-follies%2F Friday is a day to get ready to relax.  For your Friday frivolity, here are some things YOU can do to brighten up your day! Spam Tales Compose a tale made entirely of SPAM! ‘This is to inform you - what could be better than playing with the casino’s money? In order to receive uninterrupted service I want you to assist in donating and distributing these funds to charity in your region on behalf of my humble self and my late husband.  I am Mrs. Marina Litvinenko, wife of Alexander Litvinenko, a former Russian security officer who died in a London hospital after apparently being poisoned with the highly-toxic metal thallium by Mr Lugovoi,a Russian Government Paid agent. To restore access, please click on this link and sign in!’ Have you heard of googlism? Go here to find ... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=1922131 Thu, 30 Oct 2008 19:34:39 +0100 1922131 http://www.medworm.com/index.php?rid=1912476&cid=t_324180_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2008%2F10%2F28%2Fexplaining-pain-to-people-with-chronic-pain%2F One of the most challenging jobs we do in chronic pain management is help people get their heads around what chronic pain is…without giving them the idea that we think they’re imagining it, they’re mentally unwell, they’re ‘pretending’, ‘malingering’ or otherwise ‘not coping’. While I can’t say I’ve got the answer, after explaining what pain is for a few years (not telling how many!), there are some things I find work better than others… The first thing is to have a bunch of examples of everyday pain (mainly acute pain) to act as examples - mine include getting a flu jab, sunburn, a stubbed toe, sports bruises, and shark bites!  This helps people understand that pain is a normal, everyday experience that is unde... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=1912476 Tue, 28 Oct 2008 07:48:14 +0100 1912476 http://www.medworm.com/index.php?rid=1877200&cid=t_324180_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2008%2F10%2F15%2Fcue-cards-for-coping%2F One problem people have when learning coping skills is remembering what to do and when to do it.   In the heat of the moment it can be really difficult to recall exactly what the new strategy is!  We also know that pain interferes with recall because of the disruptive effect on attention, and this effect is heightened when people are anxious about their pain.  One good measure for whether attention and thinking processes are disrupted is the Pain Anxiety Symptoms Scale (McCracken & Dhingra, 2002). There are a few techniques for helping people to remember what to do - including some of my favourites like a sticker on a doorframe, post-it notes on the computer or dashboard of the car, or reminders on a cellphone or computer.  But one way that has been helpful for several reasons is ... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=1877200 Tue, 14 Oct 2008 18:16:08 +0100 1877200 http://www.medworm.com/index.php?rid=1871455&cid=t_324180_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2008%2F10%2F13%2Fpain-management-strategy-worksheet-and-activity%2F It’s been a while since I directly posted on practical pain management strategies that can be used as part of activity.  A while ago I developed an activity to use with our pain management programme that involves identifying the skills you might use during three common activities.  I’ve uploaded it here for you to use. Be aware that the photographs are from Google images, so are both of variable quality and some may be copyright. The way you can use this activity is to ask the person to match the title to the definition of the coping strategy (and yes, there are a lot of debates about the definitions so they are by no means definitive!).  You could ask the person to talk you through the strategies he or she uses, or you could use it during assessment as a means of identifyin... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=1871455 Sun, 12 Oct 2008 18:04:19 +0100 1871455 http://www.medworm.com/index.php?rid=1845866&cid=t_324180_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2008%2F10%2F03%2Fwhy-am-i-doing-this%2F This is not a whining post, just that I thought it was time I mentioned why I write this blog. I looked on the internet for ages to find a resource that gave me good information about nonmedical approaches to managing chronic pain and other chronic disorders. If you use a search engine to look for ‘chronic pain’ or ‘back pain’ you’ll find endless listings for organisations (I used Google just now and found 8,320,000 in 0.34 seconds!)  and many of them are designed for patients, but not a lot for the nonmedical treatment providers who work with them! And we need to remember that the majority of health care providers working with people with chronic pain are nonmedical. We don’t prescribe! You’ll see I also wrote ‘good information’.  Th... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=1845866 Thu, 02 Oct 2008 19:15:25 +0100 1845866 http://www.medworm.com/index.php?rid=1817340&cid=t_324180_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2008%2F09%2F23%2Fself-management-helping-a-person-become-their-own-healthcare-expert%2F and how we can help Health care in many places hasn’t moved an awful lot from a ‘patch ‘em up and send ‘em out’ mentality.  This is a great approach if you’re basically healthy, have acute appendicitis, and a quick recovery.  It’s not so good if you have chronic pain, are having to learn to live with it, and find your general coping is compromised. Most of our health care training, however, is designed to follow the medical model (despite arguments that occupational therapists, for example, are trained in a biopsychosocial model - just watch what happens when a referral for therapy is received without a diagnosis!).  There is nothing fundamentally wrong with the medical model when it’s being used in the right place - it’s simply inad... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=1817340 Tue, 23 Sep 2008 05:54:28 +0100 1817340 http://www.medworm.com/index.php?rid=1813110&cid=t_324180_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2008%2F09%2F22%2Fwhy-do-they-want-me-to-see-a-psychologist-im-not-nuts-i-just-have-pain%2F Explaining to someone that seeing a psychologist about chronic pain might be helpful can be a bit like this: Yup, brick wall - hard object! I can see it from the person’s point of view - it’s taken a long time (usually) for medical and other people to recognise that this pain isn’t simply going away, and isn’t about the person being ‘pathetic-why-don’t-you-just-pull-yourself-together’, so when someone suggests that psychology might be helpful it’s like saying ‘You’re nuts, you’re just losing it’ - or worse, ‘you’re a hypochondriac’. I thought it might be helpful to review some ways to introduce the idea of seeing a psychologist (or other allied health person), or using a CBT perspective in pain manag... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=1813110 Mon, 22 Sep 2008 05:58:06 +0100 1813110 http://www.medworm.com/index.php?rid=1811670&cid=t_324180_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2008%2F09%2F21%2Fpain-management-cbt-or-a-cbt-perspective%2F There is a bit of a misconception about CBT for chronic pain management. Some people think that it consists only of cognitive behavioural therapy as it is used for depression or other mental health problems. And this often means people think mainly of cognitive therapy as conducted by clinical psychologists - meaning that clinicians from other professions can lack confidence to be involved. I thought today I’d outline the views of one of the ‘founding fathers’ of the cognitive behavioural perspective for chronic pain, Dennis Turk. In a paper by Turk and colleagues Kimberley Swanson from University of Washington School of Medicine, Department of Anesthesiology, Seattle, and Eldon Tunk, Emeritus Professor in the Department of Psychiatry and Behavioural Neurosciences, McMast... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=1811670 Sun, 21 Sep 2008 07:56:51 +0100 1811670 http://www.medworm.com/index.php?rid=1807164&cid=t_324180_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2008%2F09%2F19%2Fterrific-trivia-look-at-what-piques-my-interest-today%2F I couldn’t go very far past Scott Blake’s site for his ‘Bar Code Art’. This guy has a mind even more way out than mine!! To quote: ‘I started making art with barcodes right before Y2K, inspired by the year 2000 computer bug, and threatening digital apocalypse.’ What he’s got on his website is truly whimsical - you too can get your own, personalised barcode to represent YOU - your age, weight, height, gender and country! And you can take a look at his barcode counter that is counting ‘10,000,000,000 UPC barcodes. (that’s 10 billion possibilities) Capturing every imaginable product. This animation takes 10 years to complete.’ Uh, I don’t think I’ll be watching them all… Anyway, if you have ever wondered about bar ... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=1807164 Fri, 19 Sep 2008 00:31:18 +0100 1807164 http://www.medworm.com/index.php?rid=1803855&cid=t_324180_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2008%2F09%2F18%2Fsuccess-why-measuring-outcome-is-so-rewarding%2F Not a research post today, but a great experience that I hope will encourage anyone who is not already a fan of regular outcome measurement to get on with it! I saw a person yesterday who has had pain for about 3 years.  Superficially she’d been managing quite well - still working, having a social life, managing all her household activities and in general, looking good.  BUT - and you knew there would be a ‘but’ - once I started to look a little deeper, it was absolutely amazing to see how much she had adapted her life to avoid specific movements. I used the PHODA (photographs of daily activities) to assess the specific movements and activities she didn’t like to do.  I’ve blogged about PHODA (Kugler et al, 1999) before - a set of photographs of everyday ac... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=1803855 Thu, 18 Sep 2008 06:10:08 +0100 1803855 http://www.medworm.com/index.php?rid=1795532&cid=t_324180_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2008%2F09%2F16%2Fwho-really-has-all-the-pieces-of-the-puzzle%2F I’ve worked in pain management for quite a while now, and longer in work rehabilitation, and seen the process from almost all sides.  For ages I thought that, as the health provider working with the person in the workplace itself, I had most of the pieces of the return to work puzzle.  I mean, I did have access to the medical information, progress reports from other health providers, I spoke with and met with the employer, the compensation agent or funder, and worked with the person…but I’ve revised my ideas since my own rehabilitation. I’ve realised that the only person who has all the pieces of the puzzle is the person who is returning to work. This person is the only one who has been at every health care meeting, treatment session, and progress report.  This p... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=1795532 Tue, 16 Sep 2008 09:29:16 +0100 1795532 http://www.medworm.com/index.php?rid=1791970&cid=t_324180_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2008%2F09%2F15%2Fthe-importance-of-doing-nothing%2F While recovering from my postconcussion syndrome, I learned a lot about saying no and letting go. I’m not usually prone to doing this, so it was a surprise to me to find out that not only could I do it, but I have carried on doing it and enjoying it! I don’t have any literature to support today’s post, but my own personal experience (an N of 1 study!). I wonder how often in rehabilitation or pain management, we even think about scheduling time for the people we work with to just do nothing. I think sometimes we might under-estimate the amount of energy that goes into following a programme of therapy. Here’s just a little from my experience. Every day I was going to work for half a day, returning home to sleep for an hour and a half. Then I would do my speech languag... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=1791970 Sun, 14 Sep 2008 19:19:05 +0100 1791970 http://www.medworm.com/index.php?rid=1783877&cid=t_324180_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2008%2F09%2F11%2Fpain-management-skills-survey%2F Something we don’t know very much about is the way health professionals view the type of coping skills that are often recommended for patients. This survey is one way to start to learn more about what you as a health professional think about some of the coping skills commonly used in pain management. It’s completely confidential, very quick to complete, and I promise it has absolutely no nutritional value! Click on this link and I promise it’ll be painless… And in a couple of months, when I reach my target number of participants, I’ll post the results! thanks heaps for doing this! (Source: HealthSkills Weblog) HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=1783877 Thu, 11 Sep 2008 09:50:52 +0100 1783877 http://www.medworm.com/index.php?rid=1776710&cid=t_324180_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2008%2F09%2F03%2Fcoping-skills-and-goals-living-a-valued-life%2F After musing about the previous two posts on coping and motivation (this is the second one), today I want to complete the set and think about how we as treatment providers might view the range of coping skills a person uses. Van Damme, Crombez & Eccleston (2008) point out that ‘behaviour will emerge to be adaptive or maladaptive depending upon the match between a person’s appraisal of their abilities and their real abilities, the accuracy of their appraisal of the threat, and their ability to switch to a different coping approach if their chosen strategy fails.’ They use the Brandtstadter and Rothermund model of goal-directed coping - assimilative in which people try to work out how to achieve the goal despite barriers, and accommodative in which people adjust their expec... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=1776710 Tue, 02 Sep 2008 19:32:50 +0100 1776710 http://www.medworm.com/index.php?rid=1776711&cid=t_324180_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2008%2F09%2F02%2Fcoping-and-motivation-take-two%2F After yesterdays’ post on coping and motivation, I’ve been pondering how we classify coping into ‘good’ and ‘not so good’. And what pain management is really doing by helping people develop new ways of coping, as if their old ways were ‘bad’. And feeling a bit of a fraud actually because when I’m working with people I do say ‘what you’ve done in the past has worked at least once’, so I do believe that people make the best decisions at the time, given the resources they have. Today I want to go into this article a bit more, but at the same time reflect on coping as I see it. Van Damme, Crombez and Eccleston propose that coping be classified not according to external features (eg active vs passive), but rather into funct... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=1776711 Mon, 01 Sep 2008 19:22:58 +0100 1776711 http://www.medworm.com/index.php?rid=1296150&cid=t_324180_151_f&fid=35822&url=http%3A%2F%2Ffeeds.feedburner.com%2F%7Er%2FWhatWinnersDo%2F%7E3%2F249850544%2F So, you know THOSE type of days. Everything that could go wrong does go wrong down to the tiny things like driving away from the drive through to realize that they gave you a flavored iced coffee instead of the coffee flavored iced coffee that you wanted and needed…desperately. So on a day when all those little things combined with a few big things start to pile up, how do you get through? That is, how do you get through with out the old standby solution of smoking or drinking or snorting your troubles away…for a little while. (more…) Related Posts:How Do You Make Yourself Feel Better (7)Addiction Recovery: Sickness or Backsliding? (4)How Is Addiction Recovery Like Baseball? (2)Lifestyle Changes In Addiction Recovery: How I Went From Queen of The Jams To Suzie Homemaker (... What Winners Do blogs http://www.medworm.com/rss/comments.php?id=1296150 Wed, 12 Mar 2008 01:44:02 +0100 1296150 http://www.medworm.com/index.php?rid=888628&cid=t_324180_133_f&fid=35129&url=http%3A%2F%2Fwhitterer-autism.blogspot.com%2F2007%2F09%2Ffeed-beast.html ‘When in doubt,... panic!’ This idiom is a local one, coined by my Dad. The words are well lodged in my brain, down deep and entrenched. The White Rabbit from Alice in Wonderland is my twin. When you see a woman running around in circles, flapping her hands and repeating ‘oh dear me,’ that in fact would be me, or rather it would be, if I had allowed the idiom to rule my response. Instead I ignore it, stomp on it and resolve to vanquish it forever. I haven't always been a nervous type, despite this early introduction to the concept. Nor would I describe myself with that delightful term 'laid back.' I'm somewhere in the middle, or at least I used to be, until I found I was surrounded by children and outnumbered.I tell you this, because it becomes clear to me, that whilst I may or may... Whitterer on Autism blogs http://www.medworm.com/rss/comments.php?id=888628 Wed, 19 Sep 2007 19:28:00 +0100 888628