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'. Sat, 03 Sep 2011 02:09:29 +0100 http://www.medworm.com/index.php?rid=5159895&cid=t_110496_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F08%2F23%2Fself-management-a-very-vexing-definition%2F Self management is one of those terms that is used to describe the aim of cognitive behavioural programmes for chronic pain. It’s even in my description of this blog! At the same time, it’s difficult to arrive at a definition of self management that “everyone” agrees upon. Self management can mean helping people to be “actively involved in their health care and to provide a variety of creative and individualized strategies to deal with their health problem in their daily life and ultimately to live as normally as possible despite their symptoms” (Zuffery & Schulz, 2009) – but the Devil is in the details! What exactly does being “actively involved” mean?  Can it mean accessing treatments like massage, injections, acupuncture &#8220... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=5159895 Mon, 22 Aug 2011 19:21:38 +0100 5159895 http://www.medworm.com/index.php?rid=5086258&cid=t_110496_109_f&fid=34750&url=http%3A%2F%2Fpsychcentral.com%2Fblog%2Farchives%2F2011%2F07%2F31%2Flifesaving-list%2F Help save lives by sharing this list. Online Suicide Prevention Resources is a small wiki focussed on crisis resources available online without a telephone. There are listings for social media, secure IM chat, and public forums. It was inspired by the International Suicide Prevention Wiki, created by Post Secret, which features a table of links and directories for telephone crisis hotlines and resources all over the world. The list I created today is solely for non-phone contacts. Included are details of the hours for each service. Why make such a list? In today’s cell phone family plan homes, calls show up on bills read by parents, and youth might want privacy for a long list of reasons including the parents being the problem. By using the Internet, people can connect one on one to ... World of Psychology blogs http://www.medworm.com/rss/comments.php?id=5086258 Sun, 31 Jul 2011 19:00:50 +0100 5086258 http://www.medworm.com/index.php?rid=5069843&cid=t_110496_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F07%2F26%2Fmanaging-migraines-without-medication%2F Ahhh, migraine – psychedelia without the high… nausea without the alcohol… The diagnostic criteria: A) At least 5 attacks fulfilling B-D; B) lasting untreated 4-74 hours; C) two of the following: unilateral, pulsating, moderate or severe pain intensity, worsening with physical activity; D) one of the following: nausea and/or vomiting, photophobia or phonophobia; E) not attributed to another disorder. (International Classification of headache disorders, 2004) (go here for one of the most comprehensive sites on migraine) The main treatment for migraine is to use medication – best evidence to date suggests:  “Only two pharmacological treatments have been shown to be effective in placebo-controlled randomized trials: topiramate and local injection of botulinum to... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=5069843 Tue, 26 Jul 2011 01:42:59 +0100 5069843 http://www.medworm.com/index.php?rid=5062519&cid=t_110496_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F07%2F25%2Fusing-the-chronic-pain-acceptance-questionnaire%2F Over the past few months I’ve been using the Chronic Pain Acceptance Questionnaire (CPAQ-8) as part of a battery of questionnaires used at intake and outcome measures.  Along with the CPAQ-8, we use the Tampa Scale for Kinesiophobia, the Depression Anxiety Stress Scale, the Pain Anxiety Symptoms Scale, the Pain  Catastrophising Scale, Pain Self Efficacy Questionnaire, and Pain Disability Index. The CPAQ-8 consists of two subscales: Pain Willingness and Activity Engagement.  Together they measure “acceptance” or psychological flexibility associated with chronic pain. Let me pull this apart a bit.  Pain Willingness refers to how prepared a person might be to experience an increase in pain so they can get something important done.  For example, I love to dance and I&#82... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=5062519 Sun, 24 Jul 2011 19:15:16 +0100 5062519 http://www.medworm.com/index.php?rid=5050956&cid=t_110496_129_f&fid=36038&url=http%3A%2F%2Fwww.everydayhealth.com%2Fblog%2Ftrevis-life-with-multiple-sclerosis-ms%2Fhow-do-you-get-your-juice%2F A long, long time ago in a land far, far, FAR away… I was the Drum Major of my competitive high school marching band. Yes; your beloved writer of the Life With Multiple Sclerosis Blog was, indeed, the geekiest of Band Geeks! This time of year often takes me back, in the Cuisinart of my mind, to the blend of heatstroke and joy that was our preseason Band Camp; the place where we but music and marching together with a well choreographed field drill with color guard accents. During those long, heat-filled summer days on a dusty back field with chalk lines — faint, sometimes, as the Nazca lines — we would march and play and march some more… and then put the playing together with the marching. Mind you, the act of marching while putting hard metal mouthpieces to lips could be far more t... Life with MS blogs http://www.medworm.com/rss/comments.php?id=5050956 Thu, 21 Jul 2011 21:03:20 +0100 5050956 http://www.medworm.com/index.php?rid=4953246&cid=t_110496_133_f&fid=39137&url=http%3A%2F%2Fcommunity.advanceweb.com%2Fblogs%2Fot_9%2Farchive%2F2011%2F06%2F20%2Fkids-will-be-kids-giving-them-a-place.aspx One of the big lessons that I learned from my wedding as far as experiments that actually work was the importance of giving kids the space to do their own thing. At my wedding, this translated not only to A.'s actions and antics, but to all of the children...(read more) (Source: From Inside the Puzzle: Raising a Child with Autism) From Inside the Puzzle: Raising a Child with Autism blogs http://www.medworm.com/rss/comments.php?id=4953246 Mon, 20 Jun 2011 15:19:00 +0100 4953246 http://www.medworm.com/index.php?rid=4911844&cid=t_110496_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F06%2F08%2Fa-brief-review-of-cognitive-behavioural-approaches-for-pain-management%2F Cognitive behavioural approaches for pain management are not exactly the same as cognitive behavioural therapy for mental health problems.  While there are some underlying concepts that are the same, cognitive behavioural approaches for pain management include a wider range of strategies, and are far less readily defined than the very structured approach used in mental health.  In fact it has only been in the last few years that research into the process of change in pain management have been conducted. What defines a cognitive behavioural approach? The assumption that people can learn to accept their chronic pain That people can broaden their self-concept beyond being “a patient” into being “a person with pain” That people can learn or re-explore skills to deal ... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4911844 Wed, 08 Jun 2011 00:39:00 +0100 4911844 http://www.medworm.com/index.php?rid=4893948&cid=t_110496_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F06%2F02%2Fcatastrophising-and-pain-ii%2F What are some of the indications that someone tends to catastrophise about their pain? How do we know? Do we have to use a questionnaire? Is it really my job to know about this if I’m not a psychologist – and what do I do about it? These are the kinds of questions that have been posed to me as I’ve explored the topic of catastrophising, and I propose to answer the last question in my next post (sorry to keep stringing you along like this – I think many may know my take on that already!). I work in a wonderful interdisciplinary team setting, in a centre where everyone who attends the Centre gets to complete a set of psychometrically sound questionnaires that all of the team are encouraged to use and interpret, so any of the team can be confident about identifying and... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4893948 Thu, 02 Jun 2011 08:26:50 +0100 4893948 http://www.medworm.com/index.php?rid=4883925&cid=t_110496_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F05%2F31%2Fcatastrophising-and-pain-i%2F One reason I love blogging is the discussion between me and readers. I wrote about the language of pain recently, and out of that discussion I’ve spent a few days digging around the literature to look at what is known about the relationship between language, pain and catastrophising. I’d argued in my post that metaphoric language can reflect distress both in the communicator and the listener, and that this is supported by fMRI studies in which various parts of the brain are activated when emotion-laden communication about pain is being carried out, while one of my readers thought I might be taking this interpretation too far. Pain behaviour My reason for being interested in how we communicate about pain is that talking about pain (including describing it) is a pain behaviour. P... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4883925 Mon, 30 May 2011 19:15:07 +0100 4883925 http://www.medworm.com/index.php?rid=4803558&cid=t_110496_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F05%2F10%2Fcatastrophising-and-maybe-what-to-do-about-it-for-subacutechronic-pain%2F This study is also an excellent one for looking at process, or how people change over time using a daily diary method. The finding in this paper suggests that one way for helping people be more resilient and modify their tendency towards catastrophising might be to help them identify and then pursue positive experiences during each day.  Scheduling pleasant or enjoyable events as part of a daily routine is certainly something any clinician can do, and often those pleasant events can be physical, such as going for a walk, playing with the kids, or even doing some stretches. Finally (but not the final word!), a study by McKnight and colleagues looked at the mediating effect of self efficacy on the relationship between catastrophising and disability.  In this study, participants with early ... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4803558 Tue, 10 May 2011 02:18:40 +0100 4803558 http://www.medworm.com/index.php?rid=4775617&cid=t_110496_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F05%2F03%2Fpsychological-stuff-isnt-in-my-scope-of-practice-so-what-can-i-do%2F A common cry from various clinicians who work in the field of pain management but who are not psychologists is “but now what?” when they recognise that a key factor in recovery is something psychosocial. The answer is not, I suspect, heading off to become a psychologist! For several reasons, I think it’s critical for non-psychologists to get comfortable with psychosocial language and principles. All clinicians use psychological principles in their interactions with patients.  Like it or not, when we give advice or encouragement we’re using knowledge gleaned from psychological study.  We might call it something like “developing rapport”, but no matter what we call it, these interpersonal skills are psychosocial in nature.  If we use these approaches, ... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4775617 Tue, 03 May 2011 00:22:24 +0100 4775617 http://www.medworm.com/index.php?rid=4753984&cid=t_110496_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F04%2F27%2Fworking-inside-the-envelope-or-pushing-the-boundaries%2F This study examines four different treatments carried out in parallel, it’s an unblinded/masked randomised trial designed to establish the effectiveness of these treatments as well as the adverse events associated with each treatment, and reviews the outcomes up to one year after treatment ended. Participants were carefully selected to meet the criteria for a diagnosis of chronic fatigue syndrome, and it’s interesting to see that only 28% of the people initially recruited actually met these criteria, and of this group, only 71% or 641 people actually progressed through to treatment.  Thankfully the CONSORT trial profile included in the paper shows very clearly who was ‘in’ and who was ‘out’ – and why! Clinicians were carefully trained, supervised ... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4753984 Tue, 26 Apr 2011 19:35:40 +0100 4753984 http://www.medworm.com/index.php?rid=4753985&cid=t_110496_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F04%2F26%2Fa-new-way-of-looking-at-coping-maybe%2F One half of knowing what you want is knowing what you must give up before you get it. ~Sidney Howard Many are stubborn in pursuit of the path they have chosen, few in pursuit of the goal. ~Friedrich Wilhelm Nietzsche There are few topics closer to my heart than goals.  This is partly because of my background in occupational therapy, where goals are seen as part of how we live purposeful, meaningful lives – but it’s also because they’re incredibly difficult to help others to do, yet goal setting is seen as integral to therapy. I’ve also been considering the whole topic of coping recently.  What is coping? Which coping strategies are helpful? Is it possible to view coping efforts without also looking at the context in which they’re being used? My current concl... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4753985 Mon, 25 Apr 2011 19:33:35 +0100 4753985 http://www.medworm.com/index.php?rid=4734700&cid=t_110496_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F04%2F19%2Festablishing-routines-and-baselines-baseline-recording%2F One of the problems novice clinicians often complain about is that journals and research papers rarely examine or provide practical approaches to daily problems that are encountered when working with people who have chronic pain. It can take a lot of work to locate suitable approaches to things like: ways to help a person who is not accepting that a cure for chronic pain is unavailable ‘motivating’ a person to engage in activities that are anticipated to increase pain how to develop a baseline and establish an appropriate rate of progression how to establish a daily routine It’s tempting to think that in the absence of evidence-based approaches, the clinical skills are artistic rather than scientific, but I’m not so sure about that.  Maybe it’s more a case ... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4734700 Tue, 19 Apr 2011 06:11:03 +0100 4734700 http://www.medworm.com/index.php?rid=4709469&cid=t_110496_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F04%2F14%2Fdaily-routines-a-framework-for-healthy-living%2F I’m working with a couple of people who are having a good deal of trouble maintaining a routine.  Things like having a reasonably regular bedtime and wakeup time, eating regularly, having periods of energising activity, and periods of rest and relaxation.  While some of our normal routines have been disrupted by the earthquake in Christchurch, and things like getting to a supermarket or petrol station or even to see a doctor can mean travelling further than normal, for these people, routines have not ever really been a strong point. As someone who likes a bit of routine, I personally struggle to understand how people can miss out a meal or go to bed at wildly different times of the night (or early morning!).  Although I have to say I’m not averse to the occasional lie-in!  ... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4709469 Wed, 13 Apr 2011 19:24:15 +0100 4709469 http://www.medworm.com/index.php?rid=4704983&cid=t_110496_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F04%2F12%2Ftalking-about-it-is-it-worth-encouraging-emotional-disclosure-for-people-with-pain%2F One of the more common coping strategies for people with chronic pain is talking about stressful experiences. It’s thought to be healthy to be open and express feelings, while the very idea of repressing or avoiding emotional content seems almost Victorian. And there are various talk therapies in which emotional disclosure is encouraged – in fact, one popular approach suggests that people risk developing chronic pain if they don’t discuss ‘trauma’ (Sarno). So, does it work? Some studies of emotional disclosure have found that it has ‘moderate’ effects – people can feel emotionally better, and their general health status can also improve.  Other studies are more equivocal, with less positive outcomes.  Even in meta-analyses, outcomes have be... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4704983 Mon, 11 Apr 2011 18:56:57 +0100 4704983 http://www.medworm.com/index.php?rid=4677137&cid=t_110496_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F04%2F05%2Fwhat-is-coping%2F When we use the word ‘coping’, what do we mean? Recently, I’ve been reviewing the whole concept of coping in chronic pain.  I’m trying to establish how people with chronic pain view this term, and what they include in their repertoire of ways to cope.  My research is looking at the ways that people who cope well with their pain, and never need input from a chronic pain management team, do so.  And in doing this research, I’m hitting some conceptual snags. The thing is, coping as a concept isn’t defined all that well.  Some definitions refer to the outcome of coping: “he coped well with that” meaning “he managed that stressor in a positive way and the outcome was good”; some definitions refer to the process of coping and don&#8... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4677137 Tue, 05 Apr 2011 06:55:06 +0100 4677137 http://www.medworm.com/index.php?rid=4664499&cid=t_110496_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F03%2F31%2Fmoodjuice%2F I had a nice email from James Hardie from Moodjuice website, an NHS Scotland site developed for both health professionals and individuals to access self help resources. For patients, the site starts by saying “Emotional problems are often the mind and body’s way of saying that something needs to be changed in our life” - I like that!  I like the way the patient area is based on practical problems like housing, childcare, hobbies and interests, meeting people, relationships and so on. For professionals, the feature that really appeals to me is the “build your own resource” area.  This enables you to put together the most relevant handouts for the person you’re seeing – a lovely feature! Then you can print the whole lot off, and it’s a pulled-tog... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4664499 Wed, 30 Mar 2011 20:12:26 +0100 4664499 http://www.medworm.com/index.php?rid=4622515&cid=t_110496_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F03%2F23%2Fits-there-and-im-stuck-with-it-chronic-knee-pain-after-knee-joint-replacement%2F I share an office with an Emeritus Professor of Orthopaedic Surgery.  He snorted at me one day, and showed me the stats from our national joint register database where I saw that while the main reason given for revision of a total hip joint was dislocation, and pain was the sixth most common reason given; in the case of revision of knee joint replacements, persistent pain was the most common reason given. Some studies have shown between 6 – 30% of people receiving total knee joint replacements have ongoing pain months after their immediate post-surgical recovery.  With knee joint replacement such a common surgery for osteoarthritic knees, and some reports of up to 33% of the adult population having OA of the knee, that’s a lot of people who continue to have pain! It’s n... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4622515 Tue, 22 Mar 2011 18:22:40 +0100 4622515 http://www.medworm.com/index.php?rid=4615450&cid=t_110496_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F03%2F21%2Fmaking-self-help-more-helpful%2F In this study, Varley, Webb and Sheeran contacted (via email) the students and staff at a university in the UK.  People who were already being treated for anxiety were excluded, and the remaining participants (251 of them) were randomised into three groups.  All of them completed baseline Hospital Anxiety and Depression Scale (HADS, developed by Zigmond and Snaith, 1983) and the state version of the State-Trait Anxiety Inventory (STAI; Spielberger, Gorsuch, Lushene, Vagg, and Jacobs, 1983). One group received no input, while the other two groups were asked to go to a web page where they downloaded a self-help booklet.  Both of the booklets were the same eight-page booklet containing psychoeducation, diary sheets for self-monitoring triggers and feelings, and two relaxation techniques &#... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4615450 Sun, 20 Mar 2011 19:20:16 +0100 4615450 http://www.medworm.com/index.php?rid=4566351&cid=t_110496_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F03%2F09%2Fopportunity-for-a-conversation%2F I had a wonderful discussion with another occupational therapist about the profession’s response to the earthquake.  ”How”, she asked, “Can occupational therapists from the other end of the country help those in Christchurch?” To further this discussion, I’ve added a new page to my blog for people to contribute their thoughts about how occupational therapists can aid in the recovery process for people in Christchurch. Feel free to contribute, comment, say your piece – and even if you’re not an occupational therapist, but you have some thoughts about how occupational therapy as a profession might be able to help, please add your comments too. Go here for the page… Filed under: Coping Skills, Coping strategies, Health, Occupational thera... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4566351 Wed, 09 Mar 2011 03:13:32 +0100 4566351 http://www.medworm.com/index.php?rid=4554805&cid=t_110496_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F03%2F07%2Fafter-quake-aftermath%2F Once again I’m lead to pondering the different ways my situation has affected me, and what might be helpful to mitigate some of the less frequently mentioned aspects of coping in a disaster. Like many people, I’m still managing with quite limited power, water that is a trickle (not enough pressure to fill a toilet cistern let alone the hot water cylinder!), and the hassles of finding a supermarket and shops that are open, a petrol station before I run out of gas, and ways to dispose of human waste matter safely. I posted before about the loss of cues that usually help me to maintain my normal routine.  With the loss of these cues, and changes to my usual routine, as well as the inevitable anxiety that comes with repeated aftershocks (Is that a truck going by or an aftershock? ... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4554805 Mon, 07 Mar 2011 03:16:10 +0100 4554805 http://www.medworm.com/index.php?rid=4536519&cid=t_110496_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F03%2F02%2Fliving-well-with-chronic-pain-a-grounded-theory-study%2F While ‘coping’ with chronic pain has been studied extensively, the people usually studied have been those seeking treatment, and because of this, little is known about how people cope well despite their pain.  A large group of people experiencing ongoing pain do not seek treatment, and while there is speculation that factors such as personality or social support may be associated with this, there is very little known about how this group of people have developed coping skills, or the strategies they employ. Consequently there is a lack of theory to explain how some people with chronic pain continue with important activities despite their pain. My PhD study is intended to develop a theoretical understanding (using a grounded theory methodology) of how people cope well despite their pai... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4536519 Wed, 02 Mar 2011 03:19:00 +0100 4536519 http://www.medworm.com/index.php?rid=4522318&cid=t_110496_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F02%2F26%2Fearthquake-aftermath%2F Dear Readers I have had many, many expressions of concern since the earthquake struck Christchurch again on Tuesday 22 February 2011.  I’m glad to say that me and my family have escaped relatively unscathed from this traumatic event – I can’t say how badly hit my home city has been though.  While the earthquake on 4 September last year was certainly awful, this one has been so much more devastating in terms of the physical damage, not to mention the human cost in loss of life and both physical and emotional damage.  The infrastructure in Christchurch is incredibly damaged – I live in New Brighton, and we are expected to not have power for several weeks; we have no water or sewerage; the roading is terribly broken up with huge holes and smelly, sewage-contaminated... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4522318 Fri, 25 Feb 2011 21:52:26 +0100 4522318 http://www.medworm.com/index.php?rid=4298821&cid=t_110496_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F12%2F30%2Fskills-strategies-resources-in-2010%2F Part of the reason for this blog is to introduce clinicians to some of the research and application of coping strategies for people with chronic pain.  While I can summarise the year’s developments in (almost) a single sentence (see below!), it’s also true that I’ve posted a lot of really interesting findings about coping over the year.  Today’s summary links to the goodies I’ve found in 2010. Oh, my summary? There is nothing especially new under the sun in self managing pain – it’s about goals, acceptance, exercise, engaging in important activities and roles, gratitude, connecting with people…oh and mirrorbox for some lucky people for whom it works well! Cognitive behavioural approaches to pain management Before I post the links, a quick w... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4298821 Wed, 29 Dec 2010 22:04:49 +0100 4298821 http://www.medworm.com/index.php?rid=4294901&cid=t_110496_133_f&fid=39137&url=http%3A%2F%2Fcommunity.advanceweb.com%2Fblogs%2Fot_9%2Farchive%2F2010%2F12%2F28%2Fsnow-days-are-tricky.aspx I know that my last entry may have made December sound as if it's all been sunshine, lollipops, and rainbows. Believe me -- despite the fact that much progress has been made, we've also had several rocky days in the middle of all of this, as well. Specifically,...(read more) (Source: From Inside the Puzzle: Raising a Child with Autism) From Inside the Puzzle: Raising a Child with Autism blogs http://www.medworm.com/rss/comments.php?id=4294901 Wed, 29 Dec 2010 04:54:00 +0100 4294901 http://www.medworm.com/index.php?rid=4272660&cid=t_110496_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F12%2F20%2Fa-year-in-review%2F This is the third year I’ve written this blog.  As the year ends, numerous people will be reviewing the year, reflecting on the good, the bad and the indifferent, and like them, I will too. What has been the same this year is the endless need to repeat to all and sundry the following: All chronic pain starts with acute pain – maybe if we were able to effectively manage risk factors for developing chronic pain in people when they first present for help with their pain, my job would be less in demand. All pain, whether acute or chronic, is a psychological experience – and can’t be understood without an appreciation of the biopsychosocial model. Because pain is a psychological experience means that we can’t divide pain into nociception and the psychological res... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4272660 Mon, 20 Dec 2010 07:22:22 +0100 4272660 http://www.medworm.com/index.php?rid=4266303&cid=t_110496_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F12%2F17%2Ffriday-funnies-43%2F Before I head out to do a little Christmas shopping – yes, in a MALL, at CHRISTMAS! I must be mad – anyway, I had to pass on the following bits of gossip.  It’s true, you heard it here first. Have a good weekend – and if there’s no post on Monday you’ll know it’s because I’ve got LOST! Filed under: Coping Skills, health, Humour, pain, Resilience, therapy Tagged: coping strategies, Friday funnies, funny, health, healthcare, Humour (Source: HealthSkills Weblog) HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4266303 Thu, 16 Dec 2010 21:16:09 +0100 4266303 http://www.medworm.com/index.php?rid=4207517&cid=t_110496_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F11%2F29%2Fcan-psychological-management-of-fibromyalgia-affect-pain%2F When I’m working with someone who has chronic pain, from the outset I’m pretty straight-up that the treatments I offer don’t directly affect pain intensity.  It’s not my focus, and very often after the first session, I don’t even discuss pain – I’m more interested in what the person is doing! And for this focus, I sometimes get some reasonably snippy comments, none more so than a doctor (who shall remain nameless) who said to some of my students that psychological and functional approaches to pain management are, in effect, useless because they ‘can’t directly address the pain’. Well, I beg to differ, kind sir. While pain intensity isn’t the focus of treatment, it very often is affected by the treatments offered using a cog... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4207517 Sun, 28 Nov 2010 21:06:30 +0100 4207517 http://www.medworm.com/index.php?rid=4197387&cid=t_110496_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F11%2F24%2Fdeveloping-a-set-back-plan-in-pain-management%2F In this study, access to this support was maintained for four months. What this research found was that across a wide range of outcome measures including pain intensity, mental health, physical activity and disability, participants maintained their changes.  Not only did they maintain these changes during the four months of telephone support, they also maintained changes over a subsequent four months – to a greater extent than those who didn’t have access to this kind of support. I think this approach is promising.  Ongoing support groups have some negative effects, particularly if they rely on volunteer or lay leaders (who may have their own issues to manage), and they can foster a degree of ongoing identification with the ‘patient’ role.  Similarly, providing i... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4197387 Tue, 23 Nov 2010 18:30:46 +0100 4197387 http://www.medworm.com/index.php?rid=4190545&cid=t_110496_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F11%2F23%2Fflare-ups-breakthrough-pain-or-set-backs-self-managing-exacerbations-of-pain%2F A couple of days ago I wrote about medication and managing flare-ups, and out of that post there was a bit of discussion about what exactly I meant by flare-up, and whether it might be better defined as break-through pain.  I’ve found that there is not a lot of agreement in the literature – nor with clinicians! – in terms of distinctions between flare-up or breakthrough, so I’ve decided to redefine the problem completely. Not that I’m the first to do so, as you’ll see from the paper I’ve referred to today.  I have to admit that I like Turk’s approach to chronic pain, as it’s the way I have been trained to approach pain management.  Turk is also the author of a self-help book for chronic pain management that I still think is one of th... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4190545 Mon, 22 Nov 2010 21:34:13 +0100 4190545 http://www.medworm.com/index.php?rid=4179536&cid=t_110496_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F11%2F19%2Ffriday-funnies-41%2F It’s nearly the weekend! Time to kick back, relax and snigger. It’s true – apparently The Doors, Talking Heads and relaxation music are.. ahem… Not In Fashion Any More.  And I do wish I’d taken this advice! Filed under: Coping Skills, health, Humour, wellness Tagged: coping strategies, Friday funnies, health, Humour, relaxation, therapy (Source: HealthSkills Weblog) HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4179536 Thu, 18 Nov 2010 21:05:22 +0100 4179536 http://www.medworm.com/index.php?rid=4175986&cid=t_110496_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F11%2F18%2Fmedication-and-self-managing-chronic-pain-iii%2F When discussing medication and pain reduction for chronic pain, it’s not surprising there are some very strong opinions and emotions.  After all, having pain is universally known to be unpleasant, very few people really want to have pain (except those who like the rush of acute pain – vis a vis body suspension!), and the first person many people go to discuss their pain is a medical practitioner. The way the centre in which I work views medication is that it forms part of a toolkit for managing pain, alongside all the self management strategies that we also endorse.  So, by and large, most of the people we see are on a stable regime of medication targeting the underlying mechanisms thought to be influencing the nervous system’s sensitivity to stimuli. A reader suggested... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4175986 Wed, 17 Nov 2010 20:03:55 +0100 4175986 http://www.medworm.com/index.php?rid=4172341&cid=t_110496_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F11%2F17%2Fmedication-and-self-managing-chronic-pain-ii%2F If medication is to be part of a toolkit for self managing chronic pain, then it seems to me that it’s important to know as much about the medication and how it should be used as possible.  Once again, today I’m not directly referring to the literature because I haven’t found an awful lot discussing this integration approach, so please bear this in mind when you read what I’ve written.  I’m also not a medical doctor, I don’t prescribe, I don’t want to have prescribing rights, and I must advise any reader NOT to change, reduce or increase medications without having a good discussion with your own medical practitioner first. There are two main paths in pain management – one focuses on pain reduction, and this is where I think medication (and surgery and... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4172341 Tue, 16 Nov 2010 18:37:08 +0100 4172341 http://www.medworm.com/index.php?rid=4168224&cid=t_110496_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F11%2F16%2Fmedication-and-self-management-for-chronic-pain%2F Last week a reader asked me for my take on using medications for chronic pain, so today I’m going to take a stab at this rather emotive and certainly very complex topic.  Before I do so, a word of warning – this is mainly my opinion and experience!  I’m also not a medical doctor, I don’t prescribe, I don’t want to have prescribing rights, and I must advise any reader NOT to change, reduce or increase medications without having a good discussion with your own medical practitioner first. Strangely, I had trouble locating journal articles on combining medication and self management, so I either need to refine my search terms – or there may not be an awful lot of information out there about it. Despite the lack of information that I could find, more peopl... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4168224 Mon, 15 Nov 2010 18:26:29 +0100 4168224 http://www.medworm.com/index.php?rid=4152303&cid=t_110496_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F11%2F10%2Frebuilding-work-identity%2F I love helping people return to work.  It’s got to be one of the most rewarding parts of pain management for me because not only is work important for health, it’s a major part of our day, and it’s a whole lot about individual identity.  So helping people reconstruct their sense of self to the point where they can go to an employer and say ‘I can do this for you’ with confidence is an enormous challenge. To feel confident enough to put yourself on the line to an employer despite chronic pain is a challenge.  It involves at least some of the following (and yes, this is mostly from my experience on this post!): Good self efficacy for managing pain - to the point where fluctuations in pain intensity can be taken with equanimity Strong knowledge of what you ca... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4152303 Wed, 10 Nov 2010 01:28:00 +0100 4152303 http://www.medworm.com/index.php?rid=4152304&cid=t_110496_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F11%2F09%2Fbroaden-and-build%2F Readers may be wondering why I’ve come over all happy clappy and jolly joy germ – well, I realised I’d been writing a lot about experimental and theoretical factors found to influence vulnerability to chronic pain, but I had been writing less about ways to help people cope more effectively with chronic pain. I do have a soft spot for positive psychology because, as we can see in most of the major journals, psychological studies have primarily been interested in what goes wrong, why people may struggle to cope with their pain, and other aspects of vulnerability. Yet more people than not live well with their chronic pain, and rarely seek help for their pain – maybe we can learn something from how these people cope, and in doing so, help people who do need treatment de... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4152304 Mon, 08 Nov 2010 18:40:11 +0100 4152304 http://www.medworm.com/index.php?rid=4143033&cid=t_110496_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F11%2F08%2Fhappy-happy-joy-joy-increasing-positive-experiences-to-improve-mood%2F I am sure there will be people who read today’s post who will feel like giving me a bit of a slapping. “How”, they will say, “Are you supposed to get happy when you’re feeling bad?” And I would have been one of these people a few years ago too, given my history of low mood and love of whining. Seriously, it’s completely counter-intuitive to think that when you’re feeling flat and low, all you need to do is get out and enjoy yourself! It goes a bit like this, I think. When someone is feeling a bit flat, maybe having done too much and started to feel fatigued, it’s normal to stop doing quite so much and rest up. But if resting fails to increase energy – maybe because of a chronic condition like fibromyalgia, or really any of the chr... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4143033 Sun, 07 Nov 2010 18:37:39 +0100 4143033 http://www.medworm.com/index.php?rid=4134291&cid=t_110496_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F11%2F02%2Fresilience-catastrophising-and-positive-emotions%2F Catastrophising, or thinking the worst, is one of those psychological factors that we know influences distress and disability in people with chronic pain. It’s quite a common phenomenon, and sometimes can stand us in good stead – after all, if we can think of the worst things that can happen, then plan to avert those possible disasters, then life will be sweet, yes? ermmmm – no, as a matter of fact.  Catastrophising can actually function to narrow our thinking down, reducing the range of options we can come up with to manage situations, and it can also function to focus us on things that haven’t worked out while at the same time minimising our appreciation of things that are working well. In chronic pain, catastrophising is often an outcome to measure – the t... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4134291 Tue, 02 Nov 2010 08:49:36 +0100 4134291 http://www.medworm.com/index.php?rid=4119760&cid=t_110496_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F10%2F28%2Fwhats-missing-from-pain-assessment%2F I am stumped. Here is a common clinical quandary – one of the most important outcomes from pain management is to increase participation in daily activity (occupation), yet the measures we use just don’t quite cut it for me. Here’s a couple of examples: in the IMMPACT recommendations from 2008 (in the paper I’ve cited below and from the one I cited earlier this week) two ‘disability’ measures are suggested as a way to assess disability.  One is the ‘Interference’ subscale from the Multidimensional Pain Inventory, and the other is the Pain Disability Index.  Both of these have sound psychometric properties, have been used for a long time in pain management research and clinical use – but both of them have problems. The problems are abou... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4119760 Wed, 27 Oct 2010 18:39:19 +0100 4119760 http://www.medworm.com/index.php?rid=4106087&cid=t_110496_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F10%2F26%2Fwhat-matters-to-people-with-persistent-pain%2F I’ve read many written expectations of people coming for pain management – and without a doubt, the majority of people want to get on with life, go back to doing what they enjoy, and feel better in themselves. The only problem with that? Most of them preface their goals with ‘reduce my pain so I can…’, or words to that effect. And the reality is that for many of them, that particular goal is frustratingly difficult to achieve. I would think that most clinicians working in pain management want to practice patient-centred care – but what is it that patients really want when pain can’t be completely eliminated? Luckily for us (maybe), the team developing the IMMPACT (Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials) recommend... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4106087 Mon, 25 Oct 2010 18:29:08 +0100 4106087 http://www.medworm.com/index.php?rid=4082343&cid=t_110496_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F10%2F19%2Fhow-did-that-happen-stories-of-returning-to-work%2F Yesterday I started to talk about returning to work with chronic pain. I mentioned that it’s often not the degree of importance an individual places on returning to work that engenders resistance – it’s more likely the lack of confidence the person has towards the process, the fear that this won’t work out and they will fail… A story or two might help detail some of the issues that people I work with encounter when they’re returning to work. Now I recognize that the people I see are possibly at the more complex end of the spectrum than many, so these stories might well be more extreme than what many clinicians see, but at the same time they illustrate where things go wrong. A note: vignettes used in this blog are composites of people I’ve worked wi... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4082343 Tue, 19 Oct 2010 05:21:29 +0100 4082343 http://www.medworm.com/index.php?rid=4077624&cid=t_110496_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F10%2F17%2Fworkability%2F There can sometimes be a delicate balance in therapy, between challenging people to try something new and step away from ways of coping that are easy because they’re habits, and at the same time respecting that people have different ways of doing things, different values and beliefs, and in the end have to choose what works for them. In a recent discussion, someone asked me why Psychology is so quick to judge treatments and why ‘evidence’ is restricted to therapy that has been subject to things like randomized controlled trials and so on. After all, lots of people come to see this person after ‘conventional’ treatment has failed, and they feel very happy with the treatment he gives them. To answer that question, and at the same time give due regard to individ... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4077624 Sun, 17 Oct 2010 05:37:29 +0100 4077624 http://www.medworm.com/index.php?rid=4055968&cid=t_110496_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F10%2F12%2Fcounting-your-blessings-or-looking-on-the-bright-side-of-life-whistles%2F My family were big on the Andrews Sisters. One of my strong memories as a child is listening to the song ‘count your blessings, name them one by one…’ [no, I will not sing it ok?!]. And I remember the book Pollyanna (you can read it for free here!) and the ‘Glad game’ where she looked for the positive in her rather dire situation when she went to live with her strict Aunt Polly. And guess what?  There is something in this approach to coping that makes a difference! While on holiday, sad person that I am, I did spend one or two days reading journal articles.  Several of them were related to the theme of positive psychology in a special issue of Clinical Psychology Review. While research into optimism, positive affect and even psychological flexibility has bee... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4055968 Mon, 11 Oct 2010 18:36:40 +0100 4055968 http://www.medworm.com/index.php?rid=4036720&cid=t_110496_109_f&fid=34750&url=http%3A%2F%2Fpsychcentral.com%2Fblog%2Farchives%2F2010%2F10%2F06%2Flet-your-children-be-children%2F Everyday, the same scene plays itself out across American neighborhoods across the United States. Mothers pull up in their Suburbans and Lexus SUVs at the entrance to their housing development. Even though the families live in perfectly safe, middle-class (or better) neighborhoods, parents feel the need to chauffeur their children the few blocks from the bus stop to home. Why? This behavior may be understandable if the child is 5 or 6. But at 8 or 10, this behavior is ludicrous and symptomatic of a dangerous infection that has spread throughout this country in the latest generation of parents. If not stopped, we may end up raising a whole generation or two of children who have little effective life coping skills and no connection or understanding to the world around them. If you’re ... World of Psychology blogs http://www.medworm.com/rss/comments.php?id=4036720 Wed, 06 Oct 2010 10:30:41 +0100 4036720 http://www.medworm.com/index.php?rid=4003454&cid=t_110496_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F09%2F28%2Ffearanxietyavoidance-%25e2%2580%2593-treatments-review%2F For years, clinicians working in pain management have mixed together a rich assortment of strategies to help people function better.  But to identify the ‘active ingredients’ of multidisciplinary pain management using a cognitive behavioural approach, it’s been important to tease each element apart.  One size does not fit all – and just as a physician chooses the most effective medication for a disorder, in time I hope we will be able to choose the most effective strategy for the problems each individual experiences rather than applying our current ‘scatter-gun’ approach. Yesterday I gave a brief overview of the three main treatments to helping people who are fearful/anxious of their pain (or harm) and avoid activities as a result. They are: Graded ex... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4003454 Mon, 27 Sep 2010 18:25:26 +0100 4003454 http://www.medworm.com/index.php?rid=4003101&cid=t_110496_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F09%2F27%2Ffearanxietyavoidance-and-some-treatments%2F I’ve been pondering the post by Neil O’Connell on Body in Mind in which he comments on a paper by Foster, Thomas, Bishop, Dunne and Main (2010) in which he makes the point that “There is a huge emphasis on psychological variables in research and current care for low back pain. My experience (the usual biased, unreliable, non-replicable shambles) tells me that this is justifiably so. But in this rigorous study the four psychological variables found to have a unique influence individually explained just 2.5% of the variance or less. The big players were the level of disability when the patient arrived at the GP and demographic factors which together explained 50%.” Now this flies in the face of the general trend towards emphasising psychosocial variables associated wi... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4003101 Mon, 27 Sep 2010 05:35:16 +0100 4003101 http://www.medworm.com/index.php?rid=3999044&cid=t_110496_109_f&fid=34750&url=http%3A%2F%2Fpsychcentral.com%2Fblog%2Farchives%2F2010%2F09%2F24%2Fmental-health-stigma-still-prevalent%2F Two stories published in the past week by our news team gives me reason to be a little pessimistic about the gains we’ve made in terms of educating folks about mental health concerns. The first article entitled, Depression Stigma Higher in Medical Students, examined mental health attitudes amongst medical students — you know, those folks who should be the most open-minded about these disorders that have significant roots in the brain. Of course, from the title of the article, you already know the study’s findings. In a survey of 505 medical students, researchers found that not only do the future doctors have higher rates of depression than in the general population (not surprising, given the stress of medical school), but they have something a little less expected —... World of Psychology blogs http://www.medworm.com/rss/comments.php?id=3999044 Fri, 24 Sep 2010 12:05:19 +0100 3999044 http://www.medworm.com/index.php?rid=3987247&cid=t_110496_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F09%2F21%2Fthinking-about-sleep-or-not%2F It’s 3.00 in the morning.  You haven’t slept since you got into bed at 11.00, and the last time you had a full night’s sleep was some months ago.  Every morning you wake up feeling as though you haven’t really slept yet – and every day is just the same. I can understand why people who have sleeping problems (and yes, I’m one of them!) often have quite strong reactions when they’re introduced to some of the concepts that are most successful for restoring a normal sleep pattern.  While the basic principles of sleep hygiene are well-known and reasonably simple, putting them – and other more challenging strategies in place – can be quite a difficult process. It’s what goes through a person’s mind that makes it difficult &#821... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3987247 Tue, 21 Sep 2010 09:06:04 +0100 3987247 http://www.medworm.com/index.php?rid=3983559&cid=t_110496_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F09%2F20%2Fsleep-problems-in-chronic-pain-what-helps%2F I have written about sleep problems in people with chronic pain several times. It is one of those aspects of dealing with pain that inevitably arise as I talk with people about energy, their activity through the day, and their mood. Many people blame the pain for their sleep problems, which is unsurprising really – once you’re awake in the middle of the night, there’s not a lot else to think about! But it seems like while pain might be associated with a sense of poorer quality sleep, and could well have been a factor influencing the onset of insomnia, it’s often other factors that maintain unsatisfying sleep. What are those factors? Well, one of the first ones is ‘general affective disturbance’ - in other words, feeling low or flat, whether frankly depre... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3983559 Mon, 20 Sep 2010 08:02:29 +0100 3983559 http://www.medworm.com/index.php?rid=3976724&cid=t_110496_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F09%2F17%2Ffriday-funnies-38%2F My world may have been rocked by the late-night quakes, but my humour remains THE SAME! Sorry. I was talking to SuperTherapist the other day, and she whispered some sayings to help maintain that sense of calm and serenity that is necessary when returning to work after a week away. I’m not so sure this was all that helpful...”Be patient and achieve all things. Be impatient and achieve all things faster.” Neither were these, probably… Be aware of your body. Be aware of your perceptions. Keep in mind that not every physical sensation is a symptom of a terminal illness. To practice Zen and the art of therapeutic motorcycle maintenance, do the following: get rid of the motorcycle. What were you thinking? – and you’ve run out of duct tape. Filed under: Cop... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3976724 Fri, 17 Sep 2010 00:07:28 +0100 3976724 http://www.medworm.com/index.php?rid=3969196&cid=t_110496_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F09%2F15%2Fthe-tigger-effect-resilience-emotion-regulation%2F Tigger. That orange-furred, black-striped, tiger character originally introduced in A. A. Milne’s book The House at Pooh Corner. Tigger is a very bouncy fella. Tigger is amongst the most exuberant creatures in the 100 Acre Wood, and his most stand out and well-known feature is his very springy tail. Tigger has resilience. The wonderful thing about Tiggers…..Is Tiggers are wonderful things…..Their tops are made out of rubber…..The bottoms are made out of springs…..They’re bouncy, trouncy, flouncy, pouncy…..Fun, fun, fun, fun, fun…..But the most wonderful thing about Tiggers is…..I’m the only one…..The wonderful thing about Tiggers…..Is Tiggers are wonderful chaps…..They’re loaded with vim and vigor…..T... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3969196 Wed, 15 Sep 2010 09:22:49 +0100 3969196 http://www.medworm.com/index.php?rid=3969197&cid=t_110496_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F09%2F15%2Fwhat-to-do-when-feeling-low-grumpy-or-fatigued%2F Yesterday I wrote about emotion regulation and how this is seen as an essential part of achieving good mental health.  Emotion regulation is about being able to monitor, judge, and work with emotional responses in order to achieve goals. People with chronic pain often experience a range of negative emotions – pain itself is characterised as being a negative emotional and sensory experience. At the same time we know there is an interaction between feeling low and experiencing pain that makes both experiences feel worse. Three of the more troublesome emotions that people experience when they have chronic pain is low mood (not always depression, often ‘demoralisation’ or simply feeling sad and down); frustration and anger; and fatigue. Fatigue you say? Is that an emotion? W... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3969197 Tue, 14 Sep 2010 19:40:31 +0100 3969197 http://www.medworm.com/index.php?rid=3965719&cid=t_110496_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F09%2F14%2Fessential-skills-for-living-with-pain%2F I could actually head this post with the title ‘Essential Skills for Living’ and leave out the pain part, because as I reflect on the events over the past week, and the aftermath as residents of Christchurch start to demolish then rebuild their homes and businesses, these same skills apply. How do people live well despite adversity? Our lives are not straightforward and both major events and daily hassles are encountered and influence thoughts, emotions and behaviour. It’s normal to have a range of emotions, abnormal to be ‘happy, happy, joy, joy’ all the time (despite the adverts!). It has been postulated that the ability to regulate emotions is a sign of adulthood, and that being unable to regulate emotions is a contributor to much emotional ill-health. Emot... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3965719 Mon, 13 Sep 2010 19:36:20 +0100 3965719 http://www.medworm.com/index.php?rid=3946537&cid=t_110496_109_f&fid=34750&url=http%3A%2F%2Fpsychcentral.com%2Fblog%2Farchives%2F2010%2F09%2F08%2Fsuicide-risk-amongst-college-students%2F Suicide is a serious concern amongst young adults, and the isolation and loneliness of some college students’ experience appear to be some of the factors that may trigger the behavior. Suicide is the second leading cause of death amongst college-aged students. Suicide is most commonly viewed as a symptom of severe depression. Depression of this nature often goes undiagnosed in a young adult, because they don’t know what it is, or have no energy or motivation to seek out help. But other risk factors can also be in play. In a survey of 1,085 University of Maryland college students, 12 percent said they had contemplated suicide. Eight out of 10 students reported having had a depressed mother. Other risk factors the researchers identified included: exposure to domestic violence, fe... World of Psychology blogs http://www.medworm.com/rss/comments.php?id=3946537 Wed, 08 Sep 2010 12:33:39 +0100 3946537 http://www.medworm.com/index.php?rid=3935926&cid=t_110496_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F09%2F06%2Ftemporary-downtime-christchurch-earthquake-aftermath%2F We’re fine after the earthquake, but things are not back to normal in Christchurch – to give visitors an idea of the damage, here are a couple of shots I took on Saturday morning. I was having a week off work anyway, which is well-timed given the circumstances, and I’ll blog occasionally over this time. My story: I was fast asleep until about 4.35am on Saturday morning.  The bed started to jiggle, a bit like when Manly Jack gets the leg twitch thing going, but instead of stopping, this became much more violent.  We could both hear crashing, tinkling sounds as things were falling off shelving, and we leaped out of bed to grab a torch and stand in the doorway.  We must have stood there for at least a minute while the house shook and a deep rumble continued.  The power w... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3935926 Sun, 05 Sep 2010 20:57:20 +0100 3935926 http://www.medworm.com/index.php?rid=3915308&cid=t_110496_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F08%2F31%2Fgraded-exposure-in-the-real-world%2F Well, not exactly the real world – yet – just the clinic. A man I’m working with is very worried about his back.  Some years ago he had a discectomy and his surgeon told him he needed to be ‘very careful’ with his back – and so he has.  No bending, twisting, lifting for this man!  He’s given up some of his favourite things like fishing and whitebaiting and even golf because of this worry, although when I talk things through with him he’s not exactly sure what might happen if he ‘disobeyed’. Let’s call him Matt for wont of a better name (and yes, as usual, details have been changed to ensure confidentiality), and he’s a fairly ‘blokey’ man who loved his fishing, diving, and taking off for days in his conv... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3915308 Mon, 30 Aug 2010 21:02:47 +0100 3915308 http://www.medworm.com/index.php?rid=3915309&cid=t_110496_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F08%2F30%2Fexposure-in-vivo-for-kinesiophobia%2F In this study, the authors firstly looked at outcomes of graded exposure and whether anxiety, depression and catastrophising moderated these.  While anxiety was found to influence outcome generally (leading to poorer outcomes for those who were more anxious), catastrophising was found to have a more complex relationship.  Graded exposure was effective for low and moderate catastrophising, but for those with high catastrophising the results were far less spectacular.  And depression? Made little difference to outcome at all. After finding that high levels of catastrophising influenced outcome, the next step in this study was to examine those people who made a good deal of changein disability  and compare them with those who made much less change in disability.   For this part of the s... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3915309 Sun, 29 Aug 2010 19:33:53 +0100 3915309 http://www.medworm.com/index.php?rid=3876912&cid=t_110496_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F08%2F18%2Fexercise-questions%2F If there is one finding that has remained pretty solid over the past 10 – 15 years, it’s the one that says being active is a good thing for managing chronic pain.  I’m not sure how many papers I’ve read where ‘exercise’ and some form of cognitive behavioural approach have been found to produce improvements in disability, mood and even pain – and the benefits are often maintained for 12 months or more.  But we have a problem, Houston.  The problem is this – many of these studies treat ‘exercise’ in much the same way as ‘interdisciplinary pain management’ – a black box that no-one really knows exactly what goes on in there, but hey it works. This is a real problem when we come to put the research findings to wor... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3876912 Tue, 17 Aug 2010 19:36:07 +0100 3876912 http://www.medworm.com/index.php?rid=3872755&cid=t_110496_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F08%2F17%2Fvalues-informing-goals%2F Unusually for me, this post is not associated with a piece of published research.  I have been mulling over ways to help people set goals that are really meaningful to them rather than superficial ones that are all too easily forgotten or avoided, and being informed by ACT (Acceptance and Commitment Therapy) I’ve been looking at values clarification as one way of tapping in to this.  At the same time as doing this I’ve been doing a little reading around the occupational therapy Kawa model which uses the river metaphor to describe ‘life flow’, or words to that effect. I’m not a strong advocate of descriptive models really, because I am more concerned about models that help to explain or predict phenomena in the world, but at the same time I use metaphors a lo... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3872755 Mon, 16 Aug 2010 19:35:54 +0100 3872755 http://www.medworm.com/index.php?rid=3831355&cid=t_110496_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Ficu-bingo-game%2F2010.08.06 Ever wonder how ICU nurses get through their daily grind? Why, with ICU Bingo, of course. How does ICU Bingo work? It works just like regular bingo. Every nurse receives their own Bingo card with different ICU diagnoses. And every time they take care of one of these conditions, they get to ”x” it out. Fill out a line or any other predetermined design pattern, and you are the ICU Bingo winner, and you win a prize. This is quite similar to my 2010 March Madness Hospitalist Bracket, only in this case the game is Bingo. As you can see, this nurse has already cared for a GI bleed, a homeless man, a drug overdose, chest pain, DKA, alcohol withrawal, subdural hematoma, a prisoner, and someone with super-morbid obesity. That’s ICU medicine for you. *This blog post... Better Health blogs http://www.medworm.com/rss/comments.php?id=3831355 Fri, 06 Aug 2010 16:30:00 +0100 3831355 http://www.medworm.com/index.php?rid=3795074&cid=t_110496_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F07%2F28%2Fa-shout-out-to-the-how-to-cope-with-pain-blog%2F One of the most useful, patient-friendly blogs around, How to Cope with Pain Blog has a monthly blog round-up that is always worth reading.  Head to here for this months’ carnival, and while you’re there take some time to read some of the excellent material that has been posted there.  Some of it is written by readers submitting to a recent competition, some of it is written by the author – all of it is worth reading and reflecting on. Filed under: Coping Skills, Education/CME, health, pain Tagged: acceptance, blog carnival, Chronic pain, coping, coping strategies, health, pain management, Resources, self management (Source: HealthSkills Weblog) HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3795074 Wed, 28 Jul 2010 04:23:06 +0100 3795074 http://www.medworm.com/index.php?rid=3795075&cid=t_110496_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F07%2F28%2Fgoals-outcomes-direction-values%2F Someone asked recently, how do you decide the difficulty level of a goal?  Or words to that effect.  It’s a good question – and like most good questions, there doesn’t seem to be a nice clear-cut answer.  So here’s a ramble on where I’ve got to with goals. The first thing I remember about goals is that there is a big difference between a goal that I am aiming for and the actions that I can do to achieve the goal.  What I mean by this is it’s pretty easy to set a goal like ‘I want to get a job by March 2011′ – but this goal could well be setting you up for failure. Why? Not because it’s about working, no, but because it doesn’t depend entirely on your actions – in fact, it depends on an employer deciding that you ar... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3795075 Tue, 27 Jul 2010 19:28:37 +0100 3795075 http://www.medworm.com/index.php?rid=3787135&cid=t_110496_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F07%2F26%2Fmindfulness-and-exercise%2F Now I know this might seem a strange heading when we think of mindfulness practice normally, but this isn’t ‘treatment as usual’. The definition of mindfulness in this study is ‘The body scan practice involves systematically moving awareness through each part of the body and noticing the presence of sensation in a detailed and precise way. This enables contact with the actual sensations of the body (as opposed to thoughts, ideas or fears about these sensations). Mindful movement involves bringing awareness to physical activity, thus allowing movement of the body within the limits of its physical capability. This is taught by means of a comprehensive sequence of movements based on yoga and Pilates.’ I’n not sure I could find a better description of how I ... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3787135 Sun, 25 Jul 2010 19:32:20 +0100 3787135 http://www.medworm.com/index.php?rid=3776629&cid=t_110496_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F07%2F21%2Faccepting-what-life-throws-at-ya%2F This study sought to look at whether the people who are more prepared to accept and be willing to ‘have undesirable psychological experiences without attempting to control them’, might be functioning better and suffer less. The study involved a group of 144 people referred to an interdisciplinary tertiary pain management centre in the UK.  Before treatment, they completed a set of questionnaires including several about acceptance.  And as usual, a whole bunch of statistical things were carried out on the results.  I won’t be too descriptive about these stats, but basically, multiple regression analyses were carried out to ‘establish the contribution of general psychological acceptance to patient functioning, after the variance contributed by patient background ch... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3776629 Wed, 21 Jul 2010 11:17:07 +0100 3776629 http://www.medworm.com/index.php?rid=3767338&cid=t_110496_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F07%2F20%2Fwhat-do-people-really-do-about-their-back-pain-an-on-line-survey-reveals%2F There are many studies describing the way treatment providers fail to follow clinical guidelines for managing acute low back pain – and because there are inconsistencies between various guidelines for chronic low back pain, it’s not surprising that people with back pain (whether acute or chronic) get a little confused about what to do.  Of course, if you use a popular search engine or two you’ll be able to find loads of sites on the internet that put forward their ideas of how to manage, and the quality of these sites is pretty variable.  So when a group of Australians carried out an online survey asking what people did when they had back pain, you can guess there was a pretty wide range of strategies used. In February 2009, 1001 participants who met the inclusion crite... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3767338 Tue, 20 Jul 2010 05:53:25 +0100 3767338 http://www.medworm.com/index.php?rid=3754108&cid=t_110496_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F07%2F15%2Fonline-self-management-works-for-some%2F Given that you’re reading this, I suspect that the thought of an on-line approach to managing pain wouldn’t take a terrible stretch of the imagination. The idea is certainly appealing – after all, there are many, many people with chronic low back pain in the community, and not nearly so many clinicians specialised (or even interested!) in helping people to learn to live well despite their pain. Along with the practicalities of getting the message across to as many people as possible, there is some evidence that people are prepared to reveal more about themselves and their health problems via computer than face-to-face (Williams, Freeman, Bowen, et al. 2000). In this well-described study, participants were recruited to either receive written material about back pain (the N... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3754108 Wed, 14 Jul 2010 19:43:20 +0100 3754108 http://www.medworm.com/index.php?rid=3750314&cid=t_110496_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F07%2F14%2Fways-to-ask-about-sensitive-topics%2F I teach postgraduate courses in pain and pain management.  Many of my students are experienced general practitioners who often ask me “how do I talk to people with pain about psychosocial issues without them thinking I’m telling them their pain is ‘all in the head’?” It can be a pretty sensitive topic for the person with unexplained pain that doesn’t go away because to somehow suggest (a) they’re not coping with their situation or (b) they have some psychological problem can seem uncaring or even that the person’s pain is ‘imaginary’. The psychosocial ‘yellow flags’ are widely known, but even after a decade or more of exposure to what the ‘yellow flags’ are, there is much confusion and misconception.  Tod... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3750314 Tue, 13 Jul 2010 19:32:03 +0100 3750314 http://www.medworm.com/index.php?rid=3743735&cid=t_110496_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F07%2F12%2Fself-report-or-really-doing-it-or-both%2F In this study, a group of women with widespread pain, some reaching threshold for fibromyalgia, who had been referred for a pain management programme had their activities of daily living performance assessed in two ways: one was the typical pen and paper questionnaire, this time the Fibromyalgia Impact Questionnaire (Burckhardt, Clark, and Bennett, 1991); and the other an occupational therapy specific measure AMPS, or Assessment of Motor and Process Skills (Fisher, 1993). All participants were assessed prior to participating in the outpatient interdisciplinary pain management programme, and once a completion of the programme and again at follow-up. AMPS requires that the person carry out two of 85 standardised personal ADL and domestic ADL tasks, calibrated to be at the level appropriate f... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3743735 Sun, 11 Jul 2010 19:36:56 +0100 3743735 http://www.medworm.com/index.php?rid=3730120&cid=t_110496_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F07%2F07%2F10-things-you-really-oughta-know-about-chronic-pain%2F …with apologies to the therapists in the Special Interest Group who first raised this topic! Something I’m acutely aware of after working in pain management for a while is the number of assumptions that I hold about what people ‘should’ know about pain…sometimes I can be quite rightly accused of leaping waaaaaaay ahead of what people are ready for in terms of new information! So it’s time to summarise the ’10 things you really oughta know about chronic pain’ In My Humble Opinion. 1.  Pain is a biopsychosocial experience, that it’s “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage” and what that means in real terms.  I think it’s imp... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3730120 Tue, 06 Jul 2010 19:37:30 +0100 3730120 http://www.medworm.com/index.php?rid=3714463&cid=t_110496_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F07%2F01%2Fconcurrent-pain-reduction-self-management%2F I don’t have the answer to this conundrum, so my post this morning is a piece of thinking out loud… For most of my pain management career it’s been a policy of mine not to try working with people to develop self management of their pain while they’re continuing to get ‘on-demand’ pain reduction treatment (primarily injections and infusions).  The main reason for this has been the contrary ends of the two approaches. Pain reduction through injections/infusions (from now on referred to as procedures) is often given to people to see whether their pain will remain at lower levels, and for the patient to use this reduced pain to increase function.  Often people are given ‘reactivation’ during this time, usually from a physiotherapist, consisting... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3714463 Wed, 30 Jun 2010 19:34:19 +0100 3714463 http://www.medworm.com/index.php?rid=3703114&cid=t_110496_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F06%2F28%2Fhi-ho-hi-ho-its-off-to-work-we-go%2F I know, it’s Monday and such cheer about work should be reserved for people with no life – but helping people return to work has been and still is one of my favourite parts of pain management. A pity that work rehabilitation has become somewhat far removed from pain management as it is practiced in New Zealand. This paper by a group of Canadian researchers takes the basic steps to returning to work, and maps them onto relevant theory associated with both managing low back pain and changing behaviour. It is one of a very few papers I’ve read that demonstrate the reasoning behind how an effective work rehabilitation programme is established. The focus of this paper is on describing how a work rehabilitation programme can work by “having trained personnel coordinate th... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3703114 Sun, 27 Jun 2010 19:37:17 +0100 3703114 http://www.medworm.com/index.php?rid=3683912&cid=t_110496_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F06%2F22%2Fwhat-obstacles-get-in-the-way-of-self-managing-chronic-pain%2F Learning to manage pain using self management strategies ain’t easy – as we know, changing habits and doing things differently is not something any of us do without a bit of effort. It’s especially difficult when life in general is full of challenges, but so much more so when pain is the problem,you have a mood disorder that saps your energy and when other people (even health professionals!) challenge your decision to manage pain independently. There are even some researchers who would say that using self management strategies is not all that important – after all, after about a year, many people don’t use any of the new skills, but still feel differently about pain anyway (Curran, Williams and Potts, 2009). The Stepped Care for Affective Disorders and Musculo... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3683912 Mon, 21 Jun 2010 19:38:18 +0100 3683912 http://www.medworm.com/index.php?rid=3645072&cid=t_110496_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F06%2F09%2Fgroup-based-cbt-for-pain-in-primary-care%2F I briefly discussed yesterday the content of this six-session group-based cognitive behavioural approach for chronic pain, delivered in the community. Today I want to look a little more closely at the way the programme was delivered and how the findings might differ from what happens in New Zealand. To refresh your memory, this is a study of around 700 people with sub-acute or chronic ‘troublesome’ low back pain, recruited via their GP, who were randomised into two groups – while both groups received ‘advice’ in the form of ‘The Back Book’, the CBT group also received the CBT programme, while the other group were able to seek their ‘usual care’. The programme was delivered to groups of roughly 8 participants by a single therapist, and t... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3645072 Wed, 09 Jun 2010 00:03:57 +0100 3645072 http://www.medworm.com/index.php?rid=3641350&cid=t_110496_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F06%2F08%2Fgroup-based-cbt-for-troublesome-low-back-pain%2F These two papers have created a bit of a storm in the health news recently – a six-session CBT group programme for chronic low back pain that not only provides good outcomes, but is also cost-effective?  Unbelievable!  And it’s not delivered exclusively by any specific health professionals.  AND it’s delivered in primary care! My take on this study is, much like others, very positive.  I think it’s wonderful that an intervention that has been used for years in secondary and tertiary health care has been successfully translated into primary care.  It seems to have used a pragmatic study methodology, and pretty fairly represents the kind of person that, at least in New Zealand anyway, misses out on pain management of this kind unless they’re funded by ACC (... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3641350 Mon, 07 Jun 2010 19:35:11 +0100 3641350 http://www.medworm.com/index.php?rid=3633636&cid=t_110496_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F06%2F06%2Fonline-calm-resources-for-calming-the-mind-and-increasing-emotional-resilience%2F I found this website today CALM – it’s put together by three lecturers at the University of Auckland, and has a whole series of downloadable MP3′s on methods that will help develop resilience and positivity for dealing with life’s ups and downs. Actually, the whole website can be downloaded and played from a computer off-line, which is great if you’re wanting to access this for your personal use. The areas covered are Mental Resilience; Managing Stress, Anxiety and Depression; Healthy Relationships; and Finding Meaning in Life. While each area is dealt with quite briefly, there are loads of worksheets and MP3′s in each area. It’s that part that excites me! The MP3′s cover topics like ‘self hypnosis’ (by Dr Bob Large, Psychiatrist ... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3633636 Sun, 06 Jun 2010 01:02:26 +0100 3633636 http://www.medworm.com/index.php?rid=3618108&cid=t_110496_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F06%2F01%2Foh-to-sleep-cbt-for-insomnia-in-chronic-pain%2F This study protocol used an eight-week programme covering the strategies I’ve described above, and I’m immediately jealous because it’s common for me to see people for 12 weeks (once a week) to cover not only poor sleep, but also activity management, understanding chronic pain, developing relaxation responses, communication etc etc!  8 sessions are not a lot of sessions, and by comparison with the short-term effects of taking medication, these skills will last a lifetime. While this study clearly demonstrates that CBT-I is an effective approach for people with chronic pain who also have the common symptom of poor sleep, I wonder whether this will influence the GP or pain physician tendency to prescribe sleep medication.  Taking a medication is a mixed blessing – s... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3618108 Mon, 31 May 2010 19:35:43 +0100 3618108 http://www.medworm.com/index.php?rid=3607846&cid=t_110496_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F05%2F28%2Flinks-to-online-cbt-resources%2F I have occasion to look for online resources from time to time – this week it’s been anxiety and CBT self-help, so I’ve been strolling through the internet and located some really great, evidence-based sites with excellent resources. First one GET.gg  – here Over 100 downloadable worksheets, all pdf documents, including ACT, Vicious Flower circle, formulation worksheets, sheets for challenging core beliefs – and I have hardly started listing!.  Definitely worth going to if you’d like some well-designed, clear worksheets you can save onto your own computer.  For a sample, click here for the Pain and Fatigue worksheet e-couch is a free online site for anxiety and depression, and other mood combinations.  You do need JavaScript to use the site.  It&#82... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3607846 Fri, 28 May 2010 07:07:16 +0100 3607846 http://www.medworm.com/index.php?rid=3585868&cid=t_110496_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F05%2F21%2Ffriday-funnies-25%2F As the onset of winter approaches, it’s time to grab every opportunity for humour, fun and silliness.  I think it’s vital – all that black winter clothing is so depressing maybe the flat mood is just because of having no colour!  While the weather today is chilly, crisp and not too bad – I can feel the bad weather in my bones… So take a break, and enjoy! After the airline pilot had managed to land the planeinto Wellington airport  — albeit bumpily — following a descent through exceptionally heavy weather, she came out of the flight deck to bid the passengers farewell as they gratefully left the plane  on their way back to terra firma. The most memorable comment he received was from a little old lady who asked him politely whether he would pleas... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3585868 Thu, 20 May 2010 23:22:51 +0100 3585868 http://www.medworm.com/index.php?rid=3585869&cid=t_110496_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F05%2F21%2Fvalues-and-outcomes-in-pain-management-occupational-therapists-only%2F This post is password protected. To view it please enter your password below: Password: Filed under: ACT - Acceptance & Commitment Therapy, Chronic pain, Clinical reasoning, Coping Skills, occupational therapy, psychology, therapy Tagged: occupational therapy (Source: HealthSkills Weblog) HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3585869 Thu, 20 May 2010 20:27:12 +0100 3585869 http://www.medworm.com/index.php?rid=3577663&cid=t_110496_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F05%2F19%2Fan-accidental-form-of-control-when-mindfulness-produces-happiness-acting-well-living-well-iv%2F I’ve had some success while working with a man I’ll call Peter.  He’s got chronic pain, and has been incredibly fearful of what it might mean – in fact, you’d probably call him a classic catastrophiser because each time his pain flared up he immediately thought it was something like cancer and he would rush off to his GP or the Emergency Department to have it checked out.  Luckily any scans he’s had haven’t shown anything operable because I’m sure with the amount of distress he was been experiencing, he would have been able to persuade a surgeon to operate had there been anything odd-but-common found. We’ve been using mindful breathing as a way to get in touch with the sensations, emotions and thoughts that occur to him, and especiall... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3577663 Tue, 18 May 2010 19:58:08 +0100 3577663 http://www.medworm.com/index.php?rid=3549591&cid=t_110496_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F05%2F10%2Fact-ing-well-living-well-ii%2F The second in a series about ACT and its use in pain management from an occupational therapy point of view. My last post (here) talked about ACT and ‘doing what matters’, or ‘valued action’ – this involves identifying what is important to a person, then helping them do it, while being careful not to encourage ‘experiential avoidance’, or avoiding coming into contact with experiences we’d rather not. Here’s the ‘hexaflex’ or diagram that provides an overview of ACT.  What ACT tries to develop in people is ‘psychological flexibility’, or the ability to be in the here and now, open to experiences (even negative ones) and do what matters to live a life in alignment with what is important.  In people who lac... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3549591 Mon, 10 May 2010 06:23:26 +0100 3549591 http://www.medworm.com/index.php?rid=3549592&cid=t_110496_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F05%2F10%2Fact-ing-well-living-well%2F For some time I’ve been learning more about ACT – Acceptance and Commitment Therapy (normally pronounced ‘act’, not A – C – T).  While I have to admit that I have been flummoxed by relational frame theory, a behavioural theory of human language and cognitionthat underpins ACT (go here for a tutorial that may enlighten somewhat), there are some very simple principles that ACT employs that I’ve found useful in my own life – and in the lives of people I work with. Over the next few days I want to outline a bit more about ACT and how I use it within pain management – I’ll be referring to journal papers that explore the use of ACT in pain management, but a lot of what I’ll cover comes more from my own experiences with moving fro... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3549592 Sun, 09 May 2010 23:33:21 +0100 3549592 http://www.medworm.com/index.php?rid=3530051&cid=t_110496_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_110496_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_110496_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_110496_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_110496_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_110496_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_110496_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_110496_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_110496_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_110496_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=3185659&cid=t_110496_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_110496_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_110496_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_110496_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_110496_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_110496_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_110496_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_110496_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_110496_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_110496_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_110496_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_110496_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_110496_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_110496_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_110496_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_110496_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_110496_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_110496_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_110496_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_110496_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_110496_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_110496_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_110496_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_110496_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_110496_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_110496_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_110496_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_110496_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_110496_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=2730383&cid=t_110496_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_110496_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_110496_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_110496_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_110496_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_110496_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_110496_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_110496_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_110496_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_110496_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_110496_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_110496_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_110496_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_110496_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_110496_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_110496_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_110496_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_110496_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_110496_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_110496_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_110496_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_110496_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_110496_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_110496_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_110496_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_110496_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