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 strategies'. Sat, 03 Sep 2011 02:09:06 +0100 http://www.medworm.com/index.php?rid=5159895&cid=t_105335_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=5140334&cid=t_105335_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F08%2F18%2Feducation-or-a-cognitive-behavioural-approach%2F In this study by Day, Thorn & Kapoor, the two approaches were used with a group of people from a rural area, with relatively low socio-economic status, and a reading grade level of about 8.  Both groups received a group-based programme of 10 sessions of 90 minutes.  They both received a workbook and additional reading material.  The CBT group had home-learning and also participated in behavioural activities such as relaxation in-session, while the education group did not. Interestingly, this study presents qualitative information on how participants experienced the sessions, rather than outcomes measures, so it’s difficult to establish whether pain, disability, mood or acceptance were influenced.  Instead it presents thematic analysis from in-depth interviews of the participa... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=5140334 Wed, 17 Aug 2011 19:35:42 +0100 5140334 http://www.medworm.com/index.php?rid=5097140&cid=t_105335_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F08%2F02%2Fmore-managing-migraines-without-medication%2F Anyone familiar with migraine will know the first signs of an impending attack. What might be a little less familiar is the precursor to the “first signs”, and what may also be unfamiliar is the thoughts that accompany those first symptoms. Today I want to talk about ways to manage this phase of a migraine – without medication. As an aside, some people have suggested that there are ways to completely get rid of migraine, often suggesting that one of the problems could be around the numerous nerves that innervate the face, neck and scalp. One of the common suggestions is to have chiropractic or osteopathic treatment to “do something” to the nerves in this area. I put the “do something” in quotation marks because I really don’t know what the so... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=5097140 Mon, 01 Aug 2011 18:30:04 +0100 5097140 http://www.medworm.com/index.php?rid=5069843&cid=t_105335_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_105335_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=5036612&cid=t_105335_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F07%2F18%2Fwhat-matters-patient-determined-outcomes-and-clinicianresearcher-outcomes%2F It’s easy to forget, sometimes, that when we choose an outcome measure, we need to seriously consider who will use the measures in the end.  Of course, I am assuming that we’re all using outcome measures – we are, aren’t we?  If anyone isn’t, shame on you – how on earth will you establish whether what you’re doing is having an effect? And don’t come at me with “oh but I just ask them” because I don’t want to have to list all the response bias, demand characteristics, and lack of consistency problems again. kthx. Anyway, where was I? That’s right, the end-user in outcome measures.  Over the past few years, interest has risen in identifying the range of outcome measures that can be/should be used in research of treatm... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=5036612 Sun, 17 Jul 2011 19:30:31 +0100 5036612 http://www.medworm.com/index.php?rid=5029273&cid=t_105335_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F07%2F12%2Fself-efficacy-and-fear-of-movement-mediate-pain-intensity-and-disability-in-acute-pain%2F Most clinicians working in chronic pain management are well aware that the time it takes for people to finally be referred for management of their pain is far too long and some of the readers of this blog who work with people who have acute pain may wonder whether anything I write about applies to them and the people they treat.  To both groups of readers – today’s post should apply! Arguably the most common reason for people seeing a doctor is because of a musculoskeletal pain.  Treatment is usually quite simple: diagnosis, pain relief, anti-inflammatories and gradual return to function.  It’s this last part of treatment that seems to cause the most trouble for people - what if the pain doesn’t settle, what if I’m damaging my body, how long should I &#8220... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=5029273 Mon, 11 Jul 2011 19:29:01 +0100 5029273 http://www.medworm.com/index.php?rid=4993017&cid=t_105335_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F07%2F01%2Fwhat-is-this-thing-called-pain%2F As I’m busy writing up research papers for publications to “count” towards my research productivity, I’m reminded of one reason I keep on blogging – and it’s this: blogs are open to anyone.  People can comment on what I write.  When someone comments, whether they agree, disagree, or simply pose a question, it’s an opportunity for dialogue and reflection. That’s not nearly as easy to do in a peer-reviewed journal! As a result of comments from my post yesterday, I’m musing on ways to explain the distinction between acute and chronic pain that will make sense to someone who experiences fluctuations in pain intensity. I think I’m clear in my own mind between the two, but perhaps things are not as distinct as I’ve made them &#8... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4993017 Thu, 30 Jun 2011 21:04:56 +0100 4993017 http://www.medworm.com/index.php?rid=4976238&cid=t_105335_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F06%2F29%2Fblack-and-white-thinking-must-be-abolished%2F Black and white thinking, for those readers unfamiliar with cognitive distortions, refers to the tendency to reduce complex ideas and situations into simple, dichotomous, and mutually exclusive categories. Think of good or bad, yes or no, all correct or all wrong, acute pain or chronic pain, neuromatrix or peripheral mechanisms, cure the pain or manage the pain. It’s a way of simplifying arguments or decisions that can work well when the situation requires very fast decision-making, or where the options are very limited. It doesn’t work at all in the messy and complicated worlds of clinical reasoning, theory development, or in discussions to broaden understanding. I’m pondering this because of the way various aspects of pain management and the science of pain are misrepre... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4976238 Tue, 28 Jun 2011 19:15:22 +0100 4976238 http://www.medworm.com/index.php?rid=4945248&cid=t_105335_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F06%2F17%2Fwhat-to-do-about-catastrophising-even-when-youre-not-a-psychologist%2F In this study, 25.9% of those reporting acute pain, and 51.3% of those reporting chronic pain endorsed catastrophising beliefs.  And this group of people were not seeking treatment (as an aside, this is one of few studies to look at non-treatment-seeking people)!  The study also found that in those with high levels of catastrophising, mental health problems were more prevalent, and that catastrophising explained a good proportion of work disability.  In other words, even in this very healthy group of people, catastrophising was associated with greater vulnerability to having difficult managing pain and keeping mentally healthy.  If this finding is identified in other non-treatment-seeking people, I think we can confidently draw the conclusion that catastrophising may be one of the more... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4945248 Thu, 16 Jun 2011 23:24:01 +0100 4945248 http://www.medworm.com/index.php?rid=4911844&cid=t_105335_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_105335_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F06%2F02%2Fcatastrophising-and-pain-ii%2F What are some of the indications that someone tends to catastrophise about their pain? How do we know? Do we have to use a questionnaire? Is it really my job to know about this if I’m not a psychologist – and what do I do about it? These are the kinds of questions that have been posed to me as I’ve explored the topic of catastrophising, and I propose to answer the last question in my next post (sorry to keep stringing you along like this – I think many may know my take on that already!). I work in a wonderful interdisciplinary team setting, in a centre where everyone who attends the Centre gets to complete a set of psychometrically sound questionnaires that all of the team are encouraged to use and interpret, so any of the team can be confident about identifying and... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4893948 Thu, 02 Jun 2011 08:26:50 +0100 4893948 http://www.medworm.com/index.php?rid=4893949&cid=t_105335_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F06%2F01%2Fpain-behaviours-persist%2F In this study by Martel, Thibault and Sullivan (2010), people with back pain were recorded on two separate occasions (on averge 22 days apart) while carrying out two lifting tasks designed to elicit pain behaviours.  These recordings were reviewed by trained observers who recorded the number of pain behaviours in each segment of film using a standardised coding scheme (developed by Keefe and Block, 1982).  Participants in the lifting tasks also completed a range of questionnaires – the Tampa Scale for Kinesiophobia, the McGill Pain Questionnaire, and the Pain Catastrophising Scale. Before I describe the findings, in this study two different forms of pain behaviour were identified – communicative behaviours are things like grimacing, speaking, sighing, moaning and so on; while... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4893949 Wed, 01 Jun 2011 05:26:00 +0100 4893949 http://www.medworm.com/index.php?rid=4883925&cid=t_105335_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=4813690&cid=t_105335_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F05%2F11%2Fthe-language-of-pain%2F Have you ever wondered about the ways we communicate our pain? Pain behaviour doesn’t just include nonverbal communication – one of the main ways we communicate our pain is through speech. Words are an incredibly powerful aspect of pain behaviour that strikes me as something we haven’t really studied much. When I was searching for the article to refer to in this post, I looked in PsychInfo under the terms “linguistics” and “pain” – and out of the tens of thousands of articles under each term, and total of 16 included both words. Sixteen! The stimulus for this post comes from someone who said the term “catastrophising” is a misnomer – a way for health professionals to dismiss or minimise the suffering and distress someone who... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4813690 Wed, 11 May 2011 00:57:33 +0100 4813690 http://www.medworm.com/index.php?rid=4803558&cid=t_105335_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_105335_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=4775579&cid=t_105335_140_f&fid=35443&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FTheSplinteredMind%2F%7E3%2FQPuNfogxByQ%2Ften-ways-i-focusing-in-on-my-success.html With a new week ahead of us, today is a perfect day to get started on whatever we've been putting off starting. You KNOW you've been putting off SOMETHING. Isn't that always the case? No? I envy you then. Unfortunately for me, I have too many irons in the fire all the time. I don't actively put anything off; procrastination is just what happens on my way to something new & exciting. This week I am fired up, however. I have decided to finish my first draft at all costs this month. You may recall that I have been confronting my obstacles over the past year in an effort to become an author. I set big goals and made big mistakes, but I learned so much about myself and how to overcome my limitations.Setting big goals is the easy part. To make this new goal happen I am knuckling down on Distract... The Splintered Mind by Douglas Cootey blogs http://www.medworm.com/rss/comments.php?id=4775579 Mon, 02 May 2011 20:17:52 +0100 4775579 http://www.medworm.com/index.php?rid=4753984&cid=t_105335_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_105335_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=4734699&cid=t_105335_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F04%2F20%2Festablishing-routines-and-baselines-recording-daily-schedules%2F I don’t know about you, but I’m not the world’s best at noting down every activity I do during a day.  I get engrossed in the thing I’m doing and I often get interrupted, so it’s not very easy to record my activity moment-by-moment.  Yet, for many of us, this is something we ask for from the people we’re working with. Luckily, there is some research on daily diary methods.  Unluckily for most of us, the best ones (ie most accurate and least intrusive) are electronic!  Useful if you’re funded for some research, less helpful if you’re trying to do this in your everyday clinical setting!  Basically, the research findings show that an electronic, automated and usually random alarm that reminds the participant to record their activity (and us... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4734699 Tue, 19 Apr 2011 19:23:47 +0100 4734699 http://www.medworm.com/index.php?rid=4734700&cid=t_105335_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=4715032&cid=t_105335_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F04%2F15%2Ffriday-funnies-48%2F It’s been a while since I posted a Friday Funnies – my apologies. I’m happy to say that despite this lack, my sense of humour has remained intact, fed by regular dollops of my favourite cartoons from The Oatmeal (who can resist the call of “15-ish Things Worth Knowing About Coffee“, or “Ten Words You Need To Stop Misspelling“, or even “Cat vs Internet“?), and XKCD – the authors who announce the site to be A webcomic of romance, sarcasm, math, and language. - and who add this warning: Warning: this comic occasionally contains strong language (which may be unsuitable for children), unusual humor (which may be unsuitable for adults), and advanced mathematics (which may be unsuitable for liberal-arts majors). I mean – how could ... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4715032 Thu, 14 Apr 2011 22:06:50 +0100 4715032 http://www.medworm.com/index.php?rid=4709469&cid=t_105335_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_105335_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=4684716&cid=t_105335_140_f&fid=35443&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FTheSplinteredMind%2F%7E3%2FT4S3RSBOoh8%2Fadhd-lil-bedlamites-make-horrible-co.html Can a full-time dad with ADHD find time to write a novel? After a year trying, I can safely say, "ARGH!" Although ADHD has been and will continue to be my greatest obstacle in completing this novel, family has proven to be my greatest external disruption. Take today, for instance. I woke up wondering if my debut novel was interesting enough. I've been working on it off and on for over a year and beginning to be bored with it. Maybe something else would be more exciting? Maybe there's not enough peril? ADHD and a bit of Depression are mixing with my morning, and after less than 45 seconds of this I think "Shut up." I'm not going to abandon this story in the last fifth of the book after working so hard to come this far. Besides, the next chapter features phantom cats with big teeth. Peri... The Splintered Mind by Douglas Cootey blogs http://www.medworm.com/rss/comments.php?id=4684716 Wed, 06 Apr 2011 19:58:47 +0100 4684716 http://www.medworm.com/index.php?rid=4677137&cid=t_105335_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_105335_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=4653616&cid=t_105335_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F03%2F30%2Fwhat-do-people-expect-when-they-get-referred-to-a-pain-management-centre%2F This study also found that many people didn’t feel they had been heard, or taken seriously prior to being referred. Participants in their study “needed to feel legitimated in the sick role, and part of the reason for wanting to know the cause of the pain was a desire to seek legitimacy in the eyes of others.” They made an interesting observation in that participants ranked the statement “I would like to have a better understanding of my pain” fifth on the list of 10 statements, and in the focus group discussion, identified having a diagnostic label as something different from having a better understanding. Allcock, Elkan and Williams suggest that “It was not so much personal understanding of their pain that they needed to legitimise it, as a diagnostic l... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4653616 Tue, 29 Mar 2011 18:25:34 +0100 4653616 http://www.medworm.com/index.php?rid=4627006&cid=t_105335_140_f&fid=35443&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FTheSplinteredMind%2F%7E3%2FxvJpTZODnZM%2Fchasing-rainbows-for-information-pot-of.html Yesterday was a day filled with addiction. Ah, the sweet glow of the screen. The endless stream of information just a tap away in my iPad. Twitter. Facebook. Links, links, links!I woke up very under the weather. Perhaps it was because Mother Nature had a bad case of Psuedo ADHD this month—not sure which season it was."Ooh! I want Spring!Ooh! Ooh! I want more snow!Ooh! I'll do both!Ooh! Ooh! A rainbow!"She's been like a newborn puppy frolicking about after butterflies, though truth be told, the butterflies have had the good sense to wait for Mother Nature to make her mind up this year before making an appearance. Yes, I realize that the caterpillars have to arrive first. Don't mess with my metaphor.At any rate, yesterday I was not as frolicsome as a puppy or as flittery as a butterfly. In... The Splintered Mind by Douglas Cootey blogs http://www.medworm.com/rss/comments.php?id=4627006 Wed, 23 Mar 2011 15:00:02 +0100 4627006 http://www.medworm.com/index.php?rid=4622515&cid=t_105335_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_105335_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=4592663&cid=t_105335_140_f&fid=35443&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FTheSplinteredMind%2F%7E3%2FAwcHIg9Dsn4%2Fdistracted-how-adhd-almost-kicked-my.html As I wrote before in "Writing and Succeeding Despite My Brain", I planned on writing about how ADHD & Distraction played a part in my writing goals over the year. Then I got distracted. 3. Distractions: Interesting things all around are as kryptonite to the ADHD mind. In hindsight, my focus on finishing a novel or three by my 44th birthday was a highly motivating factor that helped stave off most distractions. I didn't suddenly decide to become a lion tamer, or become convinced that I needed to create a network of blogs about SciFi TV with affiliate links to Amazon to roll in the scores of pennies that were bound to come my way. I said "no" to many new projects and stayed focused. However, my progress wasn't very impressive. I've covered here numerous times since August how I wrote myse... The Splintered Mind by Douglas Cootey blogs http://www.medworm.com/rss/comments.php?id=4592663 Tue, 15 Mar 2011 21:15:27 +0100 4592663 http://www.medworm.com/index.php?rid=4566351&cid=t_105335_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_105335_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=4545264&cid=t_105335_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F03%2F04%2Ffriday-in-christchurch%2F Despite the devastation, there are some wonderful sights in Christchurch right now.  This one (above) made me smile today. And this one was taken in Nelson after we had turned back to return to Christchurch last week.  Cheerful things, sunflowers, and glorious colour on a rather gloomy and very grim day. Filed under: Coping strategies, Relaxation, Resilience/Health, Wellness Tagged: christchurch, coping, flowers, hope, Nelson, photographs, Resilience, wellbeing (Source: HealthSkills Weblog) HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4545264 Thu, 03 Mar 2011 23:05:25 +0100 4545264 http://www.medworm.com/index.php?rid=4540732&cid=t_105335_140_f&fid=35443&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FTheSplinteredMind%2F%7E3%2Fwu9WsxM9XOc%2Fdouble-fisted-typing-action.html Perhaps the most unappreciated feature on my blog is the Distracted Writers Club. I can't imagine why. Who wouldn't find the blood pounding in their veins when reading about stupendous goals like writing 25 words in ONE SINGLE DAY‽ Ironically, this feeble goal was key to transforming my writing productivity. I’ve stated before that writing a lot wasn’t a problem for me. In fact, I can spout my opinion here so easily that I’ve given myself an artificial cap of 900 words per post just to spare you. The problem was sitting down and beginning. For some reason creative writing was difficult for me. I just couldn’t justify it. Perhaps because the reward was so far off in the future. With blogging, the rewards were more immediate. Google ranking. Subscribers. Page views. Comments (... The Splintered Mind by Douglas Cootey blogs http://www.medworm.com/rss/comments.php?id=4540732 Wed, 02 Mar 2011 22:41:21 +0100 4540732 http://www.medworm.com/index.php?rid=4536519&cid=t_105335_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=4532586&cid=t_105335_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F03%2F01%2Fan-occupational-view-of-the-christchurch-earthquake%2F The picture – what greeted us as we walked through the front door – and that sparkly stuff on the ground? It’s all my crystal in tiny sharp shards…The wooden thing you can see is the bottom of our sideboard, and to the far right, the doorway. It’s not often I post with a specific focus on ‘occupation’ as the occupational therapy profession defines it.  This is not, I hasten to add, because I don’t think it’s important, it’s more a case of my posts being about the processes that underlie effective engagement in ‘occupation’ for people with chronic pain. But today, in the aftermath of the horrific earthquake in Christchurch one week ago, I’m taking time to reflect on some aspects of the earthquake that people have... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4532586 Tue, 01 Mar 2011 00:34:39 +0100 4532586 http://www.medworm.com/index.php?rid=4522318&cid=t_105335_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=4460196&cid=t_105335_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F02%2F11%2Ffriday-meditation%2F As you know, Friday is about getting ready for the weekend.  Today I decided not to pass on some of the horrendous puns shared with me by one of my esteemed colleagues (although I may drop just one in because I can!).  Instead I thought this poem is a chance to consider being ‘in the now’, something clinicians working in pain management really need. Salutation To The Dawn Look to this day! For it is life, the very life of life. In its brief course Lie all the verities and realities of your existence: The bliss of growth, The glory of action, The splendor of achievement, For yesterday is but a dream And tomorrow is just a vision, And today well lived makes every yesterday a dream of happiness And every tomorrow a vision of hope. Look well, therefore to this day! Such is th... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4460196 Thu, 10 Feb 2011 21:04:50 +0100 4460196 http://www.medworm.com/index.php?rid=4429241&cid=t_105335_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F02%2F03%2Fcbt-approach-in-the-real-world%2F While there are many papers published about the outcomes from using a cognitive behavioural approach, there are very few describing the process ‘in the real world’. This leaves a gap for many clinicians who may read about it, maybe have training in delivering this type of intervention, or work in a team where it’s an integral part of practice – but who may not know how it ‘works’ except as it’s delivered in a pen-and-paper, sitting-in-a-clinic-room kind of way. Today I’m describing one way I go about integrating a CBT approach into my work.    This case study is a compilation of several people I’ve worked with, in order to protect patient privacy. Simone has neuropathic pain in her dominant hand. She’s a tough cookie who worked... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4429241 Wed, 02 Feb 2011 19:33:39 +0100 4429241 http://www.medworm.com/index.php?rid=4399841&cid=t_105335_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F01%2F26%2Fpulling-it-all-together-biopsychosocial-assessment%2F Over the past little while I’ve been writing about how a comprehensive pain assessment can be carried out.  Today it’s time to pull that information together to develop a formulation, or set of possible explanations for why this person presents in this way at this time – at least for one or two aspects of his presentation. For example, if the person’s pain is low back pain, where surgery has failed to improve the person’s pain, but he has maintained working in a teaching job where physical demands are reasonably light, but is having trouble with sleep, feels irritable, can’t manage things like mowing lawns, and is very careful not to bend because he was advised after surgery to avoid bending because it may affect healing.   Limited forward flexion, si... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4399841 Wed, 26 Jan 2011 01:00:45 +0100 4399841 http://www.medworm.com/index.php?rid=4331265&cid=t_105335_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F01%2F11%2Fbrain-training-it-happens-all-the-time%2F At the risk of seeming untrendy, the trend to rave on about neuroplasticity can be a bit overdone.  Not, I add quickly, because it doesn’t happen, or it’s not important – in fact, quite the opposite – but because it happens all the time.  And at the back of our minds, I think we’ve known this for quite a while.  How else do you think we manage to learn new things even in our elder years? The reason I’m raising this today is, after yesterday’s post on phantom limb pain and the parts of the brain that are active when we have pain and when hypnosis is used for pain relief, I started to mull over the range of treatments that are used in managing chronic pain.  Now, we don’t have fMRI studies for all the treatments available.  I don’t t... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4331265 Mon, 10 Jan 2011 21:40:09 +0100 4331265 http://www.medworm.com/index.php?rid=4327074&cid=t_105335_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F01%2F10%2Fits-really-all-about-the-brain%2F Neuroscience is such a geeky area to study. And I have to say I didn’t really study the brain all that well in my undergraduate training all those years ago – but oh, how the worm has turned! It’s so exciting to see how basic science directly influences treatments that we can use for people who don’t have many pharmacologic options for their pain. While I don’t have really up-to-date papers today, I think the 2008 paper by Herta Flor presages some of the approaches we’re starting to use in clinical settings now, a scant three years later. Flor’s work has always been impressive – she has often looked at what happens when brains are deprived of their normal feedback because of trauma or amputation, and (really exciting!) she is coming to Austra... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4327074 Mon, 10 Jan 2011 03:02:46 +0100 4327074 http://www.medworm.com/index.php?rid=4318556&cid=t_105335_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F01%2F07%2Ffriday-funnies-45%2F After a strenuous week (well, OK, maybe two days is not quite a week) – here’s SuperTherapist and featuring for the first time, Puddy, her cat! Why is it that cat’s always get the last word? Filed under: Humour, Wellness Tagged: coping strategies, Friday funnies, funny, Humour, Pain, relaxation (Source: HealthSkills Weblog) HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4318556 Thu, 06 Jan 2011 20:57:13 +0100 4318556 http://www.medworm.com/index.php?rid=4314228&cid=t_105335_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F01%2F06%2Fsleep-posts-from-2010%2F Sleep is so important for wellbeing (ask any young parent!), and yet many people with chronic pain have really poor and unrefreshing sleep, and very poor sleep habits.  Some pain conditions show changes to the quality of the sleep stages (such as fibromyalgia for example), to the point where these changes can almost be diagnostic, while many people with chronic pain also have low mood in which sleep disruption is a common feature. I’ve written about sleep several times over the past year, and today I provide links to some of these posts for your education and enjoyment. Sleep problems in chronic pain and what helps – Pain can be associated with a sense of poorer quality sleep, and could well have been a factor influencing the onset of insomnia, it’s often other factors that ... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4314228 Wed, 05 Jan 2011 18:13:48 +0100 4314228 http://www.medworm.com/index.php?rid=4298821&cid=t_105335_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=4287557&cid=t_105335_136_f&fid=39212&url=http%3A%2F%2Fbahtocancer.com%2F2010%2F12%2Fa-christmas-present%2F Today, I have a little Christmas gift for you, although you have to do a bit of the work. 1. Find or buy a notebook, small enough to go in to your handbag/briefcase/pocket, so it’s with you all the time. 2. Put a pen in the same place. 3. Every time a good thing happens to you, or something happens that makes you smile, write it down in the notebook. I’m not talking super-fabulous ‘a complete stranger just gave me the gift of eternal life’ type things. I mean everyday things. Recent extracts from my notebook include: ’seeing little dog up to nose in snow but tail still wagging’, ‘postie signed for my parcel so didn’t have to go and collect it’, ‘peanut butter cookies out of oven at just the right time -perfect’. 4. See how q... Bah! to cancer blogs http://www.medworm.com/rss/comments.php?id=4287557 Fri, 24 Dec 2010 06:56:19 +0100 4287557 http://www.medworm.com/index.php?rid=4266303&cid=t_105335_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=4266163&cid=t_105335_136_f&fid=39212&url=http%3A%2F%2Fbahtocancer.com%2F2010%2F12%2Feureka%2F Yesterday: -I was going to make the marzipan for the Christmas cake but had every kind of sugar you can imagine except white caster sugar, the one I needed. - For the third day running I made 8 unsuccessful attempts to get through to St. George’s Outpatient Department to let them know I’ve moved and I need them to transfer my care. The phone either rings forever or is engaged. Maddening. - I couldn’t use my beloved MacBook Air, because Hope chewed through the cable a few days ago and the emergency repair my Dad did until the new one arrives stopped working. - The promised Sky engineer failed to show and Sky then claimed that they were, in fact, scheduled to come today. (It was definitely yesterday. No wonder our broadband problems have now been given to the Escalation team.) - A proj... Bah! to cancer blogs http://www.medworm.com/rss/comments.php?id=4266163 Thu, 16 Dec 2010 09:21:37 +0100 4266163 http://www.medworm.com/index.php?rid=4253468&cid=t_105335_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F12%2F14%2Fknowing-how-is-not-equal-to-doing%2F There have been several attempts to develop a standardised approach to self management – one of the most popular in New Zealand is the Flinders Program (TM). This is a programme developed in Australia from the 1990 Australian Coordinated Care Trials. It’s based on cognitive behavioural therapy, includes problem solving and motivational interviewing techniques, and provides a set of tools and processes that clinicians can use to help people assess and then develop self management plans. The aim, as for any self management programme, is to shift the ‘balance of power’ so to speak from clinician-centred to patient or client-centred partnership, so that shared decision-making about health occurs. It has been used in New Zealand for some years: the Arthritis New Zealand ... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4253468 Mon, 13 Dec 2010 18:31:21 +0100 4253468 http://www.medworm.com/index.php?rid=4207517&cid=t_105335_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_105335_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_105335_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_105335_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_105335_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_105335_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_105335_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=4163048&cid=t_105335_140_f&fid=35443&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FTheSplinteredMind%2F%7E3%2FaVtPupwkMT0%2Fthoughts-on-drawing-and-success.html These past few days have been difficult ones. For no reason that I can fathom, I go through periods of increased ticking episodes. That is what I've been experiencing this week.  Yesterday it was a ticking episode in Borders that I had to ride out for an hour before I could come home. Today it was a canceled hair appointment because my back was arching violently, thus making sharp implements near my face a bit of a dangerous pursuit. Even now my head feels as if the brain is floating around disconnected. I'm not ticking at the moment, but I could again very soon. There is a pending storm in my mind, bristling with energy like bolts of motion and crashes of thought. While it brews I sit it out, but I'm as exposed to the storm as a picnic bench on a hilltop. During the storm I try to read... The Splintered Mind by Douglas Cootey blogs http://www.medworm.com/rss/comments.php?id=4163048 Sat, 13 Nov 2010 03:00:12 +0100 4163048 http://www.medworm.com/index.php?rid=4155370&cid=t_105335_140_f&fid=35443&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FTheSplinteredMind%2F%7E5%2FWQ9PmYekqm4%2Fw6e4JiLoP3Y Today Reader Becky has a question for me I thought deserved an official response. I'm sure others with ADHD experience this problem, and I'd love to know what various coping strategies people have come up with."I stumbled on your blog, trying to find techniques or help on how to speak better. Any advise, links etc. for a speaking fool? (ex: seeing a horse in a pasture, I call out to my husband, "look, look... a.. a... dog!"... yeah.. :/I assume "slowing down" my output is key... my mind racing faster than I can spit it out... maybe reading out loud or something?"What a fantastic question, Becky. ADHD folks can often have disconnects between thought and tongue. That's why we have foot-in-mouth issues all the time, but it also means we can sometimes sound stupid to our peers as our brains sh... The Splintered Mind by Douglas Cootey blogs http://www.medworm.com/rss/comments.php?id=4155370 Wed, 10 Nov 2010 21:31:15 +0100 4155370 http://www.medworm.com/index.php?rid=4152208&cid=t_105335_140_f&fid=35443&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FTheSplinteredMind%2F%7E3%2FX7PCdAKyk8Q%2Fwet-moody.html This time every year I usually undergo my annual bout of Winter Depression. The days are shorter and then daylight savings time puts the final nail in my coffin. Unfortunately for me, I am not a farmer up at dawn to feed the chickens. Instead, I usually hang with the night owls. I need my extra hour of daylight in the evening. Once that hour of light is taken away from me, I plunge into months of difficult sadness. Seasonal Affective Disorder. SAD. A stupid acronym; a boring condition. These days I use bright daylight spectrum bulbs to give my mind that missing light. It has made such a great difference. Also, I had a reminder that I set last year go off in the middle of October. I was prepared.  Then Winter came early. Snow. Rain. Overcast skies. The sunlight didn't stand a chance. Th... The Splintered Mind by Douglas Cootey blogs http://www.medworm.com/rss/comments.php?id=4152208 Tue, 09 Nov 2010 08:42:15 +0100 4152208 http://www.medworm.com/index.php?rid=4142987&cid=t_105335_140_f&fid=35443&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FTheSplinteredMind%2F%7E3%2FxqKCaoAiKUU%2Fof-fries-and-family-time.html Spent the night attending a play then unwinding at Five Guys. The fifteen year old Elf tagged along with my Mum & Dad while the newly unwrapped twelve year old Leprechaun enjoyed herself at a cast party. We discussed life and spirituality while consuming great quantities of french fries. I wonder what my Elf made of it all.Didn't write much today. Spent the lion's share ticking, which is boring and not very fun, but thankfully the virus I was suffering from has run its course. It may have been several viruses. In fact, I may have been flash mobbed by day-glo toting viruses looking for a rave in my cerebrum. It certainly felt that way.I did make great progress on my book, however. Not the sort of progress others have made in their mad, thousands of words, NaNoWriMo dash to December, but pro... The Splintered Mind by Douglas Cootey blogs http://www.medworm.com/rss/comments.php?id=4142987 Sun, 07 Nov 2010 10:34:49 +0100 4142987 http://www.medworm.com/index.php?rid=4134191&cid=t_105335_140_f&fid=35443&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FTheSplinteredMind%2F%7E3%2Fgbb57pv1jNc%2Fi-was-all-prepared-for-voting-until-i.html    Download now or listen on posterousMemo.m4a (761 KB) Sent from my iPhone, proving definitively that I am all thumbs.Posted via email from splinteredmind's posterous (Source: The Splintered Mind by Douglas Cootey) The Splintered Mind by Douglas Cootey blogs http://www.medworm.com/rss/comments.php?id=4134191 Wed, 03 Nov 2010 10:39:31 +0100 4134191 http://www.medworm.com/index.php?rid=4134291&cid=t_105335_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=4125246&cid=t_105335_140_f&fid=35443&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FTheSplinteredMind%2F%7E3%2FfRHg_w-lJHY%2Fdistracted-writers-club-25-words-per.html Main Challenge Page Like the 50 Words Per Day Challenge and the 100 Words Per Day Challenge, the goal of the Distracted Writers Club 25 Words Per Day Challenge is simple: to train distracted and busy writers to write daily. I was inspired by two things: the Inkygirl Wordcount Challenge and NaNoWriMo. One was like a fresh breath of air in a stuffy room and the other felt like a vacuum opened up into space sucking the very life out of me. My problem wasn't being motivated to write. I could write plenty. My problem was that my life was not organized around writing. Maybe you can relate. You're a writer with good intentions and high enthusiasm who writes around the edges of your busy life. You've started projects like NaNoWriMo and found that although you were emotionally committed to the ... The Splintered Mind by Douglas Cootey blogs http://www.medworm.com/rss/comments.php?id=4125246 Mon, 01 Nov 2010 11:17:34 +0100 4125246 http://www.medworm.com/index.php?rid=4125243&cid=t_105335_140_f&fid=35443&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FTheSplinteredMind%2F%7E3%2Fy0Y3CcmS638%2Fwelcome-to-distracted-writers-club.html The goal of the Distracted Writers Club is simple: to train distracted and busy writers to write daily. I was inspired by two things: the Inkygirl Wordcount Challenge and NaNoWriMo. One was like a fresh breath of air in a stuffy room and the other felt like a vacuum opened up into space sucking the very life out of me. My problem wasn't being motivated to write. I could write plenty. My problem was that my life was not organized around writing. Maybe you can relate. You're a writer with good intentions and high enthusiasm who writes around the edges of your busy life. You've started projects like NaNoWriMo and found that although you were emotionally committed to the daily effort, your time schedule was not. Soon you found work, family, responsibilities, life, etc. interfering with your... The Splintered Mind by Douglas Cootey blogs http://www.medworm.com/rss/comments.php?id=4125243 Mon, 01 Nov 2010 11:13:56 +0100 4125243 http://www.medworm.com/index.php?rid=4125244&cid=t_105335_140_f&fid=35443&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FTheSplinteredMind%2F%7E3%2FrtsopBuzcw8%2Fdistracted-writers-club-100-words-per.html Main Challenge Page Like the 25 Words Per Day Challenge and the 50 Words Per Day Challenge, the goal of the Distracted Writers Club 100 Words Per Day Challenge is simple: to train distracted and busy writers to write daily. I was inspired by two things: the Inkygirl Wordcount Challenge and NaNoWriMo. One was like a fresh breath of air in a stuffy room and the other felt like a vacuum opened up into space sucking the very life out of me. My problem wasn't being motivated to write. I could write plenty. My problem was that my life was not organized around writing. Maybe you can relate. You're a writer with good intentions and high enthusiasm who writes around the edges of your busy life. You've started projects like NaNoWriMo and found that although you were emotionally committed to the ... The Splintered Mind by Douglas Cootey blogs http://www.medworm.com/rss/comments.php?id=4125244 Mon, 01 Nov 2010 11:12:07 +0100 4125244 http://www.medworm.com/index.php?rid=4125245&cid=t_105335_140_f&fid=35443&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FTheSplinteredMind%2F%7E3%2FNYa86k6sTC8%2Fdistracted-writers-club-50-words-per.html Main Challenge Page Like the 25 Words Per Day Challenge and the 100 Words Per Day Challenge, the goal of the Distracted Writers Club 50 Words Per Day Challenge is simple: to train distracted and busy writers to write daily. I was inspired by two things: the Inkygirl Wordcount Challenge and NaNoWriMo. One was like a fresh breath of air in a stuffy room and the other felt like a vacuum opened up into space sucking the very life out of me. My problem wasn't being motivated to write. I could write plenty. My problem was that my life was not organized around writing. Maybe you can relate. You're a writer with good intentions and high enthusiasm who writes around the edges of your busy life. You've started projects like NaNoWriMo and found that although you were emotionally committed to the ... The Splintered Mind by Douglas Cootey blogs http://www.medworm.com/rss/comments.php?id=4125245 Mon, 01 Nov 2010 11:06:12 +0100 4125245 http://www.medworm.com/index.php?rid=4119759&cid=t_105335_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F10%2F29%2Ffriday-funnies-40%2F SuperTherapist has been on the job, and passes on these tips to make your days go well! Can you tell I’m procrastinating? You know, I have seen worse clangers – like the neurosurgeon who said ‘I have no knowledge of psychology, but I’m sure if you ask them to assess [Joe Bloggs] they will write you a lengthy report that you can’t understand…’ And this one is because I will be The Perfect Mother – one day – and to do so I will need SuperTherapist’s gear. Or something in the form of liquid refreshment. Child of my Womb is coming to stay the night and sew a dress. I may go grey before the night is over. But I will be grey and fat because we both luuuuurve chocolate! Filed under: health, Humour Tagged: coping strategies, Friday fu... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4119759 Thu, 28 Oct 2010 22:34:40 +0100 4119759 http://www.medworm.com/index.php?rid=4119761&cid=t_105335_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F10%2F27%2Fpsychological-therapy-works-for-fibromyalgia%2F An ‘enigmatic’ disorder – this is what Perry Nicassio calls fibromyalgia. I hadn’t thought of it that way, because so many chronic pain problems seem to be equally ‘enigmatic’! It’s a common disorder, affects many more women than men, has a multiplicity of effects on people ranging from fatigue, poor sleep, widespread aching, other pain sensations such as stabbing or needle-like pains that can appear anywhere in the body, often with low mood and loss of function.  There are few medications that seem to help, and many people never seek treatment for their pain.  If people do look for treatment, they can be faced with skepticism from some health providers, despair from others, and offered a multiplicity of treatments that don’t seem to do an ... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4119761 Tue, 26 Oct 2010 18:37:56 +0100 4119761 http://www.medworm.com/index.php?rid=4106087&cid=t_105335_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=4061062&cid=t_105335_140_f&fid=35443&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FTheSplinteredMind%2F%7E3%2Flff22cvoZe0%2Fchapter-four-torture-is-over.html With great effort, and not a little wrestling with the Embodiment of Boredom itself, I have completed my novel's revision and laid the groundwork for its rapid completion. Hahaha! I kill myself with statements like that. As if somehow this will be my last stumbling block, and writing will be no more difficult than plucking dandelions from here on out. What this does represent for me, however, is victory, no matter how small. As I have detailed over and over again, my cognitive issues are major obstacles for my writing goals. However, I have remained convinced that I can train myself via Cognitive Behavioral Techniques and sheer will to be a better, more productive writer. It's not as if I can pop a pill and make my troubles go away. It has not been an easy task.  My attention span ... The Splintered Mind by Douglas Cootey blogs http://www.medworm.com/rss/comments.php?id=4061062 Mon, 11 Oct 2010 22:52:50 +0100 4061062 http://www.medworm.com/index.php?rid=4031473&cid=t_105335_140_f&fid=35443&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FTheSplinteredMind%2F%7E5%2Fy1OeTdYDbmk%2F My mind has been turning and mulching and plowing and harrowing something I read on Friday. It fit in perfectly with concerns I've been having with my productivity. As you likely know if you've been following this blog, I am trying to overcome my disabilities in order to write a book or three. I've had success. I've had a lot of success, to be honest. However, I haven't met my goals completely. ADHD and Insomnia still remain my greatest hurdles. In addition, my gig at HealthyPlace set me behind further than I had feared. Now I must suddenly not have my problems so that I can meet the goal by December 23rd. Obviously, minds don't work that way. Since I can't wave a magic will-wand to make my disabilities disappear, I have to deal with them the hard way. This calls for lots of thinking and... The Splintered Mind by Douglas Cootey blogs http://www.medworm.com/rss/comments.php?id=4031473 Tue, 05 Oct 2010 09:02:10 +0100 4031473 http://www.medworm.com/index.php?rid=4023117&cid=t_105335_140_f&fid=35443&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FTheSplinteredMind%2F%7E3%2Fe3OuUcUcKk0%2F25-words-day-is-child-play.html A year and a half ago, David Wolverton wrote in his "Daily Kick in the Pants" about mental health issues and writing. He had many insights that were interesting, but when discussing ADHD he wrote, "Being ADHD makes it almost impossible to write—period." Was the writing on the wall for me, or was there a way I could beat ADHD and meet my goals? You can imagine I wasn't thrilled to see that in my inbox. I didn't get angry at him, however. I simply couldn't accept his comment as the definitive sentence passed upon my struggle.  I wrote back, "I'm not published yet, so writing may indeed be impossible with ADHD, but one day soon I hope to be able to say ADHD just makes things difficult."  I meant what I wrote, and determined to defy the odds. He later wrote me, "Thank you for the feedba... The Splintered Mind by Douglas Cootey blogs http://www.medworm.com/rss/comments.php?id=4023117 Fri, 01 Oct 2010 14:48:08 +0100 4023117 http://www.medworm.com/index.php?rid=4018454&cid=t_105335_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F09%2F30%2Fclinicians-and-graded-exposure%2F Some people do, and some people don’t, some of us will, and some of us won’t! Graded exposure can be an uncomfortable experience for both the person who is learning to approach activities that don’t feel very good – and for the clinician! It goes against the grain for some of us to elicit anxiety and see distress as we work with people, after all, our job is to help people feel better isn’t it? There are some consistent findings about clinician anxiety vs patient anxiety when it comes to pain. It seems that clinicians can often be more conservative with regard to what is OK for a person to do than the person can be. This conservatism can be related to clinician’s beliefs about hurt vs harm, clinician’s orientation to a biopsychosocial model –... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4018454 Wed, 29 Sep 2010 17:35:42 +0100 4018454 http://www.medworm.com/index.php?rid=4003417&cid=t_105335_140_f&fid=35443&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FTheSplinteredMind%2F%7E3%2Fa9I_cs576xw%2Fmy-brain-has-flat-but-im-jammin-tunes.html Since identifying that Depression had sunk its hooks in me, I've been making a transformation in my life. First, I stopped wearing black and listening to The Cure, and I started wearing sepia and listening to Bluegrass & Country tunes about lost dreams to really brighten my day. "Whiskey Lullaby", "I Can't Love You Anymore", "If I Die Young", "Ghost In this House", and "Hurt" gave me that little extra oomph I needed. So bring on the pain, let it kill your memory. Bring on the rain, let it drown what's left of you and me. I know the only way I'm ever gonna make it, is burying the best of us even though it's killing me. 'Cuz I don't love you any less, but I can't love you anymore. Let me tell you. It's the small things that make a BIG difference. Wow. Am I happier… Actually, I am happier... The Splintered Mind by Douglas Cootey blogs http://www.medworm.com/rss/comments.php?id=4003417 Mon, 27 Sep 2010 22:47:21 +0100 4003417 http://www.medworm.com/index.php?rid=4003454&cid=t_105335_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=3987247&cid=t_105335_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_105335_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_105335_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_105335_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=3942997&cid=t_105335_140_f&fid=35443&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FTheSplinteredMind%2F%7E3%2FSwLTZk1Joto%2Fbehold-i-write-with-words-and-such.html So what have I been doing since August 31st? I've been thinking a lot about what worked and what didn't work for me with my last gig. ADHD occasionally wreaked havoc. Depression reared its mangy head from time to time, but over all my insomnia, health, and tic disorder where the most debilitating. I couldn't do anything about the tic disorder, but I could do something about the other two.  For the past three weeks I've been on a diet of discarded sunflower seeds and distilled water. Yummy! OK, I'm kidding. For the past three weeks I've been following the Forever Fit plan, and I've lost about 16lbs. My goal is to get down to 225lbs by the end of September—only 9.4lbs away. Already I am healthier. I biked 30 miles last week and I'm eating better. In fact, one interesting side-effect of ... The Splintered Mind by Douglas Cootey blogs http://www.medworm.com/rss/comments.php?id=3942997 Tue, 07 Sep 2010 13:00:05 +0100 3942997 http://www.medworm.com/index.php?rid=3876912&cid=t_105335_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_105335_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=3795074&cid=t_105335_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=3787135&cid=t_105335_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=3754108&cid=t_105335_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=3747009&cid=t_105335_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F07%2F13%2Fold-beliefs-die-hard-case-conceptualising-coping-with-a-flare-up%2F We know about neuroplasticity – how the brain so wonderfully remodels connections continuously.  We also know how hard changing habits can be.  The underlying premise of the cognitive behavioural approach to coping with chronic pain is that people can learn new ways of viewing their situation and develop new responses, and in doing so, start to live well again.  The process is not easy! Before I go further, I want to reassure readers that the case presentation I’m going to discuss is a fiction – based on several real patients, but with details altered to protect identity. One of the most difficult aspects of coping with chronic pain is that the pain doesn’t remain at a constant level.  It fluctuates in intensity, it can remain high for varying periods, it can dr... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3747009 Mon, 12 Jul 2010 19:35:48 +0100 3747009 http://www.medworm.com/index.php?rid=3743735&cid=t_105335_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=3683912&cid=t_105335_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=3659177&cid=t_105335_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F06%2F14%2Fhow-social-is-your-biopsychosocial-model%2F It’s called the biopsychosocial model, but how much attention do we really pay to the social part of this model? While we know the medical model has its limitations (especially when we’re looking at how people respond to having health problems), in pain management I wonder whether we now have a ‘psychological’ model of pain rather than a biopsychosocial model? The first time I started pondering this was when a large purchasing body in New Zealand removed the word ‘social’ from what is called a ‘Comprehensive Pain Assessment’. This is an assessment that has medical, functional and psychosocial components – but without the social part it seems to omit some of those really important aspects of the experience of both pain and disability&#82... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3659177 Sun, 13 Jun 2010 19:42:06 +0100 3659177 http://www.medworm.com/index.php?rid=3645061&cid=t_105335_151_f&fid=35818&url=http%3A%2F%2Frecoveryissexy.com%2Fhelp-an-alcoholic-5-2%2F Seek help It’s dumbfounding to learn that some never seek help of any kind with severe alcohol abuse. One wife says, "If my husband had sought help, he would have been admitting how serious my problem was. It was a big family secret." But other people emphasize the importance of not going it alone when someone you care about has a drinking problem. This comment captures the essence of many suggestions: "Join a support group to keep your own life buoyant and prosperous and to analyze your own negative coping strategies." Not surprisingly, many people who take traditional twelve-step recovery routes suggested going to Al-Anon, also a twelve-step-based program. Also, a number of people make a general comment that family and friends should seek counselling for their ow... Recovery Is Sexy.com blogs http://www.medworm.com/rss/comments.php?id=3645061 Wed, 09 Jun 2010 15:33:00 +0100 3645061 http://www.medworm.com/index.php?rid=3625753&cid=t_105335_140_f&fid=35443&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FTheSplinteredMind%2F%7E3%2F0dN76XsNSqE%2Fsixth-time-charm-mental-acuity-all.html    Download now or listen on posterousEE5DDBE3-06BA-4CCF-89BE-E1D3CBBA25A7.wav (1549 KB) via twittelatorPosted via web from splinteredmind's posterous (Source: The Splintered Mind by Douglas Cootey) The Splintered Mind by Douglas Cootey blogs http://www.medworm.com/rss/comments.php?id=3625753 Thu, 03 Jun 2010 04:56:46 +0100 3625753 http://www.medworm.com/index.php?rid=3618108&cid=t_105335_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=3573967&cid=t_105335_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F05%2F18%2Fact-ing-well-living-well-iii-acceptance-willingness%2F One thing that strikes me as very different about the ACT approach is the very different way therapists are encouraged to respond to difficult emotions.  Part of ACT is to encourage acceptance of, and ‘sitting with’ negative thoughts or emotions or sensations rather than attempting to change them or ignore them – and in my learning about ACT and trying to model ACT consistent behaviour in therapy, I find I need to become more mindful of my own responses to other people’s thoughts and emotions. What I mean by this is that I initially have a response to avoid experiencing another person’s distress – so if the person I’m working with is tearful or angry or afraid, I have often tried to mop up the tears or calm the person down or reassure them.  What... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3573967 Mon, 17 May 2010 19:43:46 +0100 3573967 http://www.medworm.com/index.php?rid=3570085&cid=t_105335_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F05%2F17%2Fa-dilemma-act-ing-well-living-well%2F In this study, an intervention in which individuals considered their personal values (in other words, what is important to them, what influences the direction in which they take actions) was carried out, and its influence on tolerance to a cold pressor test was evaluated. Two previous studies have shown that low levels of experiential avoidance and high acceptance are reportedly related to higher pain tolerance, conversely one would expect that high levels of experiential avoidance and low levels of acceptance would be related to lower tolerance to pain.  A couple of definitions here: pain tolerance is about how long a person is prepared to ‘put up with’ pain before attempting to move away from it, as opposed to pain threshold which is the point at which the person identifies ... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3570085 Sun, 16 May 2010 19:21:00 +0100 3570085 http://www.medworm.com/index.php?rid=3530010&cid=t_105335_140_f&fid=35443&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FTheSplinteredMind%2F%7E5%2FljRt9PugjY4%2FQ7novjelx10%26hl%3Den_US%26fs%3D1%26 ADDaboy!It's May already. You may have missed it. I didn't. I was looking at the arrival of May with some dread. I promised a friend I would show art at his art show and I haven't drawn any yet. Yes, a wee bit stressful for me, but then that's life with Douglas Cootey. Lots of looming deadlines and impending doom. I probably won't live to see 50. In the meantime, please take a look at what I wrote over at HealthyPlace.com:Adult ADHD: Cover That Mouth Before You Use It!My mouth has been known to light bridges aflame behind me leaving burned out friendships to mark my passing.It gets even better. I wear a lampshade over my head. Please don't miss this or all the humiliation will be for nothing. (I sell myself for page views.)An ADHD Attribute I Love and CherishIs it true that adults with ADH... The Splintered Mind by Douglas Cootey blogs http://www.medworm.com/rss/comments.php?id=3530010 Mon, 03 May 2010 21:21:01 +0100 3530010 http://www.medworm.com/index.php?rid=3530051&cid=t_105335_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=3505121&cid=t_105335_140_f&fid=35443&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FTheSplinteredMind%2F%7E3%2FjYwBLAu3zd0%2Fin-which-douglas-spots-problem.html At first I thought the switch from MacBook to iPad couldn't have come at a worse time. Then I realized that as an adult with ADHD there never was a good time for such a switch. It was destined to disrupt my life. Exchanging one workflow for another always has a price in time lost for most people. Fortunatley, I'm up to speed now and I expect more helpful apps will arise from the iPad walled garden with a bit of Apple sunshine, some consumer supplied water, and a developer's eager hoe. I can be patient. The real threat to my novels project is not my iPad. The iPad is slick, shiny, nifty, and fun. I rather like it. I love how light it is. I like the interface. I don't regret purchasing it. There are splendiferous apps coming out for it almost daily, and a lot of them are free or only 99¢.... The Splintered Mind by Douglas Cootey blogs http://www.medworm.com/rss/comments.php?id=3505121 Mon, 26 Apr 2010 14:00:05 +0100 3505121 http://www.medworm.com/index.php?rid=3403927&cid=t_105335_109_f&fid=34750&url=http%3A%2F%2Fpsychcentral.com%2Fblog%2Farchives%2F2010%2F03%2F24%2Fwomen-and-mens-defensiveness-impacts-health%2F You probably already know that men and women deal and react to stress differently. What you may not have realized is just how different we are when it comes to dealing with stress. And one of the keys appears to be how defensive we are: Defensiveness is a trait characterized by avoidance, denial or repression of information perceived as threatening. In women, a strong defensive reaction to judgment from others or a threat to self-esteem will result in high blood pressure and heart rate. But in older men, the researchers found those with low defensive reactions have higher cardiovascular rates. This is not a finding that has previously been noted in the research. Conventional wisdom would have expected that one’s defensiveness would have a similar impact on health, regardless of gend... World of Psychology blogs http://www.medworm.com/rss/comments.php?id=3403927 Wed, 24 Mar 2010 19:19:53 +0100 3403927 http://www.medworm.com/index.php?rid=3399200&cid=t_105335_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F03%2F24%2Fefficiency-pain-management%2F I can’t remember a time when people working in health were told ‘Go and spend as much as you like to help people get well’ – in fact, in over 20 years I can only recall being told ‘there is less money in the kitty, we need to look for efficiencies, tighten your belts’! So it’s no surprise to me that once again, no matter where you look in the world, health professionals are being told to look at ways to be more efficient.   I don’t have a problem with this – if I’m a patient I want to know I can be treated quickly and effectively so I can get back to being a person and not a patient.  What I do have a problem with is when, in the urgency to save money, problems in health care are given a quick fix solution without taking a look... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3399200 Tue, 23 Mar 2010 18:32:54 +0100 3399200 http://www.medworm.com/index.php?rid=3391016&cid=t_105335_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F03%2F22%2Faccepting-chronic-pain%2F How willing are you to have persistent pain? Can you accept pain without fighting against it? If you were told your pain was going to be there forever, would you avoid important activities or would you start to get back into life again? Recently I reviewed about 200 questionnaires completed by people attending the Pain Management Centre where I work. I was looking especially at what they’d written down as goals for coming to the Centre, and unsurprisingly, most of them were to ‘reduce my pain’ – to tolerable levels, to manageable levels, or so the person could begin ‘living a normal life’. I hate to break it to you – even the most effective medication seems to only reduce pain by about 30%, and most people wanting pain reduction are after at least ... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3391016 Sun, 21 Mar 2010 18:21:45 +0100 3391016 http://www.medworm.com/index.php?rid=3383062&cid=t_105335_140_f&fid=35443&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FTheSplinteredMind%2F%7E3%2FyjbTXCXbr9c%2Fplaying-fetch-with-my-mind.html What is it they say about how life comes in threes? Oh, yeah. "Life comes in threes."I'm glad I looked that up. It was so much more complicated than I remembered.I've moved from illness to new CPAP fatigue to seasonal allergies and I haven't even left the state. So much excitement right here in Utah. I wouldn't mention it except for the fact that this is supposed to be a blog about writing, and so far it's a blog about how I don't write. I'd like to change that today. Truly, deeply…Here's what I'm going to do. As Dan Willis mentioned to me on Tuesday, I have ADD like a puppy. It's alright. He's an author. They like to use similes. Besides, I enjoyed the imagery of seeing my attention romp about with its tongue wagging too much to be offended. Anyways, what was I saying?Right. Here's what... The Splintered Mind by Douglas Cootey blogs http://www.medworm.com/rss/comments.php?id=3383062 Thu, 18 Mar 2010 23:03:26 +0100 3383062 http://www.medworm.com/index.php?rid=3370706&cid=t_105335_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_105335_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=3346710&cid=t_105335_140_f&fid=35443&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FTheSplinteredMind%2F%7E3%2FdTKUCeAS5t0%2Faddaboy-can-anger-be-funny.html After revealing my dark, secret verbal abuse issues on the highways of Utah, I hope that people can chuckle at them with me. My last article over at ADDaboy! had my wife in traction from laughter. If I doubted even once in the past 21 years that I married the wrong person, it was removed then. You don't know me as well as she does, but perhaps you will find it humorous, too:ADHD Frustration - Get Out of My Way or I Shall Taunt You a Second TimeI skirt through traffic like a hyperactive kid in a pod racer.Then I bump into somebody going 5mph slower than the stated speed who likes to brake for dust motes, or maybe they are on a cell phone and driving erratically, or they suddenly decide as I come up on them that THEY and THEY ALONE must be in front. These people irritate me in visceral ways ... The Splintered Mind by Douglas Cootey blogs http://www.medworm.com/rss/comments.php?id=3346710 Tue, 09 Mar 2010 16:51:36 +0100 3346710 http://www.medworm.com/index.php?rid=3307076&cid=t_105335_140_f&fid=35443&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FTheSplinteredMind%2F%7E3%2FwDbqHvVcW-c%2Ffacing-fear-with-pencil-in-hand-adhd-in.html On September 21st, I took part in my very first Sketchcrawl. Since no one was putting a meet together here in Salt Lake City, I thought I'd try my hand at it. I set the place and set the time, then I went there even though I knew my daughters and I were likely to be the only ones attending.You have no idea how hard it was for me to do that. I've been lurking on the Sketchcrawl site for three years and never attended a single event. I was too petrified to draw in front of people. I knew my work would be terrible.I've never been able to draw in front of people. Figure Drawing class at MassArt was a disaster. If I was drawing en plein air, all drawing would come to a stop as soon as somebody came around the corner. Heaven help me if they actually walked over to look at what I was doing. I gav... The Splintered Mind by Douglas Cootey blogs http://www.medworm.com/rss/comments.php?id=3307076 Thu, 25 Feb 2010 15:35:54 +0100 3307076 http://www.medworm.com/index.php?rid=3302623&cid=t_105335_140_f&fid=35443&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FTheSplinteredMind%2F%7E3%2FfZMdQZEdDd8%2Fi-tell-adhd-people-where-to-stick-it.html If you haven't had a chance yet, you might want to head on over to my ADDaboy! blog and check out Post It! Stick It! Remember It! Thanks to a reader comment here on this blog, I decided to explore how useful Post-it notes are, both physical and virtual. Sometimes ADHD has me so funnel visioned that I don't fully understand a comment somebody says to me. Ever experience that? So focused on one thing you misunderstand what you read or hear? In this case, reader Sy raved about Post-It notes. I don't use Post-It notes. I used to, but stopped years ago. I go into why over at ADDaboy! So I responded to Sy's comment as if it was a good idea for other people. But as I thought about it, I realized I use a wide variety of Post-It-esque apps and have since 1994. They're just on my computers. Then I r... The Splintered Mind by Douglas Cootey blogs http://www.medworm.com/rss/comments.php?id=3302623 Wed, 24 Feb 2010 04:19:23 +0100 3302623 http://www.medworm.com/index.php?rid=3298633&cid=t_105335_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=3283846&cid=t_105335_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F02%2F18%2Fdo-patients-take-their-medications%2F I don’t often write about medications, not because I don’t believe in their use but because that’s not my focus.  However, just to put the record straight: medications and medical management of chronic pain has a place in the model of pain management I use.  After all, it is the ‘bio-psychosocial’ model, not the psychosocial one! I am interested in how often people follow the advice of their health providers, because if my aim is for people to manage their pain by themselves I really would like them to go away having tried something and knowing whether it is helpful or not.  A treatment can’t be useful if the person doesn’t actually give it a good go. So something I usually ask about is how closely a person follows the advice of a doctor with re... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3283846 Wed, 17 Feb 2010 18:25:20 +0100 3283846 http://www.medworm.com/index.php?rid=3251384&cid=t_105335_140_f&fid=35443&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FTheSplinteredMind%2F%7E3%2FmvAsKWxb4zU%2Fdepression-came-in-through-back-door.html There are times when life can be overwhelming. Usually, trauma, injury, death, or heartbreak can knock normally upbeat people off their stride. Then there are people such as myself whose brains are wired in curious, but dysfunctional, ways. We tend to get knocked off our stride if the wind’s blowing the wrong way. Speaking for myself, I am often frustrated how fragile my mind seems. Not hearty or rugged, but delicate and easily crumpled. This tends to make me angry at myself, so I overcompensate in some alpha male way like exercising or attacking a pile of clutter. This leads me to something I came across last month. There’s been a tab I’ve kept up in my browser for weeks. I’ve wanted to write about it here, but wasn’t sure how to approach it. It’s an article about Depression ... The Splintered Mind by Douglas Cootey blogs http://www.medworm.com/rss/comments.php?id=3251384 Mon, 08 Feb 2010 12:50:39 +0100 3251384 http://www.medworm.com/index.php?rid=3172224&cid=t_105335_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_105335_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=3153613&cid=t_105335_140_f&fid=35443&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FTheSplinteredMind%2F%7E3%2FmOPjiPcC2Xs%2Fup-and-about-early-for-change.html If I could characterize my week so far with three words, they would have to be "ticking" and "sleep deprivation". When I set out to reinvent my life by blogging with a goal in mind instead of just mirthfully writing about anecdotal episodes of disability, I had visions of hitting the ground running, filling digital folders with reams of virtual story pages, and impressing millions by my dedication. Well, maybe not the last one, but I certainly didn't expect to spend my time ticking, twitching, and moving in slow motion. Still, I laid out quite the list of obstacles the other day and my tic disorder & insomnia were two of them. Either I learn to work around them, or I won't reach my birthday goal. One cannot ever underestimate the impact that sleep deprivation has on the mind. I simply don'... The Splintered Mind by Douglas Cootey blogs http://www.medworm.com/rss/comments.php?id=3153613 Thu, 07 Jan 2010 23:00:19 +0100 3153613 http://www.medworm.com/index.php?rid=3089600&cid=t_105335_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_105335_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=3082600&cid=t_105335_140_f&fid=35443&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FTheSplinteredMind%2F%7E3%2F0nQhB_Tj0oo%2Fstruggling-with-winter-depression.html Every year, Daylight Savings Time comes and ushers in a world of hurt for many people as they collectively deal with an hour less of precious sunlight. Our agrarian society is now a metropolitan one of artificial lights and deep indoors. The lack of sunlight at the end of the day strikes a hearty blow to those who suffer from Winter Depression, aka Seasonal Affective Disorder. The Winter months see the shortest days of the year starting in the end of September until the Winter Equinox in December. If you find yourself more depressed in the Fall than at any other time of year, this may be the reason why. I explore my own experiences with Winter Depression below. Perhaps there’s something I’ve discovered about myself that might be relevant to you as well:Daylight Savings Time - My New Sw... The Splintered Mind by Douglas Cootey blogs http://www.medworm.com/rss/comments.php?id=3082600 Sat, 12 Dec 2009 00:41:14 +0100 3082600 http://www.medworm.com/index.php?rid=3079564&cid=t_105335_140_f&fid=35443&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FTheSplinteredMind%2F%7E3%2FyyFrB2-BSQc%2Flights-out-on-winter-depression.html Two weeks ago one of my "full spectrum" bulbs went out in my kitchen. I immediately noticed a hit in my ability to push back Winter Depression over the next few days. Fortunately, I soon started turning my sleep schedule around to take advantage of daylight hours. Then when one of my readers asked me which types of bulbs to buy, I saw an opportunity. Why just buy a replacement when I could stand in the middle of Target and take pictures of light bulbs for my blog while weirding out the Christmas shoppers? So, with burnt CFL in pocket, I headed off to Target. The first thing I noticed was that there were considerably more CFLs for sale than last year. In fact, there was a veritable CFL sea. I could see why a reader might find my descriptions of the light bulbs vague and confusing. Sever... The Splintered Mind by Douglas Cootey blogs http://www.medworm.com/rss/comments.php?id=3079564 Thu, 10 Dec 2009 19:35:08 +0100 3079564 http://www.medworm.com/index.php?rid=3075755&cid=t_105335_140_f&fid=35443&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FTheSplinteredMind%2F%7E3%2FyyFrB2-BSQc%2Flights-out-on-winter-depression.html Two weeks ago one of my "full spectrum" bulbs went out in my kitchen. I immediately noticed a hit in my ability to push back Winter Depression over the next few days. Fortunately, I soon started turning my sleep schedule around to take advantage of daylight hours. Then when one of my readers asked me which types of bulbs to buy, I saw an opportunity. Why just buy a replacement when I could stand in the middle of Target and take pictures of light bulbs for my blog while weirding out the Christmas shoppers? So, with burnt CFL in pocket, I headed off to Target. The first thing I noticed was that there were considerably more CFLs for sale than last year. In fact, there was a veritable CFL sea. I could see why a reader might find my descriptions of the light bulbs vague and confusing. Sever... The Splintered Mind by Douglas Cootey blogs http://www.medworm.com/rss/comments.php?id=3075755 Thu, 10 Dec 2009 14:00:11 +0100 3075755 http://www.medworm.com/index.php?rid=3071493&cid=t_105335_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F12%2F09%2Fnorways-national-guidelines-for-evaluating-pain%2F I don’t envy the job of health economists – nor policy-makers or politicians who need to make the difficult decisions about who should receive allocation within the restricted health funding that is available.  At the same time, I’m often worried when I hear that ‘high-tech’ treatments, and those that are perceived as ‘glamour’ health problems get funding when low-status problems like chronic pain get overlooked.  So it was nice to read that Norway has enshrined the rights of people to receive evaluation and treatment for chronic pain within law. The National Guidelines for chronic pain ’seek to answerthe difficult questions of which patients should be prioritised at pain clinics and what is a medically acceptable waiting time.’ It h... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3071493 Tue, 08 Dec 2009 22:38:38 +0100 3071493 http://www.medworm.com/index.php?rid=3019250&cid=t_105335_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F11%2F23%2Fpain-management-in-groups-using-a-cbt-approach-why-do-it%2F This week I’m looking a working effectively with groups for pain management using a CBT approach.  Someone said recently ‘why should six clinicians be tied up for three weeks with only six patients? there are other people who need pain management too’ - and over the past ten years I’ve seen numerous attempts to move from the group approach to individualised therapy, so some time reviewing why groups are a useful way to help people develop pain management skills might not be amiss! Using a group approach was typical for pain management in the earlier days, say around the mid-1980’s and earlier.   It’s a convenient way to bring the specialised skills of an interdisciplinary team to people with pain, and especially within the setting often used in the be... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3019250 Sun, 22 Nov 2009 19:55:54 +0100 3019250 http://www.medworm.com/index.php?rid=3008419&cid=t_105335_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=3004078&cid=t_105335_140_f&fid=35443&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FTheSplinteredMind%2F%7E3%2F45B-RfZTVNI%2Fmailbag-anxious-cry-for-help.html Despite what others may think of me in my local community and family, I am not the mess I used to be. I have come a long way. I have still a long way to go, but I am happier and better and more productive today—more so now than in any time in my life. I take no medications, and in truth shun them. They made my life worse. I live in fear of side-effects and worry about my readers who write about the cocktails they take to deal with all the side-effects yet they still are no better off for them. Mental illness is a difficult malady to overcome, yet there is hope if we can find focus and motivation to tackle it. The other day I received this email and felt my reply to it might help other people who suffer from Panic Anxiety Disorder. I give this advice hoping that somebody can climb out of ... The Splintered Mind by Douglas Cootey blogs http://www.medworm.com/rss/comments.php?id=3004078 Tue, 17 Nov 2009 22:11:22 +0100 3004078 http://www.medworm.com/index.php?rid=2999879&cid=t_105335_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_105335_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_105335_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_105335_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_105335_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=2972043&cid=t_105335_140_f&fid=35443&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FTheSplinteredMind%2F%7E3%2FrbBZZ3Hz9sI%2Fsome-days-are-easier-than-others.html Hard day today. I had plans. Big, beautiful plans. Instead I spent the day ticking. Then company arrived and there went my plans like leaves in the wind.I managed to check off two of the six things I needed to do today, but there was so much more that needed to be done. I was powerless and sat there stuttering, and twitching, and unable to be productive. Days like these try my will. It is so difficult to keep my spirits up. In fact, I'm struggling with Depression as I type this. The first stage is to recognize that I'm depressed. The next stage is to decide if I have a reason to be. Well, I had a reason. I blew time out the window like smoke while I sat there and ticked all day.In the past I wrote about how one must, at this point, analyze whether one is feeling an appropriate amount of sa... The Splintered Mind by Douglas Cootey blogs http://www.medworm.com/rss/comments.php?id=2972043 Sun, 08 Nov 2009 09:38:51 +0100 2972043 http://www.medworm.com/index.php?rid=2954776&cid=t_105335_140_f&fid=35443&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FTheSplinteredMind%2F%7E3%2FrOaxoCeSBnU%2Fputting-spotlight-on-seasonal-affective.html Almost exactly one year ago I made a discovery: I suffered from Winter Depression, otherwise known as Seasonal Affective Disorder. As I detailed in “I Wondered What Was Happening”, I had been on the lookout for a change in my behavior once Autumn rolled in. Then I forgot about it. (Ah, blessed ADHD) When Daylight Savings Time began I had a rocky week. Most of us do. The shift in our sleep schedule is like experiencing jet lag without all the exotic scenery. At first. I thought I was just having a hard time adjusting as usual, but by the end of the first week I remembered what I was supposed to be on the lookout for: Winter Depression. I was moping, moody, miserable, morbidly sad…and all for no reason that I could think of. The only thing that made sense was that I was sensitive to t... The Splintered Mind by Douglas Cootey blogs http://www.medworm.com/rss/comments.php?id=2954776 Tue, 03 Nov 2009 14:00:00 +0100 2954776 http://www.medworm.com/index.php?rid=2950979&cid=t_105335_140_f&fid=35443&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FTheSplinteredMind%2F%7E3%2FqG3gT0Eres8%2Fdon-let-hardship-be-pain-in-butt-get.html Congratulations, Icy. You’ve won an autographed copy of “Heck Superhero” by Martine Leavitt. Send me your mailing address via email and I’ll wrap the book up and send it to you. With one last Halloween hurrah I'll share some photos with you. I'll be changing the colors here back to their normal greens and blues later today, and Halloween 2009 will be officially over for me. I must say that I was disappointed. I posted all those photos and a writing excerpt and you people were off gallivanting around in costume instead of sitting around reading my blog. You have some nerve. Don't worry, though. My family hasn't read any of it either. I have to admit, it was the most enjoyable Halloween since my Leprechaun was born in 1998 on October 30th. We brought her home in a trick or trea... The Splintered Mind by Douglas Cootey blogs http://www.medworm.com/rss/comments.php?id=2950979 Mon, 02 Nov 2009 14:00:18 +0100 2950979 http://www.medworm.com/index.php?rid=2934969&cid=t_105335_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=2927588&cid=t_105335_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=2908915&cid=t_105335_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=2905140&cid=t_105335_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_105335_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=2886724&cid=t_105335_140_f&fid=35443&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FTheSplinteredMind%2F%7E3%2FPiRDGq_f60o%2Fsome-thoughts-on-happiness-depression.html What a day. I’m typing sluggishly due to a prolonged ticking episode. They come in many shapes and sizes and this is one of the long, spindly, slow motion ones. I feel as if I’m out of sync with time around me, moving through thick air with each step nailed to the moment behind it. I simply did too much today, but there’s nothing I would have done differently.There was a time I’d rather have been by myself writing, drawing, dreaming in places such as the one depicted above. I wasn’t resigned to my duties as a stay-at-home dad. I wanted “greater” things. Instead, I spent today with my daughters in one joyous moment after another. The eight year old had a seizure on Saturday, made worse by the Croop, so she stayed home today. We worked on getting her caught up with her homework... The Splintered Mind by Douglas Cootey blogs http://www.medworm.com/rss/comments.php?id=2886724 Tue, 13 Oct 2009 08:07:43 +0100 2886724 http://www.medworm.com/index.php?rid=2886781&cid=t_105335_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F10%2F13%2Facceptance-worksheets-and-more%2F Trying to help someone begin the process of accepting chronic pain is no easy task. My observation is that people need time to recognise that their pain problem is not acute pain  (so it won’t ‘heal’), and go through the process of seeking ‘the cause’ (so the ‘cure’ can be found), then begin the long process of adjusting expectations and renegotiating the new ’self’ as the person moves toward a life living with pain rather than fighting it. I also recognise that this path isn’t linear, rather it’s tortuous, winding back and forth from emotion to emotion as treatments are offered, more investigations are available, as anger and resentment and deep sadness emerge when new losses are experienced.  Some people may have their p... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2886781 Mon, 12 Oct 2009 18:24:07 +0100 2886781 http://www.medworm.com/index.php?rid=2883228&cid=t_105335_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F10%2F12%2Facceptance-in-chronic-pain%2F It’s a truism that no-one really wants to have pain (and if they do, we probably need to ‘talk’!).  Accepting pain may be equated with ‘giving up hope’ or ‘giving in’ – perhaps acceptance is thought to be about resignation rather than acknowledgement.  In any event, very few of the people I work with seem to be ready to acknowledge the reality of having pain and at the same time being aware of the ability to also experience joy, peace, fun and all the other good things in life. I’m not entirely surprised by this when I consider the way we’re raised to believe that: (1) pain is bad and must be avoided (2) doctors are all-powerful and can fix anything if only they try hard enough (except the common cold – but we can take ant... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2883228 Sun, 11 Oct 2009 19:26:01 +0100 2883228 http://www.medworm.com/index.php?rid=2865944&cid=t_105335_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F10%2F07%2Fwhat-is-an-acceptable-outcome%2F This study didn’t appear to directly look at the relationship between distress and treatment expectation – it would be an interesting area to study. What I’ll take from this study is this: part of my role is to help people move toward accepting that even if pain is present, and it’s more intense than hoped-for, life is still good and there are things we can do to make life better. Thorne, F., & Morley, S. (2009). Prospective judgments of acceptable outcomes for pain, interference and activity: Patient-determined outcome criteria Pain, 144 (3), 262-269 DOI: 10.1016/j.pain.2009.04.004 Scheier MF, Carver CS. Optimism, coping, and health: assessment and implications of generalized outcome expectancies. Health Psychol 1985;5:219–47. (Source: HealthSkills Weblog) HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2865944 Tue, 06 Oct 2009 18:37:59 +0100 2865944 http://www.medworm.com/index.php?rid=2862760&cid=t_105335_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=2862738&cid=t_105335_140_f&fid=35443&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FTheSplinteredMind%2F%7E5%2FivpcTw0nr08%2FSplinteredNarrative012.m4a Hear this article read to you: The pretty girls of Uniqlo are back for their seasonal clothing line update. This time they traipse about gay Paree in turtlenecks, short shorts & leggings. What I love about distractions like this is that they can give me a giggle, but have a built-in timer. I can only watch so much of it before I need to move on. Do you have any silly distractions you use to pick up your spirits or fight boredom, but not lose yourself in? (Be sure to turn on the manic, upbeat music for the full effect) Like reading The Splintered Mind? Share articles with your friends, link from your blog, or subscribe! Please visit the site and leave a comment or rate the article. I live for feedback. Thanks. (Source: The Splintered Mind by Douglas Cootey) The Splintered Mind by Douglas Cootey blogs http://www.medworm.com/rss/comments.php?id=2862738 Mon, 05 Oct 2009 01:26:50 +0100 2862738 http://www.medworm.com/index.php?rid=2842828&cid=t_105335_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=2836350&cid=t_105335_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F09%2F28%2Ffibromyalgia-time-for-the-rheumatologists-to-hand-over%2F The American College of Rheumatologists developed diagnostic criteria for fibromyalgia in 1990, the culmination of many years of debate and disparagement of the existence of this pain problem.  At the time, it was thought that it was a rheumatic complaint due to the presence of body pain and soft tissue tenderness, so the diagnosis and management of it was firmly in the rheumatologists camp.  Research over the last few years shows that it is in fact a pain syndrome centered in the nervous system. Two rheumatologists now suggest that fibromyalgia should no longer be managed by rheumatologists and it should be handed over to…primary care physicians. The information above is drawn from an editorial by Shir and Fitzcharles, in The Journal of Rheumatology 2009; 36:4.  What does this st... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2836350 Sun, 27 Sep 2009 18:33:09 +0100 2836350 http://www.medworm.com/index.php?rid=2793441&cid=t_105335_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F09%2F14%2Fits-a-long-road-to-pain-management%2F In New Zealand there are three comprehensive pain management centres where interdisciplinary three week programmes for managing chronic pain are run. That’s not a lot for a country of 4 million or so. No wonder it takes many people a long, long time to get a referral to a pain management centre for their chronic pain. Now I wish I could tell you how long it takes, on average, to get to pain management, and I wish I could say how much it costs New Zealand in lost productivity, health care costs, sickness and invalid’s benefits – but sadly, we simply don’t have that information. And yes, there is a difference between people receiving ACC and those who are not – there is a very clear disparity of access between people who have had ‘an accident’ and th... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2793441 Sun, 13 Sep 2009 18:53:36 +0100 2793441 http://www.medworm.com/index.php?rid=2786258&cid=t_105335_140_f&fid=35443&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FTheSplinteredMind%2F%7E5%2FL_HXshq-mRc%2Fblog_large.swf The pretty girls of Uniqlo are back for their seasonal clothing line update. This time they traipse about gay Paree in turtlenecks, short shorts & leggings. What I love about distractions like this is that they can give me a giggle, but have a built-in timer. I can only watch so much of it before I need to move on. Do you have any silly distractions you use to pick up your spirits or fight boredom, but not lose yourself in? (Be sure to turn on the manic, upbeat music for the full effect) Like reading The Splintered Mind? Share articles with your friends, link from your blog, or subscribe! (Source: The Splintered Mind by Douglas Cootey) The Splintered Mind by Douglas Cootey blogs http://www.medworm.com/rss/comments.php?id=2786258 Fri, 11 Sep 2009 07:13:31 +0100 2786258 http://www.medworm.com/index.php?rid=2782304&cid=t_105335_140_f&fid=35443&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FTheSplinteredMind%2F%7E5%2FTGkEzW0hGKQ%2FSplinteredNarrative011.m4a Hear this article read to you: Bunny Doll Study - Step Four Originally uploaded by Darkstream. As I type this it is 3:16am and I am sitting outside my front yard along the wall that divides our yard from our neighbor’s. The weather is a balmy 77°F and a warm breeze teases a wind chime somewhere out in the night. The occasional car drives by, but otherwise I sit here alone with no soundtrack other than the sound of crickets playing their syncopated symphony. I still have yet to begin a very difficult article, but I know I will manage it very soon. First, though, I wanted to declare victory over my ADHD. The blasted bunny doll drawing is done. I began it years ago when aliens where busy organizing tribes of men into pyramid building communities. Every once in a while, a drawin... The Splintered Mind by Douglas Cootey blogs http://www.medworm.com/rss/comments.php?id=2782304 Thu, 10 Sep 2009 10:54:26 +0100 2782304 http://www.medworm.com/index.php?rid=2772731&cid=t_105335_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