233 posts · 242,894 views
This blog offers health care providers thoughtful commentary and resources so they can help people develop their skills for living well, while respecting individual values. Much of the blog is concerned with the management of chronic pain.
Adiemusfree
233 posts
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- April 14, 2009
- 05:00 AM
- 1,239 views
When and how should new therapies become routine clinical practice?
by Adiemusfree in Healthskills: Skills for Healthy Living
Bo and Herbert argue that the current way that new therapies become integrated into our daily clinical work is ‘far from optimal because innovative therapies still become accepted practice on the basis of laboratory research alone.’ I agree. Worse still, old therapies that have little evidence to support them continue to be used - even in the face of clinical studies demonstrating that they have no greater effect than placebo.... Read more »
BO, K., & HERBERT, R. (2009) When and how should new therapies become routine clinical practice?. Physiotherapy, 95(1), 51-57. DOI: 10.1016/j.physio.2008.12.001
- March 31, 2009
- 02:33 PM
- 1,953 views
Feeling the fear - and not even thinking about doing it
by Adiemusfree in Healthskills: Skills for Healthy Living
Anxiety sensitivity (AS) is basically the fear of feeling anxious, or feeling anxiety-related symptoms. Typically, when people are fearful of their own symptoms of anxiety, they’ll work to avoid getting into situations where they may experience these symptoms. AS has been shown to be a predisposing factor in some anxiety-related disorders such as panic attacks. [...]... Read more »
Lance M. McCracken, & Edmund Keogh. (2009) Acceptance, mindfulness, and values-based action may counteract fear and avoidance of emotions in chronic pain: an analysis of anxiety sensitivity. The Journal of Pain, 10(4), 408-415.
- March 30, 2009
- 02:04 PM
- 1,653 views
Attention management for chronic pain
by Adiemusfree in Healthskills: Skills for Healthy Living
Deliberately using imagery, attention diversion and mindfulness to cope with pain is not something new. It’s great though, to find that it has some very positive results when studied in a formal clinical research setting.
Elomaa, Williams and Kalso use a fairly straightforward research design to examine the effects, in a clinical population, of systematic training [...]... Read more »
ELOMAA, M., DECWILLIAMS, A., & KALSO, E. (2009) Attention management as a treatment for chronic pain. European Journal of Pain. DOI: 10.1016/j.ejpain.2008.12.002
- March 29, 2009
- 02:08 PM
- 927 views
Musing about activity levels
by Adiemusfree in Healthskills: Skills for Healthy Living
Last week I spent a little time looking at activity regulation, and especially looking at over-activity or persistence, rather than the usual under-activity or avoidance pattern. I was reading an in press paper by Hans Heneweer, Luc Vanhees and Susan Picavet, looking at a proposed ‘U-shaped’ relationship between activity and the development of low [...]... Read more »
Heneweer, H., Vanhees, L., & Picavet, H. (2009) Physical activity and low back pain: A U-shaped relation?. Pain. DOI: 10.1016/j.pain.2008.12.033
- March 23, 2009
- 02:19 PM
- 1,403 views
Overdoing or Underdoing: Activity levels in chronic pain
by Adiemusfree in Healthskills: Skills for Healthy Living
By a strange coincidence, after writing about regulating activity levels yesterday, I came across a pre-print editorial in the European Journal of Pain discussing exactly this: avoidance or persistence.
We’ve become quite familiar with the avoidance idea - avoidance leading to deactivation, leading to disability, loss of roles, depression and so on. There have been [...]... Read more »
Karsdorp, P., & Vlaeyen, J. (2009) Chronic pain: Avoidance or endurance?. European Journal of Pain. DOI: 10.1016/j.ejpain.2009.02.001
- March 22, 2009
- 02:19 PM
- 944 views
Fine tuning activity levels
by Adiemusfree in Healthskills: Skills for Healthy Living
A couple of days ago I wrote about activity patterns, and a study from Maastricht University that looked at the variable levels of activity that people with chronic pain can engage in. The study was designed to look at the pattern of activity from day to day, and found ‘… that for most of [...]... Read more »
HUIJNEN, I., VERBUNT, J., ROELOFS, J., GOOSSENS, M., & PETERS, M. (2009) The disabling role of fluctuations in physical activity in patients with chronic low back pain. European Journal of Pain. DOI: 10.1016/j.ejpain.2008.12.008
- March 17, 2009
- 02:27 PM
- 1,482 views
Self management support - what patients really want?
by Adiemusfree in Healthskills: Skills for Healthy Living
The term ’self management’ is used a lot in health care, but I’m not sure yet whether there is a satisfactory definition of it. Some of the definitions I found on the internet suggest it’s a relationship between the patient and the practitioner, with the focus on the patient ‘taking responsibility for doing what [...]... Read more »
Matthias, M., Bair, M., Nyland, K., Huffman, M., Stubbs, D., Damush, T., & Kroenke, K. (2009) Self-Management Support and Communication from Nurse Care Managers Compared with Primary Care Physicians: A Focus Group Study of Patients with Chronic Musculoskeletal Pain. Pain Management Nursing. DOI: 10.1016/j.pmn.2008.12.003
- March 16, 2009
- 02:22 PM
- 1,187 views
Which came first: pain or disability?
by Adiemusfree in Healthskills: Skills for Healthy Living
‘It’s my back, the pain - I can’t do anything because I’m so sore…’
The cry of the weekend gardener! I’m one of them - I spent a good part of my Sunday out in the garden, lugging really heavy (20 litre) bags of compost about, bending, weeding, carrying - and by the end of [...]... Read more »
HUIJNEN, I., VERBUNT, J., ROELOFS, J., GOOSSENS, M., & PETERS, M. (2009) The disabling role of fluctuations in physical activity in patients with chronic low back pain. European Journal of Pain. DOI: 10.1016/j.ejpain.2008.12.008
- March 15, 2009
- 02:18 PM
- 1,540 views
Placebo and social observational learning
by Adiemusfree in Healthskills: Skills for Healthy Living
One of the greatest enigma in health is the human response to placebo. Placebo itself is an inert substance or treatment that has no effect - yet humans can respond with physiological changes as if the substance was active. For years some unscrupulous medical practitioners have used this response in people experiencing chronic [...]... Read more »
Colloca, L., & Benedetti, F. (2009) Placebo analgesia induced by social observational learning. Pain. DOI: 10.1016/j.pain.2009.01.033
- March 4, 2009
- 06:31 PM
- 1,833 views
Graded exercise or walks for recurrent low back pain
by Adiemusfree in Healthskills: Skills for Healthy Living
As a confirmed exercise-free zone, I am always interested in studies that look at whether specific exercise makes a difference in recovery for people with chronic pain. My preference is to dance (yes, belly dance is good!), and I enjoy walking and cycling, but gyms? no way!
This study caught my eye because it is a [...]... Read more »
Rasmussen-Barr E, Ang B, Arvidsson I, Nilsson-Wikmar L. (2009) Graded exercise for recurrent low-back pain: a randomized, controlled trial with 6-, 12-, and 36-month follow-ups. Spine, 34(3), 221-228. DOI: 19179916
Rasmussen-Barr E, Ang B, Arvidsson I, Nilsson-Wikmar L. (2009) Graded exercise for recurrent low-back pain: a randomized, controlled trial with 6-, 12-, and 36-month follow-ups. Spine, 34(3), 221-228. DOI: 19179916
Rasmussen-Barr E, Ang B, Arvidsson I, Nilsson-Wikmar L. (2009) Graded exercise for recurrent low-back pain: a randomized, controlled trial with 6-, 12-, and 36-month follow-ups. Spine, 34(3), 221-228. DOI: 19179916
Rasmussen-Barr E, Ang B, Arvidsson I, Nilsson-Wikmar L. (2009) Graded exercise for recurrent low-back pain: a randomized, controlled trial with 6-, 12-, and 36-month follow-ups. Spine, 34(3), 221-228. DOI: 19179916
- March 1, 2009
- 01:09 PM
- 1,100 views
‘Psychosocial’ - is it Pandora’s box?
by Adiemusfree in Healthskills: Skills for Healthy Living
I’ve been reading a paper written by Cam Crawford about GP’s use of the ‘Yellow Flags’, or psychosocial risk factors for identifying ‘at risk’ patients. It seems clear from his sample of GP’s that few of them are comfortable with the Guidelines as they are presented - and that their discomfort arises for quite [...]... Read more »
Cameron Crawford, Kathleen Ryan, Edward Shipton. (2007) Exploring general practitioner identification and management of psychosocial Yellow Flags in acute low back pain. The New Zealand Medical Journal, 120(1254), 1-13. DOI: http://www.nzma.org.nz/journal/120-1254/2536/
- February 26, 2009
- 02:00 AM
- 681 views
‘Payment by outcome’ in pain management
by Adiemusfree in Healthskills: Skills for Healthy Living
Today I was informed that a major purchaser of pain management services was preparing to ‘move to payment by outcome’. What does that mean?
Well, over the past few weeks and months I’ve been thinking about what the major influences are on health care practice. Is it ‘the evidence’? Is it patient need? Is it patient [...]... Read more »
R. Mannion, & H. T O Davies. (2008) Payment for performance in health care. BMJ, 336(7639), 306-308. DOI: 10.1136/bmj.39463.454815.94
- February 25, 2009
- 02:24 AM
- 1,383 views
An illustration of therapist drift
by Adiemusfree in Healthskills: Skills for Healthy Living
To recap, over the past couple of days I’ve written about how therapists can contribute to ineffective treatment. These factors include our bias toward thinking that our therapy is working and we’re doing it well, while attributing failure to patient motivation or recognising small changes as much more important than they are. In addition, [...]... Read more »
Glenn Waller. (2009) Evidence-based treatment and therapist drift. Behaviour Research and Therapy, 47(2), 119-127. DOI: 10.1016/j.brat.2008.10.018
- February 24, 2009
- 03:33 AM
- 1,111 views
Drifting… from the plan: evidence-based treatment and therapist drift
by Adiemusfree in Healthskills: Skills for Healthy Living
Yesterday I looked at some of the points made by Waller in his paper on Evidence-based treatment and therapist drift (2009) when I discussed times when therapists contribute to poor outcomes from treatment. I started looking at this when I was thinking about the distinction between ‘teaching’, ‘education’ or ‘information’ and helping someone reconceptualise their [...]... Read more »
Glenn Waller. (2009) Evidence-based treatment and therapist drift. Behaviour Research and Therapy, 47(2), 119-127. DOI: 10.1016/j.brat.2008.10.018
- February 23, 2009
- 02:36 AM
- 1,862 views
Drifting… from the plan: evidence-based treatment and therapist drift
by Adiemusfree in Healthskills: Skills for Healthy Living
It’s not something we like to talk about. In fact, it’s something I think many of us don’t really even know about. What I’m talking of is how therapists drift, stray, or deviate from what is evidence-based treatment into what is not.
Strangely enough, I’ve been thinking of this in relation to my post yesterday about [...]... Read more »
Glenn Waller. (2009) Evidence-based treatment and therapist drift. Behaviour Research and Therapy, 47(2), 119-127. DOI: 10.1016/j.brat.2008.10.018
- February 18, 2009
- 02:40 AM
- 1,727 views
What is breakthrough pain, and what about using medication for it?
by Adiemusfree in Healthskills: Skills for Healthy Living
Everyone knows that chronic pain continues, and anyone who has chronic pain will tell you that it fluctuates. Some days are ‘good’ (well…better), some days are …well… not so good.
Some people think of this pain as ‘a new injury‘. Of course, the change in pain is rarely associated with tissue damage, calling it an ‘injury‘ [...]... Read more »
J MARKMAN. (2008) Not so fast: The reformulation of fentanyl and breakthrough chronic non-cancer pain. Pain, 136(3), 227-229. DOI: 10.1016/j.pain.2008.03.011
- February 17, 2009
- 01:59 AM
- 1,536 views
Comprehensive, intensive pain management is cost effective
by Adiemusfree in Healthskills: Skills for Healthy Living
There are many treatments for chronic low back pain. One paper recently reviewed the range of treatments as if they were available on a supermarket shelf - they made the point that ‘When a new treatment approach is being considered in fields as cardiology, infectious diseases, acute trauma, or neurology, there is a general expectation [...]... Read more »
I.B. Jensen, H. Busch, L. Bodin, J. Hagberg, Å. Nygren, & G. Bergström. (2009) Cost effectiveness of two rehabilitation programmes for neck and back pain patients: A seven year follow-up. Pain. DOI: 10.1016/j.pain.2008.12.015
I.B. Jensen, H. Busch, L. Bodin, J. Hagberg, Å. Nygren, & G. Bergström. (2009) Cost effectiveness of two rehabilitation programmes for neck and back pain patients: A seven year follow-up. Pain. DOI: 10.1016/j.pain.2008.12.015
- January 22, 2009
- 12:07 AM
- 1,380 views
‘So how do you feel?’ - when should you ask about pain?
by Adiemusfree in Healthskills: Skills for Healthy Living
If you have ever had to fill out a client charge-out sheet you will know just what a pain it can be to have to record what you’re doing every 10 minutes or so…and if you’ve EVER tried to get a patient to fill out a daily activity diary, daily pain diary - or any [...]... Read more »
J BRODERICK, J SCHWARTZ, S SCHNEIDER, & A STONE. (2008) Can End-of-Day Reports Replace Momentary Assessment of Pain and Fatigue?. The Journal of Pain. DOI: 10.1016/j.jpain.2008.09.003
J BRODERICK, J SCHWARTZ, S SCHNEIDER, & A STONE. (2008) Can End-of-Day Reports Replace Momentary Assessment of Pain and Fatigue?. The Journal of Pain. DOI: 10.1016/j.jpain.2008.09.003
- January 20, 2009
- 02:25 AM
- 1,779 views
What’s getting in the way of good pain management in rheumatoid arthritis?
by Adiemusfree in Healthskills: Skills for Healthy Living
It seems obvious, doesn’t it, that if there is a good understanding of the mechanism of a painful disease, some effective ways to treat it, and it’s an ‘acceptable’ disease to have (unlike some mental health disorders) - then people with the disease should really have great pain relief…or is it?
This study by Fitzcharles, DaCosta, [...]... Read more »
M FITZCHARLES, D DACOSTA, M WARE, & Y SHIR. (2008) Patient Barriers to Pain Management May Contribute to Poor Pain Control in Rheumatoid Arthritis. The Journal of Pain. DOI: 10.1016/j.jpain.2008.09.012
- January 19, 2009
- 01:01 PM
- 1,810 views
Quality assessment of diagnostic accuracy
by Adiemusfree in Healthskills: Skills for Healthy Living
I was taking a moment or two to looked through some of my RSS feeds, and came across this post on the quality of diagnostic accuracy. QUADAS stands for:
Q – Quality
A – Assessment of
D – Diagnostic
A – Accuracy
S – Studies
It’s especially developed for people who use physical assessment, and in this post written by physiotherapist [...]... Read more »
Penny Whiting, Anne WS Rutjes, Johannes B Reitsma, Patrick MM Bossuyt, & Jos Kleijnen. (2003) The development of QUADAS: a tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews. BMC Medical Research Methodology, 3(1), 25. DOI: 10.1186/1471-2288-3-25
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