Chronic pain management is NOT just like ‘any other chronic disease’

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 [...]

Accepting low back pain: Is it related to a good quality of life?

The purpose of pain management is, in the end, of no earthly use if it doesn’t change a person’s quality of life. It’s fine to maybe reduce pain intensity (remembering that most pain reduction approaches seem to reduce pain by around 10 – 40%), and it’s great to improve function – but unless the [...]

What is an acceptable outcome?

Recently I’ve been doing some content analysis of the responses people entering our service have to the question ‘What is your goal for pain management?’ The question is designed to find out what it is that people want so that in some way we can work to meet their expectations.
Along similar lines I’ve been [...]

Fibromyalgia: an overview

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 [...]

Chronic pain after surgery

Surgery is supposed to hurt. Well maybe not ’supposed’ to, but most people expect some pain after surgery – as one doctor said to me, it’s really ‘planned trauma’. The problem for some people is that the pain doesn’t settle afterwards – and up to 50% of people undergoing surgery can fail to [...]

Pacing and avoidance in fibromyalgia

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 [...]

Take the pain away and the other problems go too? A loooooong post

There are some days I despair that the biopsychosocial model will EVER take hold in the died-in-the-wool medical interventionist strongholds.
This quote from a discussion with a colleague might help you join in my pity party…The conversation is about a case of a young woman with 18 month history of neck pain post-MVA, she has been [...]

Safety behaviours – do they maintain kinesiophobia?

Let me start by saying this post is conjecture, but based both on observing patients, and after reading an interesting paper on ’subtle avoidance and safety behaviours relevant to social anxiety’.
First some definitions: I hope you’re all familiar with the term ‘kinesiophobia’, or ‘fear of movement’ – it’s the fear and avoidance of movements that [...]

Functional capacity evaluations – do they predict function in the ‘real world’?

What do you do when a client has a goal ‘to establish functional abilities for work’, spends a lot of time looking at setting baselines at home, develops a good knowledge of how to maintain consistency, starts to work and sustains abilities in a specific workplace, then completes a functional capacity evaluation that says he [...]

How do you decide when to stop doing something?

There are plenty of times when it’s easy to give up on doing something – just ask me to do the vacuum cleaning or do a workout at the gym! On the other hand, there are plenty of times when someone close to me sighs and asks ‘How long are you going to be?’ [...]