Links and other good things from my intray

One of the great things about being an information junkie is the amount of cool stuff that I get to read via the internet and email.  So I thought I’d show you some of the stuff I’ve got in the last little while.

First up is the Pain Blog Carnival run by How to Cope with Pain.  The topic this month is Thankfulness, because it’s that time of the year.  We don’t have this event in New Zealand – shame really – because it’s a great idea to celebrate all that people are thankful for.  I’m especially thankful that I live here in New Zealand – it’s a beautiful country, beautiful scenery, wonderfully open and friendly people, and the lifestyle is incredible.  Not to mention that people in New Zealand can understand me, while in other parts of the world people can find my accent somewhat hard to follow!

Next is a regular newsletter I get from RTW Matters. This week is especially cool because it has notice of a new RTW guide for occupational therapists, published by the esteemed Canadian Institute for Work and Health, in collaboration with the Ontario Society of Occupational Therapists and College of Occupational Therapists, Ontario. I’ll be commenting on this soon, so come on back for more! (more…)

Virtual Symposium on Pain

Just a quick link to the Canadian Physiotherapy Association web page with details on their Virtual Symposium on Pain.

Just like a traditional face-to-face conference, this unique online event will feature interactive learning sessions highlighting the most recent advances in pain science, and provide a forum for an energizing exchange of ideas focused on the treatment of patients with painful conditions.

This event will be relevant to all physiotherapists working with people with painful conditions. Sessions will be of particular interest to those working in multidisciplinary, return-to-work and pain management programs. Sessions are designed at an introductory to intermediate level.

How does it work?
By participating in three self-paced, interactive workshops throughout November, participants will be introduced to the vocabulary, evidence base, and current best practices in pain management. Each workshop will include one formal presentation, followed by a combination of reflective and collaborative exercises and online discussion with fellow participants, allowing you to apply your learning and explore the state of the art with colleagues across Canada and around the world.

Workshop 1: The Birth of the Pain Experience
with Dave Walton
(Begins November 3)

Workshop 2: How Pain Becomes Persistent
with Debbie Patterson
(Begins November 10)

Workshop 3: Assessment and Management Trends
with Neil Pearson
(Begins November 17)

Synthesis and Panel Discussion (Live) (Date TBC)

Cost?  Canadian $  $375 for non-members of the Canadian Physiotherapy Association.

A couple of interesting podcasts

If you haven’t ever listened to a podcast, maybe today’s post will be an eye-opener.  PainAwareness was set up during the month of September which is Pain Awareness month, but has extended beyond that.  While the content is a little limited at present, there is an interesting podcast about chronic pain (three, actually!).  While it has been sponsored by Ortho-McNeil-Janssen, the emphasis is on exercise and chronic pain.  People from the US will recognise the Olympian Nikki Stone who features on the podcast and experiences chronic pain herself.  This is a good mode for providing patients with a positive message about the usefulness (and safety) of exercise despite experiencing ongoing pain. (more…)

Medscape continuing education – 2 courses on chronic pain

I just found these CME courses on Medscape…

This one is on the use of methadone in chronic pain… a video presentation.

And this one is on Putting Together the Fibromyalgia Puzzle: New Understandings in Pathophysiology and Management

Yes, you’ll have to register, but it’s free – and great to have some quality education. I’ve used some of these CME courses for my Recertification Portfolio for registration, so keep a record of any courses you complete and include them in your portfolio. Use your critical thinking skills to critique the courses too, remembering that these ones are medically-biased, and may not represent the biopsychosocial model that is used widely in chronic pain management, especially in NZ.

The future of psychological management of chronic pain

One of my guru’s in chronic pain is Dr Lance McCracken from University of Bath.

I found this great powerpoint presentation, with his voiceover today, on the future of psychology in chronic pain. A great lecture that is well worth saving some time and listening to. Grab a couple of colleagues, a bottle of wine or a coffee, and spend an hour listening to his talk while following the slides. You can’t download it, but you can bookmark it and return to it when you want.

I have the books he refers to DAHL, J., & LUNDGREN, T. (2006). Living beyond your pain using acceptance and commitment therapy to ease chronic pain. Oakland, CA, New Harbinger Publications., and MCCRACKEN, L. M. (2005). Contextual cognitive-behavioral therapy for chronic pain. Progress in pain research and management, v. 33. Seattle, IASP Press.. Both of them are easy to read, have some depth, and help with that important process of coming to terms with accepting rather than judging the pain experience.

A personal bias

Now some readers have been wondering what my background is…Sometimes I feel like being rather provocative and asking why – while other times, like now, I feel like ‘fessing up.

Here is a clue: in pain management, to me the most important thing is to see people doing things differently.

That’s right, although I’m a strong believer in working with thoughts and beliefs and values and so on – if it doesn’t mean something observable changes, it didn’t work. My aim with pain management is to help people do what they want to do, to be in control so they can achieve their potential, not just ‘feel better’. Likewise with teaching – if I haven’t stimulated you to do something differently, then I’ve failed.

My reason? Well in pain management, because pain is a quale, that is, it has sensory and emotional qualities that we can’t directly share with each other, we cannot ever know how much pain another person is feeling. The only clues we have that pain is present (or not) is what the person does about it. That is, behaviours or actions. Even when the experience is an emotion, you and I can’t share the emotion except through the medium of language or action.

So we infer that pain is present on the basis of behaviours (including speech). This is one reason that, as clinicians, we can never truly say whether someone is ‘malingering’ or ‘faking’ (that’s more likely the job of a private investigator!) – and if behaviours are the only aspect of pain that we can observe, we also need to acknowledge that behaviours are subject to all the influences of any behaviour, such as contingencies and social learning as well as cognitive aspects such as attitudes, beliefs and so on.

As a result, we can do a whole heap of work with someone’s thinking, but unless they do something differently, nothing has really changed for them. If they feel more positive, hopefully we could count smiles; if they are less distressed, hopefully they will go to the Emergency Department less; maybe even return to work! We also know that if people do more, feel better about themselves, and they’re able to do more!

This isn’t new stuff – this is pretty fundamental to the operant conditioning model of pain introduced by Wilbert Fordyce in the early 1980’s onwards. By conceptualising pain behaviour as the subject of treatment, Fordyce introduced the idea of living despite pain. By noticing that reports of pain intensity vary depending on distress, depression, reinforcement from over-supportive others and so on, psychologists recognised that if pain behaviours reduce, often reports of pain intensity reduce. And more importantly, people began to live lives again. Now that’s what I’m about!

For more from the man himself, here are a couple of the original articles – plus a couple of others that are important to explain the biopsychosocial model.

Did the clue help? Do you know what ‘flavour’ health professional I started off as? Do you know what flavour health professional I am now? Does it really matter?

Fordyce, W. E. (1984). Behavioural science and chronic pain. Postgraduate Medical Journal, 60(710), 865-868.

Fordyce, W. E., Roberts, A. H., & Sternbach, R. A. (1985). The behavioral management of chronic pain: a response to critics. Pain, 22(2), 113-125.

Fordyce, W. E., Shelton, J. L., & Dundore, D. E. (1982). The modification of avoidance learning pain behaviors (Journal of Behavioral Medicine. 5(4):405-14, 1982 Dec.).

Gatchel, R. J., Peng, Y. B., Peters, M. L., Fuchs, P. N., & Turk, D. C. (2007). The biopsychosocial approach to chronic pain: scientific advances and future directions. Psychological Bulletin, 133(4), 581-624.

Turk, D. C., & Monarch, E. S. (2002). Biopsychosocial perspective on chronic pain. In D. C. Turk & R. J. Gatchel (Eds.), Psychological approaches to pain management (2 ed., pp. 3 – 29). New York: The Guilford Press.

Oh, here are some other on-line bits and pieces on the biopsychosocial model. Firstly, a review of a video by Bob Gatchel on Pain Management using the Biopsychosocial Model…

For those who don’t think a full-on postgraduate course is possible, this on-line CME course may be helpful:
UCLA CME course

And don’t forget the University of Otago, Christchurch, papers in Pain and Pain Management – see the link to your right…