Wandering back from the IASP World Congress

Meetings, meanderings, mind-expansions

I’ve been away for abut 10 days, attending the World Congress of the International Association for the Study of Pain. It was a time of meetings with wonderful people I’ve met via the interwebs, with researchers and clinicians, and most importantly, with people living with pain.

It was also a time for meanderings – around the very walkable city of Boston, embracing history and looking towards the future, and mind meanderings as well.

And because it was a conference, it was also mind-expanding. New ideas, new ways of investigating this human experience of pain, new discoveries, and new applications.

… and expanding the way we help people who live with pain.

What struck me between the eyeballs?

Good things: for the first time, people living with pain were included in the proceedings. I’m reminded of the old saying from the disabilities movement “Nothing about us without us” – well, it’s finally arrived at the World Congress! There are some concerns about this move amongst clinicians, and there’s no doubt that some of the people I’ve seen for whom the experience of being seen about their pain has been disheartening, stigmatising and frustrating, are very angry. I think, though, that continuing to avoid meeting with people who are in this space serves only to fuel their rage, and perhaps it’s time for us as clinicians to learn what it is about their experiences that we can learn from.

Professor Fiona Blyth talking about the Global Burden of Disability – 21%

Another “between the eyeballs” moment was when Professor Fiona Blyth discussed the knowledge that 21% of the total global burden of disability, and that this is increasing more quickly in developing countries because of the rapidly increasing percentage of older people (with multiple MSK comorbidities) – but here’s the kicker: There has been little-to-no change in funding policies to reflect this increasing burden of disease. You read that right. Funding goes to diseases that can kill you – but very little goes to the diseases that simply leave you disabled for the rest of your days.

Not so good things: Well, much of the research shows that change is incremental and that while strategies like exercise have reasonably good research support what actually matters is that exercise gets done: the form of exercise for persistent pain is a whole lot less more important than issues of adherence (Professor Kathleen Sluka’s plenary lecture showed this).

There was a good focus on behavioural science and pain, disability and response to treatment. And plenty of emphasis on sharing the responsibility for using psychologically-informed treatments with all health professionals, not just psychologists.

Why have I included this in my “not so good things”? Because a very recent Twitter discussion suggests that there continues to be a misperception that by using a psychologically-informed treatment, the aetiology of a pain problem is therefore assumed to be psychological.

There continues to be tussling over whether a biopsychosocial (or sociopsychobiological) model has sufficient emphasis on “the bio”, along with misinterpreting the historic origins of Engel’s thinking. Various people argue that “all is bio” or “but it’s reductionist” – yet readers of Engel’s original writings will recognise an interactional systems approach, where an effect in one factor will likely have flow-on effects everywhere else.

The final “not so good” for me was the dearth of discussion about occupational therapy’s historic and ongoing involvement in pain and pain management. There were at least 20 occupational therapists at the meeting, and despite Fordyce including occupational therapists in his original behavioural approach to disability (Fordyce, Fowler & Delateur, 1968), scant evidence of occupational therapy’s important contribution to this field over the years.

This is important because occupational therapy is one of the few professions to have adopted, retained and integrated a sociopsychobiological approach to healthcare. If you’re ever thinking about asking “how does one profession use the BPS model?” maybe talking with an occupational therapist will help you.

I was lucky to have a chance to offer a piece of research conducted by Brian Rutledge and me, looking at the function of an online discussion group (yes! Facebook!). The purpose was to establish whether the group Exploring Pain Science functions as a “Community of Practice“. The answer is a resounding Yes! and you can review the poster here – click

There will be a paper forthcoming, and some further analysis of the processes used in this group.

…Why look at Facebook groups?

Well, one reason is that there was a resounding call for knowledge translation – and all manner of ways thought to be useful in this pursuit. But as far as I am aware, using Facebook groups (especially ones that have emerged “organically”) is both a popular strategy – and one that has been under-examined in pain research – for people trying to implement what they’ve read or heard from research into their daily practice.

Hope this very brief tour through just a couple of the things I’ve been pondering since this World Congress will encourage YOU and others to join IASP. It truly represents the only global organisation that is transprofessional, wedded to a biopsychosocial model of pain, and one that is progressing our understanding of pain so much.

Fordyce, W. E., Fowler, R. S., & Delateur, B. (1968). An Application of Behavior Modification Technique to a Problem of Chronic Pain. Behaviour Research and Therapy, 6(1), 105-107.

NZ Pain Society Annual Scientific Meeting

Well, and now I’m back down to earth after spending a fortnight experiencing acute pain (and they’re STILL sore) and then talking pain at the Conference.
Not a major post today, just some links from the conference that might be worthwhile looking at.

First of all, Prof Mike Chester spoke about angina pain, and has an extensive website on managing refractory angina at this site. Take a look at the resources! Wow! The care pathway is a comprehensive guideline for systematically managing the problem of persistent angina (oh and much of it could also apply to persistent noncardiac chest pain). I especially appreciate the chapters on management that include the patient centred model, something that acknowledges that if a person is given adequate information about their treatment options, they can then make their own decision about what to do next, with a little support.

Another speaker was Associate Prof Mike Nicholas, a frequent visitor to New Zealand (well, you know he is really still a kiwi underneath!), who established the INPUT and ADAPT pain management programmes, and is both an articulate and informed speaker about interdisciplinary pain management. Head to here to read about ADAPT and here to read about INPUT. Something I particularly appreciated about Mike’s comments were that there is a definite dose-response in terms of how much input is needed for an effect to occur when using a cognitive behavioural approach to pain management. Pain management ‘lite’ does not have as much of an impact as intensive pain management.

If you’ve never heard Lorimer Moseley speak, you’ve missed a treat. He’s a relaxed Australian who can get a whole roomful of clinicians to stand up and ‘Do The Time Warp Again’! For a video from 2008, take a look at this…and if you do a search through MedLine, you can’t miss his publications – there are quite a few! While much of his work is basic science or related to neuroimagery, his heart is to apply the research to real people with real chronic pain, particularly complex regional pain syndrome.

And if you missed out on attending, you can go to the NZ Pain Society website and look through the powerpoints which will be up shortly.

I’ll be posting shortly about some of the other things that I enjoyed (apart from the Polynesian Spa…), and post the powerpoints from my presentations too.

NZ Pain Society Conference

This year’s conference is in Rotorua in July. Take a look at these speakers!

There is Professor Michael Chester Director of the National Refractory Angina Centre, Consultant Cardiologist Royal Liverpool and Broadgreen University Hospital NHS Trust. Professor of Rehabilitation and Preventive Health Education, Liverpool Hope University.

Lorimer Moseley, knownfor his work on motor imagery in complex regional pain syndrome, Senior Research Fellow, Prince of Wales Medical Research Institute, Randwick, Australia.

And Michael Nicholas, Clinical Senior Lecturer, The University of Sydney, Anaesthesia and Pain Management, Department of Anaesthesia.

Go here for more details, and the preliminary version of the programme.

If you’re not from New Zealand – Rotorua has to be seen and experienced! It’s a beautiful location, New Zealand’s largest geothermal region with both excitement and relaxation all within a very small area.

This is a great website to learn about Rotorua

These are the Rotorua Museum Buildings

And the mud pools are a feature, along with geysers and hot pools.

A very beautiful part of the world.

Don’t forget, if you’re an occupational therapist, the occupational therapy pain meeting is planned for Thursday 23 July, from 3.30 – 6.30pm with an informal dinner out together afterwards.  To register for this head here

There are some grants available from the NZ Pain Society, but costs of the Conference are pretty reasonable anyway (if you register before 12 June, it’s $545 for non-NZ Pain Society members).

I hope to see you there!

Calling occupational therapists working in pain management!

New Zealand Pain Society Annual Scientific Meeting: 23 – 26 July 2009

Calling all occupational therapists working in the field in New Zealand to register for the pre-conference occupational therapy meeting.

22 July, 3.30pm – 6.30pm (with informal dinner out afterwards!)

‘Doing and being: Occupational therapy issues in chronic pain management’

This will be a facilitated discussion and consensus building around issues in pain management common to occupational therapists.  Topics yet to be confirmed may include:

  • defining activity pacing
  • exposure therapy for pain-related anxiety and avoidance
  • goal setting
  • providing occupational therapy as a single discipline
  • working in teams

Registration will be a tiny $40, and the opportunity to network – priceless!

For more details,