Don’t go to the internet to get good information about chronic pain
…it’s true, you know, the quality of the information about chronic pain found on the internet is poor – at least it was when this study was conducted (of course, that was before this blog got started!). ‘In December 2007, there were an estimated 1.3 billion Internet users worldwide with the usage growth increasing by 265% from 2000 to 2007’ – I don’t think that numbers will have decreased since then!
Anyway, in this study, Corcoran and colleagues developed a scoring tool to measure the quality of the material they found when searching the internet using the terms ‘chronic pain’, and using the popular search engines like Google and Yahoo. Their scoring was developed from terms from the Health on the Net code, with some modification to improve reliability.

Their search process copied the ‘typical’ searches carried out by people looking for information on the internet – that is, they used the search term ‘chronic pain’, hit the first or maybe the second page of a website and stopped there. It’s interesting to note that the patterns Corcoran and colleagues used are very typical of the patterns I see on this blog – people hit the first page and then maybe go to one other page, but then leave.

What did they find?
‘A total of 50 websites were retrieved, 10 per search engine. There were 23 websites duplicated across the search engines, leaving a total of 27 websites to be scored’

I suppose it’s a blessing that the search engines found relatively similar sites, so there doesn’t appear to be any advantage in using one search engine over another. And from the quality scoring, there wasn’t any difference in terms of quality between the different search engines. What was a bit worrying was that only two sites scoring as ‘very good’ or ‘excellent’ – and one of them is wikipedia (which as we know, is subject to frequent revision! – and may change from day-to-day…)
Just to give you an idea of the areas considered under the quality scoring:

Authors contact
Reference quantity
Reference quality
Original date
Revised updates
Total score

So, the overall quality of the sites across these headings was, on the whole, not good. In fact, combining ‘technical’ aspects (ie, did the site cover a range of interventions for each pain condition, did it identify the type of pain condition it discussed and so on), and the ‘quality’ aspects as I’ve listed above could generate a score of 22. These scores were then converted to a percentage. The authors found that ‘Only 2 out of the 27 websites we evaluated earned a grand score that ranked them as either excellent or very good. The vast majority was judged to be fair or poor.’

They also found ‘About 67% of sites had no statement of purpose, 60% were unreferenced, whereas 75% of sites mentioned drug therapy in some form, and over 30% (9 sites) omitted any mention of nondrug therapies’

So, the average web surfer looking for information on chronic pain is likely to find sites about drugs, the sites probably don’t identify why they’re published, don’t have any references to support their claims, and don’t say much about nonpharmacologic strategies. And we wonder why patients turn up with a weird and wonderful selection of ‘new’ drugs to try.

As Corcoran and colleagues point out: Patients with a chronic condition are more likely to search the Internet for healthrelated information than acute patients, and 39% of patients attending a university pain center had searched specifically for pain information on the Internet. This tendency to search for information, coupled with the poor quality of information available, increases the risk of patient misinformation which can lead to conflicting emotions. …Patients search the Internet because they feel they have not been fully informed…It is of concern that the information patients find on the Internet differs from what their doctor provides.’

What bothers me is that some health providers slate the patient for heading to the internet to find out more about their condition. Maybe it’s not the patient who should be criticised, it’s the quality of the site! How many of us write adeqautely referenced material for patients? How many public hospital services take the time to generate informative web-based material for patients, resorting instead to photocopied bits of paper (and would these bits of paper score any more highly in terms of quality than what these authors found on the web?)

This year I hope to work with Health Navigator and the NZ Pain Society to produce informative web-based material that will be accessible to patients looking to self manage their health condition. Perhaps if, in New Zealand at least, we combined forces and developed really sound material as a joint project, we might be able to ensure our patients can get good information when they go to google or bing or yahoo. If you are writing and putting your information on the internet, consider the Health on the Net code of ethics, join MedBloggers – make sure your material is accurate and of good quality. Public health promotion on the internet can be something that individuals can influence!

Corcoran TB, Haigh F, Seabrook A, & Schug SA (2009). The quality of internet-sourced information for patients with chronic pain is poor. The Clinical journal of pain, 25 (7), 617-23 PMID: 19692804

Pre-Christmas gratitude – 5 things I’m grateful for

In these couple of days before Christmas, it’s traditional to review some of the ‘best of’ 2008. It’s been just over a year since I started this blog, and the topic list and readership has grown a whole lot!

What am I grateful for in 2008?

  1. Teamwork – the people I work with are fantastic. You can’t work alone in pain management IMHO,  a team of like-minded people to support you both professionally and personally just can’t be beaten.  I take my hat off to the team at Burwood Pain Management Centre who keep me honest, deflate my ego (gently), cushion my falls, keep me standing and give me inspiration to keep on caring about what I do.
  2. Motivation – using motivational approaches like motivational interviewing to help people make their own choices rather than remaining ambivalent.  Whatever the choice, it’s easier to make changes once you’re moving than remain stuck.  I’m grateful for the sense of freedom that using motivational approaches has given me, and that I’ve been able to apply it in my work.  Now if only it could work with my kids?!
  3. The magic of the interweb – and so many dedicated bloggers. I find it unbelievable that there are so many people who spend time writing intelligent, interesting, provoking and inspiring posts on topics dear to my heart – and it’s all free (provided you can get on the internet).  There are so many topics to choose from, and the quality can be stunning.  I’m not a ‘Web 2.0’ kind of person, and I’m not about to rave about the wonders of interactivity, I’m simply awed at how many people spend time putting up resources so the rest of us can find them. (more…)

Age can be a thief

Although I talk of my peace and contentment with my age (I think I’ve become so much more comfortable with myself as I get older), there is no doubt that being very old and having memory loss is a real tragedy.

I was wandering through the internet, winding down after gardening most of today, when I came across one of the most touching sites I have ever seen…
Phillip Toledano is a photographer – and a son. This site is called Days with My Father and is a tender, touching account of his time with his aging and forgetful father in the days after his mother died. Sadly, Phillip’s father can’t remember that his wife has died, and Phillip pretends that she has gone to Paris…
With the poignancy of a son who is incredibly close to his father – but has a photographer’s eye and a poet’s words, this site is one to take some time over. Plan on spending a good 20 minutes or more as you view the stunning photographs and read the words as Phillip describes his father in what I can only describe as a gem in the many horrible sites you can view on the internet.

Psychology of pain…

A couple of links to some interesting reads…. One of them I picked up from Psychology of pain, written by  which a link to this RSS feed… If you’re not certain about RSS feeds, don’t panic! Most of our browsers (Firefox or Internet Explorer, for example) have the ability to add in a gadget to the toolbar (menu bar at the top of the browser) which means you simply click and a list of headlines appears below.  You can always go to Google to find out more, but it’s pretty easy.  I just did that, and found this link to PRESSfeed, which gives you a nice easy overview, and a ‘how to’.

Anyway, this particular RSS feed is based in ‘HubMed’ which I hadn’t heard of, but today when I clicked on the link, listed a good bunch of posts all from journals on topics about psychology and pain.  Worth linking to if you’re not currently subscribed to any Table of Contents links like Amedeo.  If you haven’t looked at Amedeo before, you simply subscribe, identify the topics you’re interested in, and each week, or more often, you’ll get an email listing the most recent articles in a range of listed journals.

This is another RSS feed I found on Psychology of Pain site, again it covers a range of articles, this time from the PubMed database.  Yesterday’s listings included a study on sleep, and a study on the Dimensions of Pain Quality…

PsychBlog is an interesting psychology blog – it’s readable, been running for a while now so not likely to disappear unexpectedly, and it has some great links.  This post is about a study I posted on a while back, but perhaps a bit more thoughtfully than I did – so worth a look.  And while you’re there, take a look at the wealth of other information that’s on that blog.  Fantastic!  BTW – this area is his ‘Resource’ area, take a look NOW, or you’ll be missing out on a lot of info!

‘Nuff from me for now – have a browse, and think about subscribing to one of those feeds.  Oh and if you’re wandering through the internet and find some cool stuff – give me a quick email and I’ll post them on here to share!  And that would be one way I could find out if there is anyone else out there…. *echo**echo**echo**echo*

A couple of geeky websites!

I just thought I’d post a couple of websites I’ve found over the past couple of days – using StumbleUpon. If you haven’t tried StumbleUpon, and you find yourself at a loose end, or just feel like ‘browsing’ the internet instead of watching TV, try it! Full of cool sites that show up randomly, or you can guide it by adding keywords for the areas you’re interested in.

Brain Explorer is a site put together by Lundbeck Institute. It has a wide range of information, but the bits I liked the most were the Brain Atlas section, and the gallery. Lots of great images, and relatively simple explanations.

Science Daily has a wealth of newsworthy links and posts. Headings of ‘Health & Medicine’, ‘Mind & Brain’, ‘Plants & Animals’, ‘Earth & Climate’ and more – videos, articles and images. Great reading, you can spend a long time on this site!

Zack Lynch blogs about Neurotechnology on Brain Waves. He lists a bunch of quite technical blogs that he regularly visits, as well as some links that are well worth browsing on Neuroresources. Latest blog entries include the Allen Spinal Cord Altas, What’s your Brain Age?, and a great video by Jill Bolte Taylor. Worth a visit!

And my final link for today – Changing Minds is a huge site with a whole bunch of information and links to factors that influence change. From Argument to Brand Management, Theories and Techniques, this site has plenty to keep you interested, especially if you’re curious about how to help people change. Definitely one to bookmark.

I hope you have a moment or two to spend perusing the links – they’re fun and you can spend lots of time just locating information, for the true information junkie like me!!