Headlines from around the world

Pain Specialists Across Europe Launch Education Programme To Improve Chronic Pain Management – go here for more details

Up close and personal with movement – a review from the experts at Body in Mind blog

Dignity, rights and capabilities in rehabilitation – via Brainworks

Via @KCTherapist (on Twitter): Memories are made of this: Uncovering the key to how we learn and remember – proteins in the brain, from Science Daily

Auntie Stress with a recipe for simplici-tea (while you’re there, take a look at her other posts on de-stressing)

Where do I get my news?  My friends on Twitter!

Thought-provoking posts on science, health and beliefs

The blogosophere is pretty hot right now – some really interesting topics being discussed, enough to make me think again about my own biases.

The first one is the popular Science-Based Medicine blog that rarely fails to challenge those that prefer ‘belief’ over ‘evidence’ – do not proceed to this blog if you think homeopathy or reiki is ‘good for your health’, this blog does not mince words!  Three posts have particularly caught my eye recently – this one on some of the reasons people (even scientists!) find it hard to change tack when new evidence is found; this one on the misinterpretation of acupuncture trials; and this one on the role of adenosine in pain relief.

The first post really struck me as I look at my own bias towards nonbiomedical interventions – yes, even I can be tempted to ‘overlook’ studies that show equivocal findings for CBT-based approaches, or to focus on studies that show positive outcomes… I remember my initial concern about mirror therapy and graded motor imagery for CRPS – and while I still hold concerns that this treatment doesn’t seem to reduce pain and increase function in many people (notably the complex presentations we see at Pain Management Centre), I do think it holds promise for people with CRPS now that the evidence is gathering.  That’s science you see – revising what we accept in the face of accumulating evidence.

Movin’ Meat is the rather curious name of a blog written by an ER physician (and administrator, bless him).  This blog is often about    but this post is a repost and hilarious.  Do not read if you’re easily offended, but given that people with chronic pain DO have a sense of humour (how would you survive without it?!), this post on a Brand New Pain Scale hit my funny bone – read and enjoy!  After my experiences last year with tonsillectomy, I totally appreciate the need for a ‘beyond what I want to cope with’ number on a pain scale.   I’ve always thought that putting a number to my pain is a bit silly, wouldn’t it make more sense to start with ‘no pain’, move to ‘a bit of pain but it’s not bothering me’, go from there to ‘yup, this is pain and I’d like it to go no’ and finally ‘I’ve had enough, MAKE IT GO AWAY’.

And lucky last, but certainly not least, is BodyinMind blog and the rip-roaring debate going on there about exercise and back pain, and the most recent discussion about acupuncture and a critical review of some of the most recent papers on it in pain management.

If you’re a Facebook participant, head to the very informative and rational page Neuroscience and Pain Science for Manual Physical Therapists.  If you click on this link and you are not a member of Facebook, beware, you won’t be able to get in.  If you’re clicking on this at the Canterbury District Health Board, forget it, Facebook isn’t available.  Otherwise, click away and enjoy the discussions on a whole range of neuroscience and pain management topics.  Some fabulous people and over 2500 fans have joined this page and comment regularly – makes Facebook worth visiting just for this alone!

I hope you enjoy these links – let me know what your thoughts are!

A recording or the real thing?

I’m musing about an article I read while browsing the internet looking for information on hypnosis. It’s from the BBC – you can read it here – where it is announced that a recording of guided imagery is useful for kids with abdominal pain, saying ‘they can imagine themselves in scenarios like floating on a cloud’ and experience improvements in their pain.

I think this is a great piece of news with a sting in the tail. Like most news articles it fails to deliver the detail, and as you know, the devil is in the details! Let me say firstly that I haven’t read the original article which is found in the journal Pediatrics, and apparently follows on from similar studies showing that hypnosis for kids has some good effect – apparently because kids have ‘fertile imaginations’. We could add also that kids develop very strong expectancies when powerful and important people in their lives tell them that a treatment has a certain effect.

Back to the story – firstly, the study is a small study of only 30 children. The ages of the children ranged from 6 – 15, and the BBC article gives no details of the duration of the pain, the average of the kid, whether they’d had psychological input before, whether their parents supported the treatment etc etc – all quite important factors in determining the efficacy of treatment in the ‘real world’.

It seems that the kids were divided into two groups – one got normal management, the other received CD’s and were asked to use them daily for eight weeks. No mention in the BBC article about whether the CD group also got ‘other’ management!

The results – the CD group ‘73.3% reported that their abdominal pain was reduced by half or more by the end of the treatment course compared with 26.7% in the standard care group.’ … and apparently this was maintained to a certain extent in 2/3 of the kids six months later.

Why am I critical of this article? Well the first thing is that it is skimpy on details of the study. Not unexpected, this is a news article not a scientific paper! BUT it is inclined to lead parents who read this to jump to conclusions that simply by buying a CD they may be able to help little Johnny or Mary with their tummy pain. I suppose at least it won’t do harm – except if the parents delay getting their kids seen by a medical professional.

But I think it suggests rather unfairly a couple of things: firstly the article says ‘a lack of therapists led them to the idea of using a CD to deliver the sessions’ I can imagine some hospital managers rubbing their hands with glee thinking ‘ahah! we can reduce the number of occupational therapists, psychologists and social workers in paediatrics with a recording!’

Perhaps that’s a little unkind, but that’s the sort of simplistic thinking that I’ve seen before – therapist leaves, referrals for assessment have dipped a little so let’s not replace the therapist and we can save some money (haven’t you heard of natural referral fluctuations? and what is that waiting list for treatment?)

It also suggests that a simple intervention can solve what is a complex and challenging problem. In my experience, kids with abdominal pain are within family and school systems that need input. While helping a kid get off to sleep or reduce their abdominal pain is one part of the solution, there is almost always much more. And usually it involves helping parents understand their role, and the role of siblings, teachers, friends and even family doctors, in the maintenance of the child’s disability and illness role. A CD is not going to do this.

Some parents find it exceptionally difficult to accept that no clear medical ‘diagnosis’ (and therefore cure) can be found – one parent said to me ‘You can’t consign my child to a lifetime of pain’ even when my job was to help the child cope with the pain while the team worked to identify contributing factors. She’d had her pain for four years, had spent two years off school, and had seen many specialists before being referred to the chronic pain team. BTW no medical diagnosis was made for this girl apart from ‘chronic abdominal pain’, and her father removed her from our team and continued to seek further invasive diagnostic procedures. I understand she remains off school another 18 months later having had several procedures but still finding no evidence of diagnosable pathology. Maybe she really does have ‘chronic pain’ in the tummy. If a parent doesn’t support the approach, a recording isn’t going to cut it, even if it’s an effective recording for relaxation.

My final thoughts on this article: if you’ve ever tried using a relaxation or imagery recording, you’ll probably know that some ‘fit’ you and some don’t. I personally get irritated with strong accents, pan pipes, and water trickling. I also really don’t enjoy imagery of beaches.

One size of imagery does not fit all – which is one reason I prefer to do at least one session where I talk before I start an imagery relaxation or hypnosis. That way I can identify the specific triggers, words, images or sounds that work well for the individual. I can make a recording that is tailored to the needs of the individual.

I don’t know whether there is an evidence-base to suggest that this is more effective than a mass-produced recording, but I do remember when I was a kid having nightmares about fairy stories that were supposed to happy and nice. I’d rather not assume that what I give a person is right for them without having an opportunity to talk to them about it, and adjust the recording if necessary. Let’s hope the managers reading that particular article don’t assume that a recording is as good as the real thing.

Cool ‘diseasome’ graphic!

Thanks to Dr Deb for pointing me in the direction of this cool graphic showing the common genetic links between a range of disorders…here’s the link to the full article, from The New York Times.

You can find out so many teeny tiny bits of news on Twitter!
Oh and you can blame Manly Jack for passing on this bit of humour…

Sorry ’bout that. Normal transmission resumes shortly.

A round-up of blogs to keep you busy

If you’re an occasional visitor to my blog, you may find plenty here already to keep you busy while I pop on over to Brisbane for the weekend to attend the PainLang forum to hear Harold Merskey and others talk about
“• an overview of the current state of play in research on pain language
• to investigate specific topics in pain language, especially in relation to the McGill Pain Questionnaire
• to explore current studies at the cutting edge of pain language research
• to explore social suffering associated with chronic pain, especially in the relation between the language of pain and other pain indicators and symptoms”

When I get back I’ll be posting on what I learn, but until then…

Try this post on Psychology of Pain talking about factors that may influence placebo…

or this one on the neuromatrix, at the same blog.

Dr Deb’s blog has some great things on it, so for some light relief head on over to this post not just for cat lovers, but anyone with a funny bone!

And the American Psychological Society has heaps of great resources, if you haven’t been in there for a while.

Oxford University Press Psychology Blog is worth cruising through too, because of the variety and depth of coverage.

And two blogs I go back to frequently are BadScience and Mindhacks.

If you’re out there surfin’ away and come across something cool or groovy, just drop me a line and let me know – I’ll head on over and include it in my blog and let others know too. That way we all learn!!
Have a great weekend and I’ll be back with a vengeance on Monday!

Brainblogger and GNIF

You know, there are so many places on the net that have excellent information – the world really is a small place now.

I ran across Brainblogger today, where there are many different people writing about “topics from multidimensional biopsychosocial perspectives. It reviews the latest news and stories related to neuroscience, psychiatry, and neurology. It serves as a focal point for attracting new minds beyond the science of the mind-and-brain and into the biopsychosocial model.”
They have their own Wikipedia entry Brain Blogger, and adhere to a biopsychosocial and interdisciplinary view of health, and the mind and body.

OK, so who is GNIF? GNIF stands for Global Neuroscience Initiative Foundation. They seem to be keen on open-source information, and destigmatisation of mental health problems – great stuff!
What appeals to me so far is the open-source nature of their information. This means its readily available, well-referenced, and modifiable. Its aims seem laudable.

So, take a look yourself – Basic brain facts is just what it says…
And there is the Distance Education Division that has a range of self-paced and online learning materials such as ‘Physical Interventions for Stress’ and ‘Self Marketing for Individuals with Disabilities’.


Online info for Aussies – can we play too?

I totally agree with this post at Medgadget – most of the information on the internet is focused on North America. Thankfully there are a few of us based in the Southern Hemisphere, and it looks like there will be more than one resource for us! This wee article from University of New South Wales doesn’t give much away, but as soon as more details are known, I’ll let you know. In the meantime you can bet that what I post on here is written by a New Zealander, and applied in New Zealand – or I’ll let you know that it’s not yet available!

Remember that if you’re interested in what I’m posting, you can subscribe using the RSS feeds above – and I really love comments and always respond! If you’ve got something to share – why not drop me a line and either do a guest article, or let me know your link and I’ll post it on here.