What does ‘Pain Medicine’ mean to readers of HealthSkills?

What comes to mind when you hear the words ‘Pain Medicine”

Medical treatment of pain


Pain reduction


Management of pain within a biopsychosocial model


Study about pain and pain management


Anything to do with the study of pain and health


Other (see below)


 Other Answer:     morphine; beating someone into submission… for their own good; narcotics – medicine to reduce pain, drugs of abuse; clinical reasoning

These results from the survey conducted online here at HealthSkills.

Occupational Therapists in New Zealand – Survey and a prize!

A collegue of mine, Blair Cross, is conducting a survey on beliefs and attitudes about back pain in occupational therapists.  Here is his introduction to the survey:

Invitation to Complete an OT Internet Survey

BE IN TO WIN!! ‘The Back Pain Revolution’ – a textbook by G. Waddell ($220)

Dear fellow OT’s

I have developed an on-line survey about beliefs regarding chronic low back pain. You are invited to complete this survey if you have assessed someone, in the last year, who reported having low back pain for 3 months or longer. NB. Pain does not have to be their primary problem.

The survey takes 10 -15 minutes to fill out. More information is given in the survey introduction. You do not have to put your name on the survey.

If you are unable to fill the survey out at this moment, you could make a note in your diary to fill it in within the next 8 days J. Your response would be greatly appreciated – it will help contribute to the body of OT research, and you have the chance of winning a very helpful book on back pain.

Please click on this webpage link to view the survey. You may have to hold down the control key.

Here is the link

If you’re not an occupational therapist practicing in New Zealand, please don’t complete the survey.  When results from the survey are completed, I’ll be sure to include them on this blog.

Thanks heaps!

Coping strategies survey – the results 3!

Today’s post completes the results from my coping strategies survey by identifying how important the skills are in the respondent’s view. Remember these are all health professionals who work in pain management, and the questionnaire was completed online and confidentiallyskills-summary.

What you can see there is that the most important skill, as identified in this survey, is ‘Working with realistic thoughts’. What’s surprising about this is that respondents were not ALL psychologists! In some ways, this is probably one of the most important components in pain management because it encompasses all the cognitive elements involved in reconceptualising chronic pain from something that represents alarm and harm, into something that is simply ‘noise in the system’.

Self regulation was the next most important skill. This is the process of setting goals, and organising the ‘self’ to achieve them by modulating arousal level, establishing steps for moving forward, and working with feedback to persist with progress despite set backs. It’s interesting that self regulation is not mentioned at all in the documents I recently reviewed for ‘Intensive pain management programmes’ with a major purchaser of services in New Zealand. Self regulation is certainly something that is included in almost all the pain management programmes delivered at Burwood Pain Management Centre, although it may not be called that in so many words. It can masquerade as ‘goal setting’, ‘activity scheduling’ and ‘relaxation’ – all of which are components of the larger dimension of self regulation.

I was curious to see that task simplification scored as highly as it did. I think I mentioned that I rarely think of helping people develop this as a skill – as one respondent said, and I agree, it ‘infers avoidance’. I can see the value of task simplification in health conditions that have a gradually reducing level of energy such as multiple sclerosis, but chronic pain doesn’t need to have this prognosis. Task simplification suggests that simply by reducing activity level (or the strength or energy required to carry out a task), pain will reduce. Sadly, this isn’t so except in the short term, which is why resting is not recommended. Regulating activity level to ensure a consistent amount of activity is carried out through a day (rather than booming or busting, or being completely inactive – or even overactive) seems to be a more helpful approach, although it’s not easy to do.

Finally, although exercising brought all sorts of comments out of the woodwork when I asked about it earlier in the survey, it wasn’t thought to be the most important skill. At least nobody thought it was least important, but the majority thought it was either important or very important, with 3.8% of respondents indicating it was ‘critical’ (that must have been a physiotherapist!). Personally, I think activity can be substituted for exercise, provided that the activity can be carried out regularly, raises the heart rate, encourages full range of movement, and is fun!

I enjoyed conducting this survey. Even though the response rate was lower than I had hoped, it does provide you, reading this blog, some indication of what other professionals who also read this blog, think about coping strategies. I’ll be carrying out another survey soon, looking at goals and goal-setting – another area of pain management that is assumed to be great and helpful, but the process isn’t well-defined and deserves more investigation specific to pain management.

Coping strategies survey – the results 2!

Yesterday I started reviewing the coping strategies survey I’ve been running. 33 participants, a mix of health professionals – and some interesting results. Today I’m looking at when to use pain management strategies, and why.

Question 1 – Reducing pain behaviour has been recommended as a part of effective pain management. When do you think it should be encouraged?
24.1% When the person’s pain is at a ‘usual’ daily level

69.0% At all times, even during a flare-up of pain

6.9% When the person is around other people

Further comments:
As often as the person can sustain the focus without stressing out

Interesting responses to this question – I’m curious because I don’t read much specific information about how therapists typically address reducing pain behaviour.  I’ve personally used video, role play and the ‘pain thermometer’ – but I’m sure there are other ways.  I’d love to know how you do it – let me know via the comments section at the bottom of this post.

Question 2 – Assertiveness is part of effective communication, and has been included in many pain management programmes. When would you consider suggesting a client/patient should use this approach?

0.0% Never, assertiveness is not part of pain management

10.3% Only in situations where the person can cope with the consequences

24.1% At all times, honesty is the best policy

65.5% Selectively, when the person has the skills, energy and can cope with the consequences

Again, I was surprised at the responses to this question – what? No-one argued with me that assertiveness shouldn’t be included?!  I haven’t read much about this in my perambulations through the literature, so again I’d love to hear from you to see how you include communication skills in pain management.

Question 3Self regulation is defined as systematic efforts to direct thoughts, feelings, and actions, toward the attainment of an individual’s goals. Why would you include this in pain management?

40.7% To help the person focus on the future rather than on pain

63.0% To help the person become more able to implement coping strategies

18.5% To ensure the person maintains the use of newly acquired coping skills

Other comments:
To faciliate increased awareness of a persons responses to things and facilitate increase self-control and self efficacy.

Self regulation encompasses a large range of skills, and yes, I agree it needs to be included to help people move from being ‘patients’ to ‘people’, actively using their skills to achieve things they really want in their lives.  It does involve increasing the person’s awareness of their responses – and ability to adjust their responses to achieve the result they want.

Question 4 Most people participating in a chronic pain management programme will be encouraged to participate in a regular exercise schedule. Why would you encourage someone to exercise?

59.3% Exercise provides an opportunity to use pain management skills – especially task persistence

33.3% Exercise is good for reducing pain intensity

18.5% Exercise is easy to do on a regular basis so it encourages pacing

Other comments:
Maintains healthy lifestyle, holistic approach
For muscle strength, endurance, cardiovascular fitness, and because normal movement can impede pain signals
Maintaining an active component helps maintain general health and wellness
ALL! And mood elevation, and stress management…
Hope for some translation to improved function. Specific exercises movements can target fear avoidance and also improve general confidence with activity.
All of the above
Exercise in moderation and tailored to the patient is a necessary physical progression for health and a prophylactic against other maladies

Well, that brought you all out of the woodwork!  Exercise looks like it is an essential part of what health professionals think should be included in pain management.  As a confirmed exercise-free zone, it looks like I might have to sway to popular opinion!

Question 5 – Having chronic pain can be a very challenging experience. Cognitive therapy emphasises the role of realistic thoughts. When a person’s thought is realistic, but not helpful, would you challenge their thinking?

14.8% Yes – they may still be using maladaptive thinking patterns

7.4% No – it’s difficult to argue against reality

81.5% Yes – but not to challenge the reality, just to establish a more helpful view of the situation

I was curious to see that some people wouldn’t use cognitive therapy to help people develop a more helpful view of their situation.  While a person might be describing ‘reality’ to them, simply acknowledging this without checking out that the thought is helping them achieve goals may produce a ‘reality’ that is more negative than it needs to be.  I’m reminded of an illustration someone once gave of a line-up of swimmers at the beginning of a race – do they look left, they look right and say ‘Oh no, everyone else is bigger than me, what chance do I have?’, no!! ‘They say ‘I’m going out there to go, go, go!’

My last post will be tomorrow – looking at the ratings of importance for each of the coping strategies.  See you then!

Coping strategies survey – the results!

Over the next couple of days I’m going to review the coping strategies survey I’ve been running.  I’ve had 33 participants, so it’s not a large sample, but it does represent some of the professions working in the field of chronic pain.

Who responded?

12.5%   Social workers

4.2%     Nurse

29.2%  Occupational therapists

25%      Physiotherapists

12.5%  Medical practitioners

20.8% Psychologists (health or clinical)

plus 4 ‘others’ – students mainly.  You’ll see the total is more than 100% – rounding, or so I understand from SurveyMonkey!

The first set of questions related to defining three terms commonly used in pain management. I’ve just reviewed a paper about ‘pacing’, so it’s interesting to see how these participants defined it.

Question 1 – How do you define ‘pacing’?

15.2%  Working to a pre-defined quota of time or activity task despite fluctuations of pain

45.5% Breaking an activity into smaller pieces rather than completing the entire task

45.5% Starting with an achievable pre-defined quota and gradually increasing this over time despite fluctuations of pain

Other responses:
Breaking activity into smaller pieces, then taking breaks as needed between sections
Managing activity levels so as to be doing the optimal amount in terms of managing pain levels (e.g., not doing too little or pushing yourself too hard)

I’m interested that the concept of pacing is related to pain intensity, and that half the respondents thought it should involve breaking a task down to avoid flare-ups.  This definition would seem to confirm the place of pacing alongside passive coping strategies as McCracken & Samuels found, and the general lack of consensus that Gill & Brown identified in the literature (McCracken & Samuels, 2007; Gill & Brown, 2008).

Now I put this next question in as a bit of a red herring – I personally never use the term ‘task simplification’ with people.  It comes from around the era of the term ‘pacing’, so probably in the mid-1970’s, and is related to conserving energy as you might do for something like multiple sclerosis, or chronic obstructive airways disease – in other words, where the person is unlikely to regain fitness.  It’s been brought into pain management probably because of the relationship between early ways of coping with rheumatoid arthritis (in the same way as pacing was), although over time the management of rheumatoid arthritis has moved from reducing activity to maintaining activity despite flare-ups.

Question 2 – How do you define ‘task simplification’ to a client/patient?

42.4% Finding the most efficient way to carry out a task

3.0%   Deciding whether a task needs to be carried out at all

36.4% Breaking a task into smaller parts

18.2% Reducing the demands of a task so that it can be carried out without flaring pain up

Other responses:

I don’t – I think it infers avoidance.

Task persistence is a term that isn’t often used by patients in relation to managing their pain – but is one skill that health professionals might consider important.  I think it forms part of activity management because in order to increase overall activity tolerance, it’s necessary to persist over the existing ‘limit’ to a certain extent.  Task persistence often needs to be used within a work situation in order to meet a deadline, achieve an outcome, or make it through to the end of a working day!

Question 3 – How do you describe ‘activity persistence’ or ‘task persistence’ to a client/patient?

15.2%   Continuing with an activity until it is completed

51.5%   Continuing with an activity until the pre-determined quota is reached, despite fluctuations in pain

36.4%  Completing as much of an activity as is possible but not so pain flares up

Other Comments:
I don’t use this term
Pain may increase (within tolerance) but calms down on stopping activity

This is the first part of my survey – more tomorrow on when to use different types of coping strategy. If you’ve enjoyed reading this post, and want to know more – you can click on the RSS feed link above, or you can bookmark this blog and come on back!  Don’t forget to comment (I love them – it makes me feel wanted!), and let me know what you think or what you want more of.

J GILL, C BROWN (2008). A structured review of the evidence for pacing as a chronic pain intervention European Journal of Pain DOI: 10.1016/j.ejpain.2008.03.011

McCracken, L. M., & Samuel, V. M. (2007). The role of avoidance, pacing, and other activity patterns in chronic pain. Pain Vol 130(1-2) Jul 2007, 119-125.

Pain Management Skills Survey

Something we don’t know very much about is the way health professionals view the type of coping skills that are often recommended for patients.
This survey is one way to start to learn more about what you as a health professional think about some of the coping skills commonly used in pain management.
It’s completely confidential, very quick to complete, and I promise it has absolutely no nutritional value!

Click on this link and I promise it’ll be painless…

And in a couple of months, when I reach my target number of participants, I’ll post the results!

thanks heaps for doing this!

Quick plead — and a plug for my survey

As you’ll know, research of any kind is a challenge.  That’s why I’ve resorted to using an on-line survey to find out some things that I’ve been wondering about for a while.

Sooooo, as I said I would, I’m nagging again to ask you to please consider clicking on this link to my brief survey about pain management strategies.  What YOU think matters! It takes about 5 – 10 minutes to complete, and it’s simple to do, just answer 10 questions on your thoughts on some common pain management strategies.  I’d like to get 100 responses – so keep ’em coming!

Thanks to those of you who have filled the survey out, I’m really grateful.  And to anyone else? Think about clicking, at least to see what I’m raving on about!

This is the link – thanks!

Pain Management Skills Questionnaire

There are lots of coping skills out there in pain management land – but we don’t always agree on what they are, when they need to be used, or even on how important they are in the overall scheme of things. I’ve developed a brief (anonymous and confidential) questionnaire about different coping strategies – it will take between 8 – 13 minutes (really!! I tried it myself! – well, OK, I’m just guessing), and I would be very grateful if you’d consider participating. I can’t obtain any details about you, your computer or anything personally revealing through the questionnaire. I’ll publish the results once sufficient responses have been made, so get clicking!!

Click Here to take survey

Thanks so much for participating!