Friday Funnies!

As the onset of winter approaches, it’s time to grab every opportunity for humour, fun and silliness.  I think it’s vital – all that black winter clothing is so depressing maybe the flat mood is just because of having no colour!  While the weather today is chilly, crisp and not too bad – I can feel the bad weather in my bones… So take a break, and enjoy!

After the airline pilot had managed to land the planeinto Wellington airport  — albeit bumpily — following a descent through exceptionally heavy weather, she came out of the flight deck to bid the passengers farewell as they gratefully left the plane  on their way back to terra firma.

The most memorable comment he received was from a little old lady who asked him politely whether he would please satisfy her curiosity on just one point: “Did we land, or were we shot down?”

Why doesn’t this happen more often huh?

…and I can empathise with this kitteh!

Pardon, my cynicism is showing.

But still, there is light and hope and colour – it’s not quite winter yet!

Working when you have chronic pain

I found this resource today – thought I’d share it with you.  It’s Chronic Illness Coaching, blog and website written by Rosalind Joffe.  She has many freely available resources, and this one really stood out for me – I think I’ll be passing it on to the people I work with who have chronic pain, and maybe one or two at my workplace!  It’s a pdf of the ’10 things I want you to know about working while living with chronic illness’.

It includes things like:

For most people, health, like the weather, is relatively unpredictable and there’s an element of luck. But living with chronic illness means that I face unpredictable health daily. It can change as quickly as the weather, often without warning. I find this difficult, constantly challenging and even demoralizing. But, I try very hard not to let this prevent me from delivering my best.

I know it doesn’t seem to make sense, but I can feel terrible and look fine. When most people have the flu or even just a cold, they look sick. My symptoms, sometimes disabling, are usually invisible. I know it’s hard for others to understand this, especially when I look the same through it all. That’s why I’m often nervous about what others believe about my health and think about me. It might sound odd but when I hear, “You look so good!” I wonder if you think I’m exaggerating my experience.

Healthy people can work (or play) too hard but they can catch up after pushing their bodies too far without too much wear and tear. Part of the problem with this chronic illness, however, is that my limits can vary greatly. I can’t ever be sure how hard I can push without hurting myself. Some days, walking upstairs to the water cooler feels like I’m running the marathon. Sometimes it can take days or even weeks to feel “normal” after working a few late nights and weekends. And, yet, at other times, I can do any of this without a problem. Go figure.

See what I mean about a great resource?  Awesome!

Thanks to Rosalind Jeffe.

Work conditioning, work hardening and functional restoration for workers with back and neck pain

In New Zealand most people who have been off work with chronic pain, and receive compensation from ACC, will have been a participant in some sort of fitness programme.  It’s almost a rite of passage for people to have a programme of functional restoration before or during an attempted return to work once the person has been off work for around 3 – 6 months.

There are a lot of different types of programme available:

  • two of the Prof Mick Sullivan’Goal attainment’ programmes for sub-acute pain,
  • Functional restoration programme – for sub-acute pain, involving activity with some ‘education’
  • Pain management psychological services – for psychological strategies for pain management
  • Activity focus programme – for chronic pain, involving activity and cognitive behavioural therapy approach for self management
  • Multidisciplinary programme – a three-week intensive interdisciplinary programme with a cognitive behavioural approach, including reactivation



A couple of interesting sites to drop into over the weekend – I took a look at PsyBlog and what a wonderful video I found there! This one is about the Psychology of Magic – three critical techniques that good magicians use to trick the audience.  Makes me wonder whether people that believe in psychics should read it and be just a teeny bit more critical of their performances…

Ever wondered what type of person bothers to write a blog?

Well, wait no longer – there’s an answer for you!  Clinical Cases and Images posts about Who Blogs – Personality Characteristics.  What did they decide? ‘According to the … studies … people who are high in openness to new experience (both men and women) and high in neuroticism (women) are likely to be bloggers.  Women who are high in neuroticism are more likely to be bloggers as compared to those low in neuroticism. There was no such difference for men.’

Hmmm, not so sure about the neuroticism (Who me? Neurotic? No way!!) – I wonder if anyone has evern checked out the characteristics of people who READ blogs?!!  And of course I wonder whether there’s a difference between this type of blog, and the blog of those who write about everyday life?

Now, settle down for a bit of news about pseques.  (Written like that to avoid the net detector treating this blog as something to block!).  Great post from one of my favourite sites, MindHacks – which was itself blocked at my workplace the other day for ‘criminal and undesireable’ information!  It’s about the medicalisation of normal human sexuality – some great information on how certain normal variances in human behaviour are pathologised by stretching the diagnostic criteria for one disorder to include behaviours in an entirely different area – and not always sensibly either!

Finally today, some people get just a wee bit titchy on Monday mornings, while others are bright and breezy.  This post from Positive Psychology News Daily talks about team energy – and suggests that emotions are contagious, especially if you’re the boss.  Well, I’m not the boss, but I can tell you this: NEVER get between me and my coffee cup!

Return to work resources

Two great resources to click through to on return to work topics. Not just for people with chronic pain, but more general.

The first is new, and has a wealth of resources for health providers, employers, return to work rehabilitation professionals. This is RTWMatters which is written by a group of professionals with years of experience helping people to return to work … Publisher – Robert Hughes (no, not that one), 40 years in publishing and network development; Editor – Dr Mary Wyatt, 10 years an Occupational Physician; and General Manager – Cheryl Griffiths 12 years in administration and marketing.

As their introduction says ‘Creating a network for return to work professionals, a site that contains the best research, and the best tools and resources from around the world, while also providing access to advisory services and other members makes sense to me.’

There are heaps of pages covering topics like Research, General topics, a Handbook for RTW professionals, and a great area listing events and conferences in the Australasian area.

You do have to register (it’s free at the moment) to access much of the content – but I think from what I can see already, that it’s going to be both a repository for loads of information, but also a place for interaction between the various groups involved in return to work.

Resworks is the other site I want to introduce you to. It’s not new, and from what I understand, is no longer being added to – but it contains a LOT of material that is both relevant and authoritative. One page I particularly liked was the Australian and International Research link, and their large list of relevant journals.

Take a look around both these sites for good quality information that is relevant not just to Australia and New Zealand, but probably anywhere in the world. And it’s not just for health professionals, but also for employers and others who are interested in helping people return to the place they spend so much of their time.


A man with a lot on his mind

For over two years, Joe (definitely not his real name!) was waiting for someone to tell him that his pain could be cured, or not. One way or another he’d have liked to know. In the meantime he looked everywhere for things to fix his pain.

He’d, in his words ‘smashed’ his hand up in a crush injury, and developed what seemed to be complex regional pain syndrome in his non-dominant hand, which would have been fine if he had a pen and paper job. Joe didn’t, he worked as a joiner, a craftsman. What’s worse, he was self-employed, and during that two years his business went under, and his future as a skilled craftsman looked bleak.

Yes, he had compensation – 80% of the income he’d declared for tax purposes, which was nothing like what he’d actually made because much of his income had been plowed back into his business. And with compensation came a whole lot of requirements: to attend various people for assessments (he worked out he’d had 9 different assessments just for the medical or treatment part of his rehabilitation, a further 4 for vocational rehabilitation, and several for necessary equipment and support for home); to attend treatments (none of which had resolved his pain); to tell people about his distress and worries about his future; his life which had been very private, was now an open book to more people than he wanted to think.

Joe was asked to see me because he had refused to consider any of the options that his vocational assessment had come up with, and because when he had started to think about work, he became depressed and anxious. He told me he threw the vocational assessment in the bin because the suggestions were, in his words, ‘insulting’. He told me the assessor had no idea what a craftsman joiner actually did, and the list of potential jobs included ‘retail assistant’, ‘carpenter’, ‘builder’, ‘courier driver’.

When I reviewed the concerns Joe had about work, it’s no wonder he was stressed. I used a work self efficacy assessment to identify the areas he felt confident about, and those he didn’t. The areas he felt fine about were his ability to work out ways to keep himself safe at work, to let people know what he needed, and to be ‘a good employee’ – but he had very low confidence in these areas:
(1) ability to work a full day
(2) ability to meet quality requirements
(3) ability to tell others about his pain
(4) ability to obtain support and assistance from others
(5) ability to work in a way that used his skills

He told me the work was important because ‘it is who I am’. And who he was was a very capable, highly skilled man with an 18 year history of work as a joiner who produced quality goods that he could be proud of. He said he felt ashamed of his pain, and that he couldn’t be a ‘real man’ because his pain hadn’t resolved. And what’s more, he felt frustrated that the job options he’d been given were of such a low skill level. He’d put a huge investment of himself and his time and energy to develop a high level of technical skill into being a hands-on craftsman.

A couple of interesting things about this case – first of all, although details have been changed, this is a real situation. His angst is real, and his concerns about his future – and his response to his situation – are real.

He’d waited two years to hear that his pain was either going to go, or not. No-one had been clear with him that pain can become chronic, and that this is neither a death sentence, nor a life sentence. Life is possible with persistent pain. Instead he’d been held in stasis for that time, being uncertain which way to turn, and consequently he lost his business. Once he’d received the diagnosis and prognosis, he was able to confront his future – and yes, admittedly for a while he has become very distressed, but he told me that at last he could make clear choices.

What do we learn from that? Don’t fudge! If the chances of pain resolving are slim, let the person know so they can start to live.

The second point is that work is so much more than a way to earn a living.
I don’t know whether this particularly applies to men, but it certainly applies to tradesmen – their work is part of their identity, it carries more emotional significance than the pay-packet, it represents years of skill development, and no, suggesting that someone like this consider a job that is a step down is just not going to sit well!
I don’t know whether Joe will return to his previous work. He won’t be able to return to his business.

I do know that he now has a sense of hope as I’ve started to help him review his situation and see that what he views as a liability (ie his functional limitations) can be turned into an asset – he’s much more likely to be careful, safety-conscious, and efficient at his work because it matters to him if he hurts himself.

It will be a long road for Joe, he has a lot of pain management to develop, as well as addressing his lack of confidence and the mismatch between his expectations of himself and his current abilities. But this is pain management at the coalface – this is what I love.

Why work in pain management?

I’m curious about why we work in pain management…  My reasons are that it’s one of the most complex areas in health, it uses a wide range of skills, every person I work with has a different set of concerns and coping strategies, and I do enjoy working with people of working age who communicate readily about their problems.

Although chronic pain management is very demanding on clinicians, it’s also rewarding as people develop ways of achieving fulfilment in their lives.  There is never a feeling of ‘same old, same old’ because every person is so very different.  And although sometimes the process takes a long time, the momentum is always forward and onward.

I also really appreciate the team approach – and I simply can’t say too many grateful thanks to the team I work with – fabulous people who are not only sensitive and caring with patients, they are also supportive and enthusiastic and are there for each other.

Why do you work in the field? What keeps you working in it?  Comments are always welcome!

Oh and don’t forget you can subscribe using the RSS feed (look to above left), or bookmark this site and come on back.

Attributions regarding unmet goals after treatment

After searching for a while, and finding not that much about goals in the peer-reviewed pain management literature, it’s nice to have an article that specifically discussed goals and the effect of not meeting goals on participants. This article by Guck and colleagues from the University of Nebraska, examines how a group of participants in a pain management programme view their achievement of goals – do they blame themselves, or external factors for their ‘lapse’ or ‘relapse’.
It’s interesting that this piece of research is based around the concepts of relapse prevention, because one of the main reasons for considering the place of goal-setting is to ensure participants make changes in their lives that matter to them – and retain those changes over time. So relapse prevention theory will have much to add for therapists wanting to help their clients stick with the ‘programme’. I’m not sure that many therapists would have really considered this body of knowledge in relation to physical exercise or using coping skills, because much of the theory is directly related to smoking cessation, dietary change or alcohol abstinence.

Anyway, onto the research.
In this study 100 particpants from 263 people who entered an interdisciplinary programme over a five-year period were asked to participate. Of the original 263, 30 failed to complete the programme, and of the remaining people, 100 provided complete information.

From the description, the programme sounds very similar generic and consisted of a four-week programme of exercise, medication review, active coping strategies and other issues such as work, family and social issues were also addressed in both individual and group sessions.

In the final week of the programme, relapse prevention sessions were held, covering high risk situations, and how to reduce the likelihood of the rule violation effect.

Interestingly, the group developed their goals for after the programme at the time of this discussion – in full awareness of the role of ‘slips’ and ‘lapses’. Participants develop between 4 – 6 goals, and staff assisted them to ensure goals met the ‘SMART’ goal schema. The goals were to be achieved in the next six months.

Six months after discharge from the programme, participants were contacted with a copy of their goals list, and were asked to identify whether they had met the goal, and for each unmet goal, to record on four attributional rating scales, the reason for not doing so. The attributional scales were 1 – 7 likert-type scales, with ‘internal’ to ‘external’, ‘stable’ to ‘unstable’, ‘gobal’ to ‘specific’ and ‘uncontrollable’ to ‘controllable’ factors as the anchors.

Results – Overall, the 100 participants identified 487 goals they intended to meet – 322 of these goals were recorded as met, while 165 goals were not. 46 of the 100 participants met most of their goals, while 16 failed to meet more than 2/3 of their goals. Chi-squared analysis indicated that more goals than not were met in most of the goals categories – except for work.

The causes for not meeting work and social activity goals were attributed to external rather than internal factors more often than were causes for not meeting coping skills, medication change, or exercise goals. Work goals were more often to be thought to be uncontrollable.

So, it seems that goals that were set during this programme by and large were met – except in the two areas that depend a lot on other people (social and work). And the attributions that people made as to why these goals were met or not met differed depending on the type of goal. This suggests that it’s not helpful to use the same relapse prevention model for some of the goals – that is, people do tend to believe that when they can’t manage work or social goals, it’s about external factors, uncontrollable factors, and global factors that are stable.

This makes it very difficult for people to reconsider how to cope with these demands, and from other research in relapse prevention, makes it more likely for them to feel there is nothing they can do to change the situation, and reduce the likelihood they will attempt again.

The researchers in this study suggest that people who need to set goals in social and work areas need to be taught how to cope with factors that affect work and social goals that are external and uncontrollable – unfortunately, as many pain management programmes don’t even consider return to work as a goal, and certainly don’t seem to break that goal into manageable ‘chunks’, this may remain a concern within New Zealand at least.

Once again I’m left with the impression that developing pain management skills and goals to help people return to work despite chronic pain is different from and more complex than simply helping people develop generic pain management skills. The workplace is different from the home – and goals made for using pain coping strategies, exercise and medication at home seem to be much more easily achieved than those about using them at work. Food for thought: perhaps pain management at work is a specialised area for pain management, and not simply the same as ‘any old pain management’?

Gluck, T.P., Willcockson, J.C., Schmidt, R.L., Criscuolo, C.M. (2008). Attributions regarding unmet treatment goals after interdisciplinary chronic pain rehabilitation. Clinical Journal of Pain, 24(5), 415-420.