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What, why & how: two out of three ain't bad?

I’m guilty. I’ve posted over 1300 posts on this blog, and I know I’m guilty of doing two out of three, and failed to do the third. The two I’ve done a lot? What and why. What the evidence suggests and what could help people with pain and the clinicians they see. I’ve written about why these ideas might help and why they’re important. But I have not spent nearly enough time on how. And here’s…

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Relevance: Understanding the 'So What' of Pain Management Research

Something I teach and bring to my research reading is the ‘so what’ question. So what is about bringing home the implications, the rationale, the WHY in all that I do. I’m reflecting on this as I consider my blog. When I started writing in 2007, I wanted to get information out to people just tiptoeing into pain practice and who might not have access to research. At the time research was hidden…

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Beware the echo chamber: Attitudes to pain amongst health professionals

As a long-time social media commentator (since listservs and message boards!) it’s tempting to think that health professionals have shifted to a modern understanding of pain. And then I hear or read something to remind me there are people who haven’t ventured into this complex world… Sales, Miyamoto & Valim (2024) conducted a study of ‘non-specialist’ pain professionals working in primary and…

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Taking pain into account

Recently I’ve been pondering internalised ableism. This term refers to adopting common societal beliefs about ‘normal’ and the converse ‘abnormal’, and consequently judging themselves in light of those norms. It can include expectations and attitudes like shame for being disabled, comparing yourself with ‘normal’ people and being incredibly critical of your own capabilities and limitations as a…

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Pushing pause: When is it OK?

Over the years I’ve worked clinically I’ve noticed that many people with pain have had ongoing rehab. Like almost never-ending. One programme after another. In some cases this has gone on for years. A new goal is set as soon as an old goal is reached. And on and on. While sometimes this endless rehab has been initiated by the individual, more often than not in a compensation setting it’s been at…

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Menopause? Or Ovation!

Someone on social media suggested we rename menopause, and I love this idea! Life after women stop having periods is more than ‘Oh now you can’t have babies’ so I suggested Ovation! As I’ve been posting recently here and here menopause and life after menopause is often associated with more musculoskeletal pain, so I thought it time to look at what clinicians might consider. The problem is…. oh…

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Do you see me?

As a young woman growing up in a small town in New Zealand, my educational and career choices were somewhat constrained. Not for me the push to become a medical practitioner, a lawyer, a scientist. No, I was encouraged to consider nursing or teaching. The subjects available to me did not include metalworking, woodworking, technical drawing (that was for boys, until my friend Tania challenged…

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Menopause and musculoskeletal pain

Once a woman (or person with female sex hormones) reaches menopause, things change. I experienced the usual rush of hot flushes, brain fog (later found to be previously undiagnosed ADHD – and responsive to methyphenidate – yay!) and an array of other symptoms like night sweats, sleep problems, wrinkled skin, and lost libido. Every person who menstruates will, if they live long enough, stop…

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Exercise/Movement practices for pain: I wonder...?

I’ve written before about exercise – actually I’ve written quite a lot about exercise here, here, here and here and definitely elsewhere on my blog. Exercise is, without a doubt, one of the most commonly ‘prescribed’ approaches for persisting or chronic pain. Whether ‘exercise’ is the thing, ‘movement practices’ or ‘meaningful movement’ is ubiquitous. So much for not enjoying exercise, if you…

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A study I'd love to see...

After reading more ‘exercise plus [insert therapy]’ than I’d like to count, here’s a study I’d really like to see – and why. Exercise for chronic or persisting pain is widely touted as a means to reduce pain and maintain function. So much so that when I do a search in Google Scholar using the terms ‘exercise and chronic pain’ in 0.10 seconds ‘about 2,450,000 results’ show up. I can’t even…

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The cumulative effect of ill health

When researchers use randomised controlled trials as the way to investigate health interventions, it’s usual to clearly describe inclusion and exclusion criteria. This makes sure the participants all share the same characteristics so any effects from the experiment can be fairly evaluated. It wouldn’t be fair to have some people in the experimental group without the disease, or for them to have a…

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Beyond pain reduction: Why some treatments might not be worthwhile

If you live with pain that’s lasting longer than three months, it’s likely you’ll be feeling frustrated, worried and possibly a little desperate. People in this situation are inclined to look at possible treatments with a bit of fatalism – like ‘As long as it doesn’t kill me, I’ll give it a shot’ – and as a result (and because of effective marketing and the occasional success) go ahead with…

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Dealing with a flare-up

Over the last two weeks I’ve written here and here about painful flare-ups and the little we know about them. This week I’m turning to how to manage them. Firstly, it’s difficult to avoid flare-ups. They happen for so many reasons, can be quite unpredictable in terms of duration and intensity, and there are times when people quite literally choose to Do The Thing knowing a flare-up is likely,…

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Pain flares

Last week I talked about making the choice to do some activities that are not my usual thing. And as predicted, I had a flare of my pain! And then I decided to do some gardening this weekend and my already ouchy body has got even more uncomfortable as a result. I’m definitely in the middle of a flare-up. It’s time to dig into pain flares as they’re investigated in research papers to see if my…

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Life is about choices

Every day we make thousands of choices. Some of these are habitual and strongly reinforced so we forget we’ve made them (like which side of the road to drive on), some of these require deliberate effort and we are aware of them. It’s the latter ones that have mental load and slow down our decision-making. Naturally, humans want to conserve effort, so we’re prone to what psychologists call…

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Implications of Multimorbidity in Pain Treatment

Last week I discussed a large epidemiological study using data from the UK Biobank to derive pain profiles: four groups of population-level profiles each thought to represent different facets of functional impairment. This study found that pain location doesn’t describe real-world, clinically-relevant differences between people with pain, and instead found that clinical variables and treatments…

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Four Pain Profiles and Their Health Implications in chronic/persisting pain [long]

I came across this really interesting paper by Barron and colleagues (Barron et al., 2024) about ‘function-based pain profiles’ and their relevance to chronic disease management. This paper is a study analysing data from the UK Biobank to understand how well the typical ‘body part’ diagnostic approach fits with data-derived profiles drawn from the Biobank. It explores whether data-derived…