Search

Introduction: The Pain and Movement Reasoning Model is a tool to assist clinical reasoning. It was created for physiotherapists to use in musculoskeletal outpatient clinics but may be appropriate in other clinical contexts. The Model has also been used in physiotherapy education.Objective: To determine physiotherapists' perceptions of the appropriateness (suitability) and benefit (utility) of the Pain and Movement Reasoning Model across clinical contexts in hospital and community practice. Methods Physiotherapists from two health networks in Melbourne, Australia, received training in using the Model and over 4-6 weeks applied it in their clinical interactions. Drawing on a deductive phenomenological approach, transcripts from focus groups and interviews were analysed to determine the suitability and utility of the Model across clinical areas.Results: Twenty-nine physiotherapists from 12 different clinical areas participated. Two themes represented the participants' comments: Suitability for Practice and Utility in Practice. Participants reported the approach to clinical reasoning, promoted by the Model, aligned with existing physiotherapy practice. Enhancements to practice included more comprehensive assessment, selection of broader management techniques and increased confidence with reasoning and explaining the complexity of pain to patients. Participants described using the Model for developing junior staff and training postgraduate students. They also saw potential in adapting the Model for other disciplines and for other multifactorial conditions.Conclusion: Physiotherapists working in a range of clinical contexts considered the Pain and Movement Reasoning Model appropriate and beneficial in clinical practice and in teaching. Further evaluation of the Model in wider settings is warranted.

Purpose Active pain self-management (PSM) for patients with chronic pain is assumed to require multidisciplinary care, leaving prescribing analgesics the most accessible option for general practitioners (GPs). We sought to upskill GPs in multimodalPSM with a harm minimisation approach for any opioid prescribing. Design and Methodology Having developed an educational training resource, a multidisciplinary team delivered the program to attendees at a GP conference in 2017. The educational package comprised pre-readings, a 6-hour interactive, skills-based workshop, and post-workshop resources. The single-group intervention was evaluated with an original and unvalidated pre/post-test (three months) survey of four domains: knowledge; attitudes; utilisation of strategies involving PSM and opioid harm minimization. Paired t-tests were conducted on each domain score and overall, with effect sizes assessed with Cohen’s d. A sensitivity analysis was performed on the data lacking a post-test survey response. Post-survey scores were imputed via chained regression equations, then paired t-tests analyses were conducted on imputed datasets using Rubin's method to pool estimates. Findings Of 99 participants, 33 returned both surveys for primary analysis. These were combined in the sensitivity analysis with 60 unpaired surveys. Internal consistency was modest (Cronbach’s alpha 0.736). Primary analysis demonstrated significant self-reported improvements in each educational domain with overall score increasing 10.54 points out of 130 (p

SUMMARYMore than 68 million people worldwide have been forcibly displaced and one-third of these are refugees. This article offers an overview of the current literature and reviews the epidemiology and evidence-based psychological and pharmacological management of post-traumatic stress disorder (PTSD), sleep disturbance and pain in refugees and asylum seekers. It also considers the relationship between sleep disturbance and PTSD and explores concepts of pain in relation to physical and psychological trauma and distress. During diagnosis, clinicians must be aware of ethnic variation in the somatic expression of distress. Treatments for PTSD, pain and sleep disturbance among refugees and asylum seekers are essentially the same as those used in the general population, but treatment strategies must allow for cultural and contextual factors, including language barriers, loss of freedom and threat of repatriation.LEARNING OBJECTIVESAfter reading this article you will be able to:•recognise the challenges faced by the large number of refugees worldwide•understand the relationship between PTSD, sleep disturbance and pain in refugees•broadly understand the evidence for psychological and pharmacological therapy for treating PTSD, sleep disturbance and pain in refugees.DECLARATION OF INTERESTNone.

Background The pain experience associated with labour is complex. Literature indicates psychosocial and environmental determinants of labour pain, and yet methods to support women usually target physiological attributes via pharmacological interventions. Aim To provide an update of our understanding of labour pain based on modern pain science. The review aims to help explain why women can experience labour pain so differently — why some cope well, whilst others experience great suffering. This understanding is pertinent to providing optimal support to women in labour. Method A literature search was conducted in databases Medline, Cumulative Index to Nursing and Allied Health Literature and PsycINFO, using search terms labor/labour, childbirth, pain, experience and perception. Thirty-one papers were selected for inclusion. Findings Labour pain is a highly individual experience. It is a challenging, emotional and meaningful pain and is very different from other types of pain. Key determinants and influences of labour pain were identified and grouped into cognitive, social and environmental factors. Conclusion If a woman can sustain the belief that her pain is purposeful (i.e. her body working to birth her baby), if she interprets her pain as productive (i.e. taking her through a process to a desired goal) and the birthing environment is safe and supportive, it would be expected she would experience the pain as a non-threatening, transformative life event. Changing the conceptualisation of labour pain to a purposeful and productive pain may be one step to improving women’s experiences of it, and reducing their need for pain interventions.

Opioids have important roles in the time-limited treatment of acute and cancer pain, end-of-life pain or dyspnoea, and in opioid dependency. Maintaining focus on biomedical treatments, including drugs, has limited success in chronic pain. Active self-management and healthy lifestyle choices are fundamental to addressing multisystem complexity and harnessing neuroplasticity in chronic pain. Addressing psychosocial maladaptations and physical deconditioning requires a variety of approaches, frequently involving multiple care providers. In practice, most pain care is delivered outside specialist centres by GPs and other non-pain specialists. Although they are well placed to provide multimodal care, they often lack training and confidence in delivering this care.

Introduction:. Survivors of torture are for many reasons at particularly high risk for inadequate assessment and management of pain. Among the many health problems associated with torture, persistent pain is frequent, particularly pain in the musculoskeletal system. The pathophysiology underlying post-torture pain is largely unknown, but pain inflicted in torture may have profound effects on neurophysiology and pain processing. Methods:. A narrative review of assessment and treatment studies, informed by clinical experience, was undertaken. Results:. The clinical presentation in survivors of torture shares characteristics with other chronic primary pain syndromes, including chronic widespread pain. Unfortunately, such pain is often misunderstood and dismissed as a manifestation of psychological distress, both in specialist psychosocially oriented torture services and in mainstream health care. This means that pain is at risk of not being recognized, assessed, or managed as a problem in its own right. Conclusions:. The available research literature on rehabilitation for torture survivors is predominantly targeted at mental health problems, and studies of effectiveness of pain management in torture survivors are lacking. Rehabilitation is identified as a right in the UN Convention on Torture, aiming to restore as far as possible torture survivors' health and capacity for full participation in society. It is therefore important that pain and its consequences are adequately addressed in rehabilitative efforts. This article summarizes the current status on assessment and management of pain problems in the torture survivor.

The aim of the study was to investigate the difference in response to a motor imagery task between individuals with and without painful temporomandibular disorders (TMDs). The participants were 24 adults with and without TMD (TMD and control group, resp.). A set of photographic images of the profile view of a person’s head and neck and a hand and a foot were presented in a random order. The set consisted of six different orientations with rotations of each image at 0, 60, 120, 180, 240, and 300 degrees and included left and right representations. The participants were required to view the image and make a decision as to whether it was a left or a right side presented, that is, mental rotation (MR) task. Data were collected on 48 tasks (including left and right) at each orientation for each body part. Reaction times (RTs) for correct answers and accuracy in making the left or right judgements were recorded. The RT was slower in the TMD group than in the control group. The RT for the profile image was slower than those for the hand and foot images. For images that were 180 degrees, the RT was slower and the accuracy was lower than those for five of the other image orientations. The judgements made about the 180-degree rotated image were more inaccurate compared to images of all other orientations among all types of stimuli.

Introduction: Anxiety sensitivity has been proposed as a psychological vulnerability factor for post-traumatic stress disorder (PTSD). Studies have also supported the protective role of resilience for overcoming the negative effects of trauma exposure. Given the linkages between anxiety sensitivity, resilience, trauma exposure and post-traumatic stress, this study explored the potential moderating roles of anxiety sensitivity and resilience on the association between trauma history and PTSD symptoms in a sample of individuals with chronic pain. Materials and Methods: A total of 100 patients with chronic pain were recruited from a large public hospital. Patients who had pain lasting for more than 3 months and a pain intensity rating of at least 4/10 were included. The study participants were administered measures of PTSD symptoms (PTSD Checklist – Civilian Version), resilience (Brief Resilient Coping Scale) and anxiety sensitivity (Anxiety Sensitivity Index). Results: An analysis of outcome measures indicated that anxiety sensitivity and resilience were independently associated with PTSD symptoms, where βs were 0.57 and -0.23, respectively. The relationship between trauma and PTSD symptom severity was also moderated by anxiety sensitivity. Trauma history was associated with higher PTSD symptom severity only in those with high anxiety sensitivity. However, contrary to the hypotheses, resilience did not serve as a moderator. Conclusion: There are potential benefits of PTSD interventions that increase resilience and decrease anxiety sensitivity in individuals with chronic pain, especially for those who have experienced a traumatic event. Given that the presence of PTSD symptomatology in chronic pain populations negatively impact patient well-being, it would be important for clinicians to assess, monitor and treat PTSD in individuals with chronic pain. Key words: Singapore, Trauma exposure

Objective labour pain is unique and complex. In order to develop a more sophisticated understanding of labour pain this exploratory study aimed to examine women׳s experiences of labour pain within the perspective of modern pain science. An improved understanding of labour pain will assist in informing and enhancing pain management approaches. Design a qualitative study was performed using phenomenology as the theoretical framework. Data were collected from telephone interviews. Thematic analysis of transcripts was performed. Setting Melbourne, Australia. Participants a diverse sample of 19 women who gave birth in a large maternity hospital was interviewed in the month following labour. Findings the data suggest that a woman׳s state of mind during labour may set the stage for the cognitive and evaluative processes that construct and give meaning to her pain experience. Women׳s descriptions of their pain experiences suggested two states of mind. The first was characterised by the mind remaining focussed, open and accepting of the inner experience, including pain. This state tended to be accompanied by a more positive reporting of the labour experience. The second was characterised by the mind being distracted and thought processes featured pain catastrophising, self-judgment and a negative evaluation of pain. Although these two mind states appeared to be distinct, women could shift between them during labour. Women׳s evaluations of their pain were further influenced by their personal beliefs, desires, the context and the social environment. Key conclusions women׳s state of mind during labour may set the stage for the cognitive and evaluative processes that construct and give meaning to their pain experience. Implications for practice developing interventions for labour pain that promote positive evaluative processes and cultivate a state of mind focussing on the present may improve women׳s experiences of labour pain.

Pain is no longer considered to be simply the transmission of nociception, but rather an output subsequent to the complex interactions of homeostatic systems. Manual therapists' clinical reasoning needs to incorporate this complexity in order to develop individualised effective treatment plans. Pain classification strategies attempting to assist clinical reasoning traditionally define multiple types of pain - nociceptive, neuropathic, centrally sensitised - potentially fitting elements of the pain experience to linear independent systems, rather than embracing the multiple dimensions. It is our contention that pain should not be classified unidimensionally. In all pain states consideration should be given to the combined influence of physiological, cognitive, emotional and social inputs, all of which have the potential to influence nociception. The Pain and Movement Reasoning Model presented in this paper attempts to capture the complexity of the human pain experience by integrating these multiple dimensions into a decision making process. Three categories have been created to facilitate this - central modulation, regional influences, and local stimulation. The Model allows for the identification of a predominant element to become the focus of treatment but also for the identification of changes to clinical presentation, where new treatment targets can emerge.

The International Classification of Functioning, Disability and Health (ICF) was adopted as one of the key models to support early health professional learning across a suite of new preregistration health science courses. It was decided that an online resource should be developed to enable students, course designers and teaching staff, across all disciplines, to have access to the same definitions, government policies and other supporting information on disability. As part of the comprehensive curriculum review, enquiry-based learning was adopted as the educational approach. Enquiry-based learning promotes deeper learning by encouraging students to engage in authentic challenges. As such, it was important that the online resource was not merely a site for accessing content, but enabled students to make decisions about where else to explore for credible information about the ICF. The selection of a host location that all students and staff could access meant that the resource could not be located in the existing online learning management system. Construction using software being trialled by the library at La Trobe University allowed for the required access, as well as alignment with an enquiry-based learning approach. Consultation for the content of the online resource included formal and informal working groups on curriculum review. The published version included resources from the World Health Organization, examples of research completed within different disciplines, a test of knowledge and a preformatted search page. The format of the online resource allows for updating of information, and feedback on the utilisation of the software has been used to enhance the student experience. The key issues for the development of this online resource were accessibility for students and staff, alignment with the adopted educational approach, consultation with all disciplines, and ease of modification of information and format once published.

This study aimed to evaluate the implementation of a same-year peer-assisted learning (PAL) scheme, introduced in the first year of an undergraduate degree. The students participated in voluntary timetabled PAL sessions which encouraged a cooperative approach through student-directed activities. An action research design was used, and evaluation at each stage led to subsequent modifications over three years of implementation. Evaluation showed that the majority of students agreed that PAL helped with social aspects of learning but not that PAL contributed to improved study skills or assignment preparation. Between stages 1 and 2 small yet significant improvements in satisfaction occurred, and these continued in stage 3 when clearer guidance was provided. Based on our experience, PAL may provide effective learning environments; however, those interested in implementing it should be warned that it is not an easy option, and students need help to structure sessions effectively.

New mothers frequently experience breastfeeding problems, in particular nipple pain. This is often attributed to compression, skin damage, infection or dermatitis.To outline an integrated approach to breastfeeding pain assessment that seeks to enhance current practice.Our clinical reasoning model resolves the complexity of pain into three categories: local stimulation, external influences and central modulation. Tissue pathology, damage or inflammation leads to local stimulation of nociceptors. External influences such as creams and breast pumps, as well as factors related to the mother, the infant and the maternal-infant interaction, may exacerbate the pain. Central nervous system modulation includes the enhancement of nociceptive transmission at the spinal cord and modification of the descending inhibitory influences. A broad range of factors can modulate pain through central mechanisms including maternal illness, exhaustion, lack of support, anxiety, depression or history of abuse. General practitioners (GPs) can use this model to explain nipple pain in complex settings, thus increasing management options for women.

Pain is the most common reason that people seek physiotherapy care. Despite major advances in our understanding of pain in the past 40 years, the burden of pain worldwide remains enormous, whether gauged in humanitarian, health care, or financial terms (National Pain Strategy 2010). Physiotherapists have an ethical imperative as health professionals to have an accurate understanding of the human pain experience so as to best help those seeking their care. This means physiotherapists need to be educated appropriately in modern pain neuroscience, so they can assess relevant factors that might modulate the pain experience and provide effective pain management.