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Culturally Competent Care in Chronic Pain It is impossible to outline all the possible idiosyncratic social and environmental contexts that may be important to consider for each person with pain. Translate materials and have the translation reviewed for readability and sensitivity Persons — collaborate with individuals native to the culture and seek advice on adapting the program in a culturally sensitive way Metaphors — collaborate with individuals native to the culture to develop metaphors to explain important concepts Content — provide culturally specific examples to communicate concepts such as pacing Concepts — use culturally appropriate models e.

What do you think has caused it? Why do you think it started when it did? What problems do you think the pain causes? How does it work? How severe is your pain? How long do you think it will last? What kind of treatment do you think is necessary? What are the most important results you hope to achieve?

What are the main problems this pain has caused you? What do you fear most about the pain? Treatment Planning Not all individuals will require the same level of detail of information or level of care. These components address chronic pain that is influenced by biological factors such as CS and primarily psychological yellow flags: Education Improving function, activity, and overall quality of life Promoting self-management self-efficacy These treatments and management principles are fundamental and are relatively basic competencies. The key components of PNE are: 49 Learning about pain is therapy — when you understand why you hurt, you hurt less Pain is normal, personal and always real — pain is a response to what your brain judges to be threatening There are danger sensors, not pain sensors Pain and tissue damage can each exist in the absence of the other Pain depends on the balance between factors that threaten the body and those that promote safety Pain relies on context e.

Three of the primary principles in chronic disease self management may be applied to individuals living with chronic pain: Acknowledgment that one may have to live with the condition Positively managing the condition Optimizing physical and emotional health to minimize the effects of the condition The following websites provide useful, accessible information for both patients and health-care professionals on self-management.

Better choices, Better Health Pain BC Information for health professionals and patients self-management Life is Now provides information and resources for people living with chronic pain, health professionals, and others who work with this population Pacing and planning programs help teach strategies for being active without triggering pain. Improving Function and Activity Strategies to improve function and activity address assessment findings for biological factors such as central sensitization and deconditioning, as well as for psychological factors such as maladaptive thoughts or beliefs.

Disturbed Sleep Patterns Sleep disturbance is a common symptom in patients with chronic pain, and research shows that sleep and pain may have a bidirectional reciprocal relationship. Available assessment tools include: Pittsburgh Sleep Quality Index , which measures sleep quality in the clinical population Pain and Sleep Questionnaire PSQ-3 , which measures the impact of pain on sleep in chronic nonmalignant pain of various etiologies 54 In addition, asking the patient to keep a sleep diary may help to better understand their sleep patterns.

Strategies the clinician may consider: Be clear and specific in all communication — a vague comment or response may trigger anxiety Continue to provide clear descriptions of therapeutic goals e. Consider framing discharge as their positive achievement i. Strategies for the clinician to consider: Avoid treatment positioning in which you are above or looking down at patient — try to be at eye level Set good boundaries so you do not overextend yourself.

Can you think of anything that may have brought this on? Medications used in Management of Chronic Pain Optimal care includes awareness of the medications used in chronic pain management and their potential side effects. Support from Other Health-Care Providers. Common Chronic Pain Conditions. Complex Regional Pain Syndrome Complex regional pain syndrome CRPS is a sensory, vasomotor and autonomic disorder of an extremity which can result in disability and impacts to quality of life.

Medically, the following differential diagnoses should be ruled out: 65 Infection — particularly osteomyelitis Post-traumatic conditions Post-operative states Neuropathic pain Bone diseases Rheumatic diseases Vascular disorders Psychiatric conditions — fictitious syndrome Dermatological Treatment For this complex condition, it is critical that the physiotherapist displays and maintains empathy — a clear understanding of the severity of their symptoms but does not enable disability.

The approach is similar to those in graded exposure therapy. One hour later symptoms should be no worse 68 Proprioception and balance training Functional activities may be introduced before standard or typical exercises, e. Exercises are increased very gradually using baseline symptoms as guideline. Evaluate the need for modified work hours and tasks. In some cases, the patient is removed from the work place to obtain symptom control and prevent their condition from spiralling downwards.

Specific Pain Neurophysiology Education for CRPS Pathophysiology of CRPS in patient-friendly language Include fact that currently CRPS is considered a permanent condition that can be self-managed and controlled not cured 69 Discuss the influence of stress, anxiety, depression and poor sleep on pain Explain adaptive coping Pacing and Planning 70 Provide specific instructions for treatment interventions and teach self monitoring: Attention is not focused on symptoms but on mindful awareness, respecting baselines Ensure the patient knows they are heard and understood: they have frequently been called malingerers or misdiagnosed as having psychiatric diagnoses Help patient use neutral or positive language, and to reframe negative statements, particularly around body image Education is an ongoing process and repetition will be necessary.

Neuropathic Pain Neuropathic pain can be the result of a variety of conditions, such as illness, injury, or medication. Fibromyalgia FM FM is a syndrome of diffuse body pain with associations of fatigue, sleep disturbance, cognitive changes, mood disturbance, and other variable somatic symptoms.

Click to resize. The need for a Canadian pain strategy. Physical functioning and opioid use in patients with neuropathic pain. Pain Med. Epub Feb 3. International Association for the Study of Pain. IASP Taxonomy. Accessed December 15, Updating the definition of pain. Houben, R. European Journal of Pain, 9: — Expectations, perceptions, and physiotherapy predict prolonged sick leave in subacute low back pain.

BMC Musculoskeletal Disorders, 10, A Delphi survey of expert clinicians, Man Ther. Clin J Pain. Epub Dec Wijma et al. Physiother Theory Pract. Epub Jun Central sensitization: Implications for the diagnosis and treatment of pain. J Pain. Epub Nov Main, George Main C and George S Psychologically informed practice for management of low back pain: future directions in practice and research Phys Ther May;91 5 Epub Mar Amundsen, Katz Asmundson G.

Understanding the co-occurrence of anxiety disorders and chronic pain: state-of-the-art. October , p Hoy et al. The unequal burden of pain: confronting racial and ethnic disparities in pain. Pain Med, ; Defining racial and ethnic disparities in pain management. Clin Orthop Relat Res, ; Epstein et al. Epstein A, Ayanian J. Racial disparities in medical care. N Engl J Med, ; Booker et al. Geriatr Nurs, ; Core competencies for pain management: results of an interprofessional consensus summit. Kirmayer L. Culture and metaphoric mediation of pain. Transcult Psychiatry. Stats Canada National Household Survey, Alberta, Statistics Canada.

Physiotherapy Theory and Practice. Darlow et al. Roussell N,Neels H, Kuppens K et al History taking by physiotherapists with low back pain patients: are illness perceptions addressed properly? Disabil Rehabil. Epub Aug Bishop et al. How does the self-reported clinical management of patients with low back pain relate to the attitudes and beliefs of health care practitioners?

A survey of UK general practitioners and physiotherapists. Coudeyre et al. Epub Jun 5 DOI Applying modern pain neuroscience in clinical practice: criteria for the classification of central sensitization pain. Diener et al. Public Health Rep, ; Integrating culturally informed approaches into the physiotherapy assessment and treatment of chronic pain: protocol for a pilot randomized controlled trial. BMJ Open ;7:e Am Fam Physician. Josephson et al. Louw et al New Zealand , Journal of Physiotherapy 44 2 : Depicting individual responses to physical therapist led chronic pain self-management support with pain science education and exercise in primary health care: multiple case studies.

Arch Physiother. Butler and Moseley Vibe Fersum, K. EJP, — Relaxation and Mindfulness in Pain: A Review.


  1. State University of New York Farmingdale (Campus History).
  2. Hypnosis for Chronic Pain Management Workbook (Treatments That Work).
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Reviews in Pain, 4 1 , 18— The Pain and Sleep Questionnaire three-item index PSQ-3 : A reliable and valid measure of the impact of pain on sleep in chronic nonmalignant pain of various etiologies. Physiother Theory Pract] Jul; Vol. Mechanism-based classification of pain for physical therapy management in palliative care: A clinical commentary, Indian Journal of Palliative Care, January , 17 1 Akyuz G, Kenis O.

Kemler M, de Vet H, Health-related quality of life in chronic refractory reflex sympathetic dystrophy complex regional pain syndrome type I. Galer B, Henderson J, Perander J Jensen M Course of symptoms and quality of life measurement in complex regional pain syndrome: A pilot survey, Journal of pain and symptom management [] yr vol iss:4 pg Bruehl, S. Subgroups of CRPS.

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Marinus et al. European journal of pain [] yr: vol iss:9 pg Harden et al. Harden, R. Validation of proposed diagnositc criteria the "Budapest Criteria" for complex regional pain syndrome. Pain ,Aug , Hand Ther. Packham et al Somatosensory rehabilitation for allodynia in CRPS of the upper limb: a cohort study. Journal of Hand Therapy. Complex Regional Pain Syndrome. Manual Therapy ;e 2. Pacing: A concept analysis of a chronic pain intervention. Bernardo from Mission, Texas, US. It was very well organized. Very good examples of how the process works for pain management.

Lori from Johnstown, Pennsylvania, US. I enjoyed this lesson. I liked that it was made into 2 lessons. Very informative. The scripts were very helpful.

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Tasha from US. I felt this course was very practical. It was more than sufficient to give me a working knowledge of the subject. Elia from Antioch, California, US. It is invaluable to watch the progression of hypnotherapy over sessions. I love that. The theoretical background of everything that was done was great!

The hypnosis processes itself seemed extremely slow to me. Michael from Eindhoven, Brabant, NL. Amazing lecture by the amazing John Melton. Always learn a lot from John. Good lesson. Kerry from Libertyville, Illinois, US. This is an interesting lecture on pain and its effects on the body and also, it is interesting to learn the use of the subconscious to reframe the discomfort to ease. Candy from Billings, Montana, US. This lesson was very good. I liked it. The process unfolds itself.

It was very informative and good. Rajiv from Aptos, California, US. Perfect class, I got a lot of new knowledge about hypnosis. Very useful and I learned a lot about hypnosis and pain. Very good. I had learned a lot of useful knowledge with Hypnosis and Pain Management. It was really helpful being able to watch all the sessions and seeing how they progressed one session to the next.

Bethani from Syracuse, Utah, US. Enjoyed the lessons and case history series. Niki from Gardena, California, US. A very in-depth course, thank you. Roberta from Glencoe, Minnesota, US. I am inspired to use the templates provided and create my own library of inductions and techniques. Terrific in depth exploration of applying hypnosis to Pain Management.

You know when John Melton is lecturing it's going to be a good one. Lots of experience and a great teacher who is happy to share his learning to accelerate my own. Thank you. Frankie from Wishaw, Scotland, GB. It was interesting to know that tension in the body is related to pain and that is why relaxation is very important in the process of dealing with pain management. I really loved it. I appreciate the style and insight that John Melton brings to every case.

Appreciate differences between chronic and acute pain. I felt more comfortable with it immediately and it's work very well with my clients I've received more from this online course that I find much easier to understand than hours of classroom instruction. Uncommon Hypnosis is my 'ready reference' for practical, easily understood explanations of all aspects of the human condition - and aren't we many faceted! Along with the background understanding provided, step by step assistance in the application of measures to move forward are available, either for individual use or as part of a well structured course.

Articles continually provide useful tips. UH is a service-oriented organisation - both through the web and direct office contact. In all ways the Uncommon Hypnosis is extremely supportive of all clients. I found the Uncommon Hypnosis course more effective than most courses because of the combination of different learning techniques, and the short, easy to take in sections.

I appreciate the demonstrations and the downloads which make it good value and entertaining, and Mark's communication skills are unsurpassed. I've read a dozen books about hypnosis over the years. So when I was searching for an online course, I had limited expectations and supposed that I would already be quite familiar with the techniques that I would be taught. So it was with great surprise and delight that Uncommon Hypnosis hit me on the side of the head at virtually every point.

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I will continue to use Uncommon Hypnosis. The definition of the term utilization was most helpful and how it is used in inductions. Another helpful thing was that using the staircase induction counting on the exhale because the exhale engaged the parasympathetic branch of the autonomic nervous system was a useful fact. Finally, the demonstrations of inductions was helpful especially observing Mark saying "that's it" when the person was REMing. I found this was a helpful model that was useful with my own clients.

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For three years I have heard over and over that I have Chronic Fatigue and I just need to get more sleep. That this is just my life because I have special needs kids. I knew there was more to it than that, but the doctors could never seem to look past my life circumstances of autistic kids, and a husband that served in the army, and is often away. They continued to run the same tests over and over, and kept prescribing me sleeping pills to help me get more sleep.

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I knew in my heart that my health issues were not a matter of lack of sleep, and the sleeping pills were not helping me. So it was time to get rid of them. So get rid of them I did. I haven't looked back.

Healing Chronic Pain: 20 Minute Guided Meditation

And I haven't taken a sleeping pill since. I now live near family, and my husband is still across the country getting ready for an overseas tour with the army. I am raising the kids on my own. But with hope. I have a civilian doctor this time, who believes me. He has run many tests and has discovered that not only do I have Fibromyalgia, but that I also have Systemic lupus erythematosus Lupus.

I have downloaded many Self-Hypnosis downloads to help me manage everything; from my outlook on life with living with a chronic illness, to my eating habits, to managing pain. Hypnosis downloads has changed my life. But most off all I am thankful to my friend, for without her, I'm not sure I would have found hope again. I was at the bottom of the barrel I had been kicked out of my house, gotten my second DUI, lost my job and had no family near me. I am an alcoholic, I say that because its not a disease you ever just stop having.

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While Andy declined to continue with the route, Neil and I pressed on. Approximately metres of the c. We successfully navigated these sections, and my last memory that day was to crack a joke to Neil, feel the wind pick up over my right shoulder a similar feeling just before the motorcyle crash , then woke up 13 days later in Southern Glasgow Hospital's ICU.

Neil was killed during the c. Spent 3. Walked out of the burns unit the closest thing the NHS has to treating frost-bite! Moved into my own bungalow in Glossop, where one of my sisters lived, in Feb , to work out what was next in my life. Didn't fancy being on state benefit for the rest of my days, so I invested my savings into retraining for a career in IT. Gained access to a Hypnotherapist via the NHS to enable me to overcome the fear and anger I experienced through working with the emotional trauma.

I planned and orchestrated the return to the tower for mid-June I utilised self-hypnosis, positive affirmations and visualisation through my preparations. To cut a long story short, me and Andy - who had identified Neil's body the following day we were rescued - reclimbed the route, 'slayed the dragon', and returned to the Ben Nevis Inn to celebrate. Neither of us have looked back since Andy is now a UAV submarine freelance pilot, involved in gas and oil exploration, now living in the Languedoc. I will be visiting him in the summer of as part of a cycling holiday.

I now run my own Transformational Life Coaching clinic in central Nottingham, as part of a teach of holistic healthcare practitioners. I have been given my life back and that gift is priceless. Thank you from the bottom of my heart. Hypnosis has completely changed my life. I came from a broken family that didn't instill positive behaviours, thought process, or self esteem.

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I finally broke the cycle. I've learned to trust, believe, and enjoy the adventure. Home Hypnosis Audios Please choose a category below Why hypnosis is the key to unlocking your creativity, focusing your energy and understanding yourself. Over 38k fans on Facebook. The Sunday Times "There are many collections of CDs that take you through the process of self hypnosis, or act as aids, but this collection is particularly well regarded" view source here. Why hypnosis is exactly what you've been looking for Let's talk about the you you've always known you could be Have you ever felt if you could properly direct your focus and concentration, you could build a better career for yourself?

Have you ever felt you could supercharge your communication skills? Have you ever felt tiredness or stress has gotten in the way of quality time spent with your partner, children, or friends? Have you ever wanted to tackle a big project - running a marathon, for example - but not known how to keep up momentum and drive? The 5 best things about hypnosis. You'll become highly productive without getting stressed I know what you're thinking - what on earth does stress management have to do with hypnosis?

Tap into your creative energies instantly Those magical moments when time stands still because you're engrossed in something creative. Really understand yourself and others Ever feel like your kids or your partner don't get the best out of you? You'll learn how to stay calm in high pressure or uncomfortable situations Dealing with the workplace bully. Develop laser-like levels of focus and concentration You know that feeling when you're reading a book or watching a film and you're so engrossed by it, you're barely aware time is passing? Hypnosis is like water But the big question is Who would you trust to teach you hypnosis?

And because it's such a powerful learning tool, you can use it to un-learn, too. Professional trainers since Here at Uncommon Knowledge, we've been teaching people how to use hypnosis since Why we're Uncommonly different Not just the 'You are getting sleepy' hypnosis Not just simplistic directive hypnosis Not just softly spoken suggestions. We're Uncommonly different because we'll teach you about psychology, too What's inside the Uncommon Hypnosis course.

Live workshop footage of hypnosis in action How to hypnotize yourself and others How your unconscious mind works and how to get it to work for you How to create a post-hypnotic suggestion How to make hypnosis work quickly with anyone.