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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.
- State University of New York Farmingdale (Campus History).
- Hypnosis for Chronic Pain Management Workbook (Treatments That Work).
- Devil Ash Days (Devil Ash Saga Book 1).
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.
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.
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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.
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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.