11:26. PhD: People who live well with ongoing pain
Elite athletes with significant pain
13:37. Studying the healthy or the coping, rather than the unhealthy or the non-coping
Seeing people only at their worst
18:16. Classical Grounded Theory and Main Concerns
Constructivist Grounded Theory
Classical – being the Observer (Hypothesis generating)
Emergence of order from chaos
25:10. The Main Concern
How can I still be “me”?
Re-occupying the self
26:19. Three parts to the process:
Deciding on a new path
27:18. Diagnosis – a double-edged sword?
29:26. Illness Representation in Low Back Pain
Matching the label with the experience
30:24. Predicting (prognosis)
What’s the impact?
Neuropathic pain’s unpredictability
Stressors – physical / emotional / mental
Can only find out by “doing”
Noticing what’s happening… importance of tracking pain
Where do I spend my energy?
34:10. The 3rdProcess: Occupational Existing
People are not looking to the future (Pain Consciousness diagram)
Goals are too abstract / removed from the pain experience
36:01. Acting as a bridge to flexibly persisting
Being trustworthy, non-judgementally supportive
Having an occupation (personally meaningful activity)
42:47. 13-36% of those experiencing persistent are living well
Making coping strategies meaningful
44:36. Non-Judgemental Awareness or Mindfulness
Intuiting hurt doesn’t always equal harm
46:21. Doctor Movement
Movement for headspace
“Sometimes the truth depends upon a walk around the lake” William Stafford
A bigger picture view and making sense
Mindfulness as a means to an end versus “just noticing”
49:37. Doing anything that helps
Idiosyncratic – coloured lights…
The problem with “pacing”
Flexibility versus Prescription – based on the individual’s values
52:33. Contextual Behavioural Science
The importance of autonomy in behaviour moment to moment
Choice points and making time for activity and recovery
54:57. Listening to themselves better in the context of their new sense of self
Alignment with values
ACT (Acceptance & Commitment Therapy)
Enhancing awareness of pushing and what thoughts / feelings emerge when you don’t…
Managing value conflicts
What we do
Why we do it
How other people respond to us
What makes you feel most like your self
59:21. Biopsychosocial element
Higher incidence of persistent pain in women
Gender differences in rehabilitation
The ability to say “No”
1:04:32. Reoccupying a sense of “self”
Recognising it’s a process
Being definitive that pain is not going to go
Probability – tempering the search for “being who I used to be”
1:07:58. Acceptance and giving up hope
Permission to reinvent
The Chinese (sometimes Mexican) Finger Trap… putting life on hold
What is it about your (former) passion that matters to you?
Identifying the underlying values is where the therapy happens
1:11:54. Exercise versus Movement
1:13:12. A problem with pain Neuroscience?
Not a stand-alone, but fits with “making sense”
Information alone does not change behaviour
Readiness: somebody on my side; a reason to get on with something that matters; I know what’s going on; I can predict it.
1:15:58. Part of the pain experience is allowing others to understand your pain.
Pain Measures (eg visual analogue scales) conflated with Pain Behaviour
Change the behaviour
Pain measure doesn’t change disability
1:17:45. Most people seek help when pain interferes with important activity
The focus has to be more about health
Behaviour, not education, changes disability
Learn by doing, not by talking
1:21:07. From Bronnie’s website:
So… what does a good occupational therapist offer in pain rehabilitation? These are only some of the things I’ve contributed over the years:
graded exposure in daily life contexts like the shopping mall, supermarket, walking at the beach, fishing, catching a bus, driving
self regulation using biofeedback, hypnosis, progressive muscle relaxation in daily life contexts like getting off to sleep, at work in between clients, while doing the grocery shopping, while driving
effective communication with partners, children, employers, co-workers, health professionals in daily life contexts
guided discovery of factors that increase and reduce pain in daily life contexts like the end of a working day, over the weekend, at the rugby, in the pub, on your own, in a crowd, at home
information on proposed neurobiological mechanisms as they influence pain and doing/participating in daily life contexts, things like attention capture, distraction, memory, emotions, stress, excitement
values clarification about what is important to a person’s sense of who they are in their daily life
progressive meaningful movement in daily life contexts
goal setting, planning, managing and progressing overall activity levels in daily life
positive, pleasurable activities to boost mood, reduce anxiety and live a life more like the person wants
1:22:03. Identify what’s important – values
What do you like to do?
Take me through a 24 hour day
What’s your theory?
How have they got to where they’ve got to?
What’s their main concern?
1:25:57. Distinction between CBT & ACT
Does this action take you closer to being youor further away?
1:27:26. Health Professionals ideals…
The wounded healer
Fitting the patient to our model… versus the patient’s model – what’s important to them?
Let the person what’s important to them?
Asking the person “What do youthink is the next best step?”
Offering help without driving the solution
1:31:20. Making sense before setting bigger goals
Meeting the individual where they’re at
Sleep / rest, Diet, Movement, Fun
1:33:15. The 4 Doctors
1:34:11. Bronnie’s 5thDoctor: Dr Purpose
Purpose from immediate purpose to longer-term purpose
Be your own expert on your self
1:35:10. Maslow’s Hierarchy of Needs
The need to relate
The need for autonomy
What are the doingthings that matter?
The drive to create
What would you be doing of pain was less of an issue for you?
1:37:40. How to find out more or get in contact with Bronnie
Exploring Pain Facebook Forum
1:41:01. Closing comments
If you’d like to learn more about Bronnie’s work, or to get directly in touch, please head to her website here.
In March 2020, I’m heading out to Bronnie’s home-turf – New Zealand – to put on a 2-day Seminar to help health and fitness professionals better understand how to facilitate a return to optimal function for people experiencing persistent pain. I will be applying some of Bronnie’s amazing work using evolutionary modelling, and expanding on the information presented in the “Ghost in the Machine” papers* I wrote with Paul Chek. If you’re local, I hope our paths will cross there!
To find out more or to book your place, head to this link.
*NOTE: this paper is usually behind a $31.50 pay-wall, but has been made available for free by Elsevier at this moment in time.