Canadian Physiotherapy Pain Sciences Group (CPPSG)

[Diane]

Hi there,

I thought people might be interested in a new group that formed in Canada recently. You could call it "the little group that could." I'm proud to be a member. These are some of its first steps. We're working on the premise that "If you build it, they will come." I'm including the second newsletter (just out) as an example of what a small group of determined people can and will do on a limited budget ($0 actually, at the moment) if they organize around a vision. It's like one of those home renovation shows, except that we would like to renovate the profession just a tad.

Both the co-chairs are bright young men who are out in the community (both PT and at large) teaching pain science. (Lorimer has replicated himself and his memes! :D) We received letters of endorsement for establishing a division of CPA from Morris, Moseley, Butler, Shacklock, and Melzack, among many others, about a dozen in all.
Enjoy.

[nari]

Thanks for sharing this, Diane.

I think the group has potential to become quite a driving force in pain education, world wide.

Let's hope so. There are many who will benefit.

Nari

[Diane]

Hopes remain high Nari. After all, theoretically at least, in chaos theory, a butterfly flapping its wings can set off tsunamis.. :)
I would characterize this not as heavy plowing with a sharp stick, but rather with a plow that has already been developed and is available to those who want to take it up, and strong pre-existing oxen.

[emad]

Diane ;

Thanks for providing the newsletters.

Regards
Emad

[Jon Newman]

Hi Diane,

I'm quite excited to see how this develops. Check out the following links (you probably have already read these) for some thoughts about your project.

It's your passion (http://headrush.typepad.com/creating_passionate_users/2005/06/tell_microsoft_.html)

In the article you'll notice they mention something about Foo Camp (http://headrush.typepad.com/creating_passionate_users/2005/08/foo_camp_adhoc_.html). Perhaps you could organize such a thing in Southwestern Ontario.

Good luck!

ps Maybe you could describe your efforts this way (http://alex.pudmenzky.com/)

[Diane]

Thanks for the blog link Jon. :)
Loved the mirror neuron discussion on there as well. I'll send a link to this whole thread to the co-chairs.

[Diane]

Here is a book review Ian wrote, and sent me to put up on SS:
Narrative, Pain, And Suffering (2005), Carr, D, B. Loeser, D, J. Morris, D, B (Ed’s): Seattle; IASP Press, www.iasp-pain.org

He included this link to another review (http://www.ampainsoc.org/pub/bulletin/fal05/reso1.htm) of the same book.

This book is a collection of twenty-four essays based on a unique conference held in Bellagio Northern Italy in 2003.
The conference was chaired by the editors of the book who are all highly influential figures in the pain management world. Loeser an Anaesthetist and former president of the IASP was the originator of the ‘onion skin bio psychosocial’ model which conceptually assisted in interpreting pain and illness behaviour – this subsequently influenced Waddell’s approach to back pain and the influential Back Pain Revolution.
David Morris an English Professor has written widely on pain and his books; The Culture of Pain and Illness and Culture in the Post-modern Age have been very influential in understanding the important socio cultural factors surrounding and influencing biology. Daniel Carr is Professor of Pain Research and lead editor for pain trials in the Cochrane collaborative review group on Pain, Palliative and Supportive Care.
The twenty four chapters although varying in style, content and quality are I feel an important first step in genuine integrated collaboration between medical practioners at the ‘coalface of suffering’, basic neurobiological researchers, writers, anthropologists and sociologists.
As the title suggests the book and conference title is Narratives and Pain and for many this may be seen as ‘unscientific’ in the sense that biomedicine tends not to value first person experiences in its search for ‘objectivity’. As Morris suggests, Pain although studied utilising knowledge gained from basic sciences is deeply personal and will never totally be understood by studying neurotransmitters and reductionist biological methods - although this methodology is extremely important.
Academically and clinically there is renewed interest in formally studying narrative as an enhanced method of interactive communication and intervention. This narrative movement has been highly influenced by the Physician Rita Charon and her programme at Columbia University and a well-written chapter by Charon details the value and role narrative has in understanding and working with people in pain.
Many chapters in the book contrast strongly with the dominant biomedical interpretations of pain and suffering and reveal the highly experienced clinicians thoughts and experiences. Pain is probably one of the most complex human experiences and is an extremely common reason for patients presenting to therapists, particularly in primary care and outpatient settings. One chapter by Chapman and Volin on Narrative as a window on chronic disabling back pain is perhaps a way for many therapists to understand the complexities of spinal pain and think about non biomedical possibilities when interacting with similar patients in a clinical setting.
Arthur Frank a Sociologist and author of the influential The Wounded Story teller in an extremely moving chapter on Generosity, Care and Narrative suggests that one important question is: how can pain be understood as a part of life and how do we cope and enable people to flourish despite experiencing pain? This may appear deeply philosophical however Frank who has experienced serious personal trauma and disease suggests that it is perhaps ironic that in order to receive palliative care we have to be certified as dying in order to receive it when many of its practices are relevant to pain care in the community and health care environment.
Morris in a well-written chapter on ‘success stories’ promotes a relatively upbeat view in the promotion of enthusiasm and the importance of anecdote and success in health care. Although well grounded trials are the aspired basis of modern health care many papers do not seem to offer a positive or enthuisasistic platform on which to practice, particularly in the complex uncertain world of chronic pain. Morris uses examples from the ‘new’ movement of positive psychology where an enthusiasm and promotion of positive traits is contrasted with the more typical emphasis on unravelling and understanding unhelpful behaviour. Perhaps as Morris suggests more emphasis should be placed on studying and highlighting people who lead meaningful and happy lives despite chronic pain and this may be be more than anomalous statistical data.
Carmen Green an Anaesthetist reveals how the complex issues of race, culture and socioeconomic factors permeate health care and pain treatment in the United States. This chapter I am sure could be readily ‘translated’ into many areas of the United Kingdom.
Contrasting the personal accounts, qualitative methodologies and sociological perspectives on pain there are chapters on objective interpretations of pain utilising new imaging technology. Personally, one of the most interesting chapters was by Gundell and Tolle on the interaction of physical and psychological pain and the mutual neurobiological basis of emotion and pain. This excellent chapter made complete sense clinically where often during clinical consultations a patients ‘narrative’, particularly in a pain clinic or outpatients setting will often reveal a complex personal and social background history.
In summary this book has chapters, which will appeal to a wide variety of clinicians who interact with those suffering ongoing painful problems. In many ways some of the chapters are reflections of what is perceived to be wrong with a totally ‘objective biomedical scientific stance’ when interacting with people who are experiencing pain.
It is perhaps interesting that the newer imaging technologies are providing evidence for the complex interrelationship between psyche and soma. In addition the ‘humanities’ and the personal experiences offered in this text help and give value to the often difficult to evaluate subjective factors such as empathy and personal understanding .

Ian Stevens, Physiotherapy Forth Valley.

[BB]

Way to go CPPSG! Sounds like a great group and direction Diane. Way to go.

Cory

[Diane]

Hello there,
A new issue has just been mailed out. I'll attach it for any/all to read.

[bernard]

Diane,

There is an error link about NOI group (typed as nio instead of noi).
Perhaps you may tell the group to send a email that give the correct link?

[bernard]

The same occurs with the American Academy of Pain Management link.

[Diane]

I will mention this to Dave. Thanks Bernard.. lesson learned. Test all links before mailing out.

[bernard]

Diane,

I tried the same issues, many times.
Experience comes only with practice.

[Diane]

Hi there,
CPPSG has just published a new newsletter, downloadable by visiting the CPPSG website (http://cppsg.squarespace.com/home/) and clicking on archived newsletters (http://cppsg.squarespace.com/archived-newsletters/) in the menu on the right. The latest issue is Volume 3 Number 1.
We invite everyone who is a PT to fill out an attached survey. There's even a chance to win a prize, Margaret Caudill's pain-management book "Managing Pain Before it Manages You". You do not have to be a Canadian PT to have a say. :)

[BB]

Great stuff as always, Diane. I'm curious if you've read the Motivated Interviewing book that is reviewed in the newsletter? It sounds like something I might be interested in reading as I've been thinking on the topic of increasing patient compliance lately. From the sounds of it, it almost sounds like ideomotion in conversation form. Non-coercive, allowing the interviewee to express themselves in a non-threatening context to find their way to self efficacy.

[Diane]

Thanks Cory, I haven't yet, but Dave's article is spurring me on. I think you are right about the similarity. Maybe ectodermal approaches are the same regardless of which sense one is accessing the patient through..

[Barrett Dorko]

I used to say that Art Linkletter used Simple Contact verbally when he spoke to children on TV in the 50s and, I suppose, this is when I first began to appreciate the power of unconscious expression in its presence.

I watched him when home sick from school and this was a show my mother liked. Years later I would write of her showing me ideomotion early in her Alzheimer's.

Margaret Hinske Dorko - The Mother of Simple Contact.

[nari]

Cory,

I did a course on MI in the 90s and thought it was a refreshing change from the usual banter on counselling.

It is precisely how you summarised it - non-coercive, allowing expression, the interviewer is remarkably passive and yet is there... and the onus is always on the interviewees to discover themselves in ways previously unknown to them.

It also is useful for interactions with people who are not patients...


Nari

[Bas]

Diane, thanks. Just so you know: the survey "no longer exists" according to the page the link brings one to....

[Diane]

YIKES! Thank you for bringing this to our attention Bas!

[Diane]

Sebastian, Dave just tested the link at work, with a colleague, on a different computer, and it worked ok. He wonders if your security settings might be a bit too tight... :confused:

[Bas]

Well, thank you Diane! Used my other computer - no problem!
Sorry to cry 'wolf" a bit premature.....

[Diane]

Hello again,

We haven't received enough feedback on our survey yet, so if you would be so kind, CPPSG would love to learn what you think. Please take a moment to fill out our brief on-line survey to provide us with more information on our readership, and the direction you would like to see CPPSG take in the near future. The survey will take you less than 5 minutes, and you can enter to win a copy of Margaret Caudill's excellent CBT-based pain management book "Managing Pain Before it Manages You". Remember, you don't have to be a member or even Canadian, to fill this out - we're all in this together.

Here is the survey link:
http://www.surveymonkey.com/s.asp?u=580913194646

Thank you so much,
Diane Jacobs
for CPPSG

[Diane]

Hi there,
I'm pleased to announce that the latest newsletter by the Canadian Physiotherapy Pain Sciences Group is hot off the press:

[emad]

This last newsletter is really up to date .

Emad

[Crazy Pole]

Diane,

This stuff is great. Thank you for sharing. As I'm trying to get up to speed with you "pros", this is quite helpful. Keep up the great work.

Wes

[Diane]

You are more than welcome. Thank you for the feedback. It's such a pleasure to bring synthesized science info forward in a useable way, without a naggy chorus with their eyes rolled up to the sky and their fingers stuffed in their ears, going, "We :note2: can't :note: hear you :note2: until/unless you show us OUT :note: comes :note2: ...."

One begins to wonder where their intellects disappeared to, why they can't put two and two together.