There’s a saying that goes something like “If you’re the smartest person in the room, you’re in the wrong room*”. There was no chance that I was in the wrong room today with PainAdelaide, possibly the best pain meeting in the world, providing an unequalled opportunity to definitely be in the right room.
Into only its second year, PainAdelaide has quickly become a day marked well in advance in the calendars of many clinicians, researchers, therapists, and, people experiencing pain.
PainAdelaide 2014 provided a veritable feast of juicy ideas, but it also didn’t shy away from serving up a bit of gristle for attendees to chew on – a bit of tough reality to challenge dogma, keep us grounded and focussed on the big problem of pain.
I thought I might provide a bit of a summary and some of the highlights of the day.
After a brief introduction from Lorimer the day kicked off with Professor Mark Jensen from the University of Washington. Professor Jensen spoke about Motivational Interviewing and hypnotic language; but I don’t remember anything after he said I was feeling very sleepy…
Bad jokes aside, Professor Jensen strongly recommended reading Miller and Rollnick’s Book “Motivational Interviewing: Helping People Change” now in its third edition – he summed it up with “when I am at my best as a clinician, I am doing what is in that book”.
Professor Jensen suggested that therapists consider undertaking hypnosis training and shared a few language patterns including avoiding the use of the word “try”. To try something he suggested implies failure – “I tried but I couldn’t do it”. Rather, hypnotic language might go something like “you might be surprised and delighted at how easy you find it to relax and at the same time notice that your pain has decreased”.
As an aside, Milton Erickson, one of the most important figures in modern hypnotherapy, would use the word “try” often, but he knew its powerful potential. Erickson might say to a person that he was helping into a trance state something like “… and as you try to keep your eyes open, you may find your eyelids becoming heavier and heavier… ”
After waking up and noticing my mouth was full of chicken feathers, Professor Mac Christie from the University of Sydney spoke about what’s new in opioid signalling. Some intriguing nuggets, including the discovery that different opioids engage different regulatory mechanisms inside cells with an impact on the variability of their effects; including tolerance and addiction, and, the work being done on drugs that could enhance the endogenous opioid system rather than working directly on opioid receptors.
Dr Tasha Stanton gave a fantastic presentation on the power of perception and the use of multi sensory illusions to target pain. Dr Stanton can be found here giving a public presentation in her polished and professional style. Dr Stanton spoke of her use of the MIRAGE device to manipulate real time video; allowing the production of the visual illusion of a finger or knee being stretched or shrunk while also providing a corresponding pull or push on the body part. These illusions have been shown to alter pain, but the mechanisms are still not fully understood.
Professor Michael Nicholas from the University of Sydney spoke about adherence and its importance in therapeutic outcomes. To maximise adherence, Professor Nicholas suggested a number of strategies including asking the patient what they think, referring to the patient’s beliefs in any explanations and checking whether the patient understood what was discussed.
Following Professor Nicholas was Dr Neil O’Connell, regular writer and section editor for Body In Mind, over from Brunel University in the UK. Dr O’Connell discussed the evidence for chronic pain interventions, with an emphasis on understanding some of the tricky statistics that can be used to demonstrate greater results than really exist. A brilliant line from Dr O’Connell was “if you torture data long enough, it may confess to anything”. Dr O’Connell really livened up the room with his excitement and passion, but he’s not afraid to call it as the data sees it, even if that does mean ruffling some feathers. Dr O’Connell finished with a challenging quote form one of his heroes, Archie Cochrane; “One should be delightfully surprised when any treatment is effective, and always assume that a treatment is ineffective unless there is evidence to the contrary”.
This post is getting very long and I’ve only just gotten to the lunch break, so I think I will call it a day and provide a part 2 tomorrow. For those that can’t wait that long (and I know there will be lots of you), the entire day was “live tweeted” by a few attendees including yours truly – a search of Twitter for the hash tag #PainAdelaide will bring up the timeline, or you could have a look at @altThinq, @bodyinmind and @Trevail.
– Tim Cocks
Missed out on PainAdelaide? Don’t fear, noi has you covered with possibly the best courses going around, so get your think on and get up to date.