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When Everything Becomes an Outcome: Untangling the Confusion in Outcome Measurement
An outcome measure is a measure used to evaluate the results of an intervention – typically evaluating changes over time. But I hear the term used to refer variously to any assessment at any time, only questionnaire scores, only standardised assessments that result in numbers – so maybe it’s time to do some untangling. Outcome measurement and baking a cake An outcome is the result of something.…
Do you need to be a psychologist to help people living with pain?
I’m tempted to start with a TL;DR — and many of you will know exactly why. But some topics simply can’t be reduced to a single declarative sentence, and this is one of them. There’s a persistent belief that pain is simple: fix the “noci‑bio” and the person returns to normal. Others argue that bringing in psychological aspects implies fragility, or that it means the pain must have a…
Listen to the STORY
Have you ever read a clinical report about someone living with pain? It will probably include the age, gender, occupation, diagnosis, a brief history and a plan. But – where is the person? What does pain mean to them? Healthcare values objectivity. Objectivity is dispassionate, unbiased, impartial, based on fact not feelings. Roger Martin writes “The dark shadow of the powerful light of science…
Depression's quiet influence: What if pain rehabilitation means understanding mood too?
“When Cheree came for help with her low back pain, it wasn’t hard to notice her low mood. It wasn’t her tears, she didn’t cry. It was her lack of energy, her low ‘get up and go’, how slowly she replied to me, the difficulty she had telling me about her goals for the future. She wasn’t seeing me for her depression. “Back pain” was written on her GPs referral. In fact, nothing in her notes…
Person-centred or person-directed - Some thoughts
Person-centred: what do we mean by it? The WHO defines person-centredness as ‘Healthcare approaches and methods that consider the individual as a unified entity with multifaceted needs and objectives which stem from their unique social determinants of health.’ Themelis and Tang (2023) consider it to be ‘respectful of and responsive to individual patient preferences, needs, and values.’ In 2001,…
Autonomy not assumptions: The missing pieces in pain self-management
Clinicians carry clear ethical responsibilities: to benefit the person, to avoid or minimise harm, and to respect each person’s values and preferences (Singer et al., 2001). These responsibilities are reflected in the four foundational principles of health ethics:• Beneficence — acting for the person’s benefit• Nonmaleficence — avoiding harm• Autonomy — supporting people to make their own…
The Emotional Dimensions of Pain Assessment
Take your mind back to your last pain assessment. I can bet good money pain intensity was measured (that 0 – 10 ‘how much does it hurt’ question). Where it hurts on a body map. Perhaps even duration and constancy (intermittent, ongoing, fluctuating). Quality or ‘what does it feel like?’ could be included: burning, aching, gripping, cramping, stabbing…. All excellent things to know as clinicians,…
Understanding Psychological Factors in Pain Management
Pain is defined by IASP (International Association for the Study of Pain) as ‘an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage.’ There are notes accompanying this definition and you can see them here click. Last week I defined some terms often used in association with ‘pain’ – suffering, nociception,…
The Complexity of Pain: Beyond Simple Words
OK I’m a little pedantic at times, but hear me out! Words, how we use them and what we mean by them matter. They matter because distinctions help us stay focused on what we believe we’re actually helping people with. Pain: by now we should know that pain is defined by the International Association for the Study of Pain (IASP) as “An unpleasant sensory and emotional experience associated with, or…
What will 2026 bring? Reflections on Blogging in the Pain space
The start of a new year almost always brings reflections on the last 12 months. I often affirm what matters to me and think about how well I’m living my values. I have no idea what this year will bring, and neither does anyone else. What I can do is set some intentions. So here goes. Someone said blogging is dead. That it’s not a thing any more. I disagree – the form of blogging has changed, but…
Transformation: Paradigm shifts in pain therapy
I’ve sometimes felt like I’m swimming against the current. Things I promote on this blog like ‘biopsychosocial’: mainstream in many parts of health today (see below) but operationally? Non-pharmacological approaches to pain: mentioned as a one liner in clinical updates “Encourage deep breathing or relaxation techniques, especially if light sedation is not used.” Rehabilitation programmes focusing…
Luck, Fate, Personal Responsibility
For a moment, I’d like you to stop and answer this question: “How much do you think individuals are responsible for their health status?” If you can, give a number out of 10 where 0 = not at all responsible and 10 = fully 100% responsible. Hold that number in mind. I want to tell a story, it’s real. I’d had widespread pain all my life, but was slim and fit: healthy. So when I became pregnant…
Drowning in 'evidence'
A recent bibliometric review of journals with ‘pain’ in the title revealed 19 journals (Chi et al., 2025). There is no shortage of research being published in the area of pain – and not a gnat’s chance of keeping up with all the papers published. Papers aren’t only published in these ‘pain’-oriented journals, they can be in many other journals. And this raises some questions for me. Especially…
Do You Believe Me? Trust and the Politics of Pain in Clinical Practice
Trust. A term we use to mean our belief in the reliability or truth of someone or something. An attitude or belief that involves allowing ourselves to be vulnerable to another; an expectation that another will act in a certain way even though we can’t be sure. Trustworthiness is the inherent quality of being reliable, honest, and worthy of trust. Trustworthiness refers to the characteristics or…
Does accepting your pain mean you're giving up?
Acceptance and commitment therapy (ACT) for pain is sometimes seen as just about ‘giving up’ on reducing pain. TL:DR ACT doesn’t mean giving up How on earth can that be? Isn’t it called ACT because it’s about ‘acceptance’? Let’s unpack ‘acceptance.’ According to the Oxford Dictionary of Languages, acceptance means “the action of consenting to receive or undertake something offered.” If I look…
Tailoring Pain Management: The Importance of Individual Concerns
I’ve been thinking about person-centredness and what this means in practice recently. Person-centred or patient-centred was first used by psychologist Carl Rogers in the 1970s, later aligned with a biopsychosocial approach espoused by psychiatrist George Engel. Two key ideas underpin person-centredness: (1) people should be seen not just in terms of their ‘presenting problems’, but as whole…
Chronic Pain Management: Why Brand Loyalty Matters Less
When I read social media content about managing or treating pain, I get the feeling there’s some sort of competition going on. Brand X therapy gets Y outcomes – yay! Brand A gets B outcomes – we win! Almost as if brand loyalty matters. If there were clearly better outcomes from Brand X, or better outcomes for some people from Brand A I might be willing to buy into this kind of dialogue. For…