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, the US Institute of Medicine published a report 'Crossing the quality chasm: A new health system for the 21st century' listing patient-centred care as one of six drivers of health quality.

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…

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 decisions…

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…

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, and as people seeking help - we need to know 'what it is like' because none of us can feel another's pain, and yet clinical decision-making relies on it.

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).…

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, interference and bothersomeness - making distinctions and pointing out relationships between these words.

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…

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)

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…

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.

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.…

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 on compliance, not life integration and flexibility.

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…

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.

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…

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.

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…

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.

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…

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 at…

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.'…

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 people with a full emotional, personal and social life outside of the clinical encounter…

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…

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.

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…

Empower. A conversation. verb: give (someone) the authority or power to do something. Power has several meanings: in legal terms, power means authority, so empowerment can mean authorisation. Power can mean the ability to control people or events, or the political control a person or group has in a country. It can mean strength, it can mean capacity, it can mean energy. To…

Empower. A conversation.

verb: give (someone) the authority or power to do something. Power has several meanings: in legal terms, power means authority, so empowerment can mean authorisation. Power can mean the ability to control people or events, or the political control a person or group has in…

Noticing, without judgement, being present: An introduction to mindfulness Mindfulness as a term comes with a lot of baggage. Mindfulness is given to many people with pain (see this from Harvard) and it can evoke a groan and a 'OMG' eye-roll from some. It's touted as a way to reduce pain and stress, and almost like a panacea for everything that ails us. Today I thought it was time to review some of the evidence for mindfulness, and discuss ways to introduce the practice without getting that eye-roll response!

Noticing, without judgement, being present: An introduction to mindfulness

Mindfulness as a term comes with a lot of baggage. Mindfulness is given to many people with pain (see this from Harvard) and it can evoke a groan and a 'OMG' eye-roll from some. It's touted as a way to reduce pain and…

Where are we going? End goals for pain interventions Of course we want to reduce pain. Pain is unpleasant so why wouldn't we aim to 'get rid of it'? But let's dig a little more deeply. We want to reduce pain to 'get back to normal', to reduce distress and to reduce disability or interference. If we successfully reduce pain it seems reasonable that both distress and disability will also have less impact.

Where are we going? End goals for pain interventions

Of course we want to reduce pain. Pain is unpleasant so why wouldn't we aim to 'get rid of it'? But let's dig a little more deeply. We want to reduce pain to 'get back to normal', to reduce distress and to reduce disability or interference. If…

Is it worth it? Minimal Clinically Significant Difference On this blog I've pointed out the rather mediocre effects of most (perhaps all) treatments for chronic pain. It's incredibly sad for people living with pain to be promised The Thing, go through the rollercoaster of hope and end up with very little change. This internal disappointment is compounded by the pressure from external sources (family, friends, employers, treatment funders) who fully expect that The Thing Works.

Is it worth it? Minimal Clinically Significant Difference

On this blog I've pointed out the rather mediocre effects of most (perhaps all) treatments for chronic pain. It's incredibly sad for people living with pain to be promised The Thing, go through the rollercoaster of hope and end up with very…

Starting movement practice: Handling flare-ups Do you know why people with pain stop (or never get going with) movement practices? Apart from the 'but it's sooooo boring and hard', that is... (or is that just me?) Flare-ups. Increased pain. DOMs that last for ages - weeks for me! And a bunch of other factors (see Gilyani et al., 2024 for more for people with low back pain).

Starting movement practice: Handling flare-ups

Do you know why people with pain stop (or never get going with) movement practices? Apart from the 'but it's sooooo boring and hard', that is... (or is that just me?) Flare-ups. Increased pain. DOMs that last for ages - weeks for me! And a bunch of…

Social stuff matters I've recently discovered a researcher I'd not heard of before but thanks to Michael Ray, a colleague in the US, I've come across Hanna Grol-Prokopczyk from University at Buffalo, New York. Hanna is a medical sociologist who has been researching the NIH-funded “Demography of Chronic Pain: A Population Approach to Pain Trends, Pain Disparities, and Pain-Related Disability and Death” (R01 AG065351; 2020-2025), and co-authored the study that sparked this blog (see below).

Social stuff matters

I've recently discovered a researcher I'd not heard of before but thanks to Michael Ray, a colleague in the US, I've come across Hanna Grol-Prokopczyk from University at Buffalo, New York. Hanna is a medical sociologist who has been researching the NIH-funded “Demography of…

Pacing – what do we mean by this? and how do we do it? Pacing is one of the more divisive terms among clinicians and people living with pain. It's either the best thing since sliced bread - or the worst thing in the world. Let's define it, because some of the problems might start here. Pacing may be defined as a strategy to modify over- and under-activity, and to work at a steady and consistent level.

Pacing – what do we mean by this? and how do we do it?

Pacing is one of the more divisive terms among clinicians and people living with pain. It's either the best thing since sliced bread - or the worst thing in the world. Let's define it, because some of the problems might start here. Pacing may…

What, why & how: two out of three ain’t bad? I'm guilty. I've posted over 1300 posts on this blog, and I know I'm guilty of doing two out of three, and failed to do the third. The two I've done a lot? What and why. What the evidence suggests and what could help people with pain and the clinicians they see. I've written about why these ideas might help and…

What, why & how: two out of three ain’t bad?

I'm guilty. I've posted over 1300 posts on this blog, and I know I'm guilty of doing two out of three, and failed to do the third. The two I've done a lot? What and why. What the evidence suggests and what could help people with pain and the clinicians…

Relevance: Understanding the ‘So What’ of Pain Management Research Something I teach and bring to my research reading is the 'so what' question. So what is about bringing home the implications, the rationale, the WHY in all that I do. I'm reflecting on this as I consider my blog. When I started writing in 2007, I wanted to get information out to people just tiptoeing into pain practice and who might not have access to research.

Relevance: Understanding the ‘So What’ of Pain Management Research

Something I teach and bring to my research reading is the 'so what' question. So what is about bringing home the implications, the rationale, the WHY in all that I do. I'm reflecting on this as I consider my blog. When I started…

Taking pain into account Recently I've been pondering internalised ableism. This term refers to adopting common societal beliefs about 'normal' and the converse 'abnormal', and consequently judging themselves in light of those norms. It can include expectations and attitudes like shame for being disabled, comparing yourself with 'normal' people and being incredibly critical of your own capabilities and limitations as a result. Much of the literature on this topic focuses on autism spectrum and ADHD, and mental health, but there are few papers in the chronic pain space such as Sheppard (2020).

Taking pain into account

Recently I've been pondering internalised ableism. This term refers to adopting common societal beliefs about 'normal' and the converse 'abnormal', and consequently judging themselves in light of those norms. It can include expectations and attitudes like shame for being…

Pushing pause: When is it OK? Over the years I've worked clinically I've noticed that many people with pain have had ongoing rehab. Like almost never-ending. One programme after another. In some cases this has gone on for years. A new goal is set as soon as an old goal is reached. And on and on. While sometimes this endless rehab has been initiated by the individual, more often than not in a compensation setting it's been at the behest of the insurer.

Pushing pause: When is it OK?

Over the years I've worked clinically I've noticed that many people with pain have had ongoing rehab. Like almost never-ending. One programme after another. In some cases this has gone on for years. A new goal is set as soon as an old goal is reached. And on and on.…

Menopause? Or Ovation! Someone on social media suggested we rename menopause, and I love this idea! Life after women stop having periods is more than 'Oh now you can't have babies' so I suggested Ovation! As I've been posting recently here and here menopause and life after menopause is often associated with more musculoskeletal pain, so I thought it time to look at what clinicians might consider.

Menopause? Or Ovation!

Someone on social media suggested we rename menopause, and I love this idea! Life after women stop having periods is more than 'Oh now you can't have babies' so I suggested Ovation! As I've been posting recently here and here menopause and life after menopause is often…

Do you see me? As a young woman growing up in a small town in New Zealand, my educational and career choices were somewhat constrained. Not for me the push to become a medical practitioner, a lawyer, a scientist. No, I was encouraged to consider nursing or teaching. The subjects available to me did not include metalworking, woodworking, technical drawing (that was for boys, until my friend Tania challenged it!).

Do you see me?

As a young woman growing up in a small town in New Zealand, my educational and career choices were somewhat constrained. Not for me the push to become a medical practitioner, a lawyer, a scientist. No, I was encouraged to consider nursing or teaching. The subjects available to me…

Menopause and musculoskeletal pain Once a woman (or person with female sex hormones) reaches menopause, things change. I experienced the usual rush of hot flushes, brain fog (later found to be previously undiagnosed ADHD - and responsive to methyphenidate - yay!) and an array of other symptoms like night sweats, sleep problems, wrinkled skin, and lost libido. Every person who menstruates will, if they live long enough, stop menstruating.

Menopause and musculoskeletal pain

Once a woman (or person with female sex hormones) reaches menopause, things change. I experienced the usual rush of hot flushes, brain fog (later found to be previously undiagnosed ADHD - and responsive to methyphenidate - yay!) and an array of other symptoms…

Mine is manzarilla and it's the first time I have grown them. Google will be my friend!

‘Trumpian’ edict: Health leaders slam new rules, Seymour glad ‘muppets back in their box’ The Acting PM has dismissed doctors’ concerns of censorship, saying they shouldn't make public submissions about “fast food restaurants” or “leading advocacy campaigns”.

So, let’s see if I have the government’s position correctly:

Doctors are “muppets” who need to stop talking publicly about avoiding disease and get back their waiting lists clogged with the sequelae of avoidable diseases.

Gobsmackingly stupid.

#nzpol #nzhealth

www.stuff.co.nz/politics/360...

Looking about as good as mine! When do you pick them is my question. I have 19 on my wee tree!