I was born in the mid-60’s. A child of the 70’s, growing up in the orange, brown, gold and lime green colours of the small city of Gisborne on the East Coast of Aotearoa. The ‘riviera’ of New Zealand at the time – best place for surfing, pub band tours, 2ZG Gisborne radio, and my Father the Youth for Christ Director (Dad, in the photo bottom right, he’s on the left with all the hair, sideburns and mo!). The things we got up to as part of YFC rallies (would never be allowed today, health and safety… ) I do remember the moon landing – being brought to the black and white TV by my parents and to ..read more

The last two posts I’ve written here and here have explored differing perspectives and current debate about the term catastrophising – and I hope I’ve been clear that I don’t dispute the usefulness of (or the accumulated data about) a construct that is associated with poor outcomes across so many pain experiences. I just don’t find the term and its definition lands well with people living with pain, and the way it’s discussed amongst some clinicians is problematic. This post is my take on a nuanced approach. The term catastrophising is defined as ‘an exaggerated negative mental set’ (Sullivan ..read more

Last week I posted the first in a series on pain catastrophizing. This week, instead of looking at the measurement instruments, I thought it worthwhile seeing what people with pain feel when looking at this construct. After all, when we’re talking about us (people with pain) shouldn’t our perspectives be taken into account? Nothing about us without us. Webster and a large team of collaborators (Webster et al., 2022) conducted possibly the largest study examining the responses of people living with pain to the terms associated with catastrophising. Now the number of collaborators on this projec ..read more

There are few constructs more widely known in pain psychology than catastrophising. Defined as “an exaggerated negative mental set brought to bear during actual or anticipated pain experience” (Sullivan et al., 2001), catastrophising is associated with poor outcomes including greater pain intensity, distress and disability in almost every situation where pain is experienced (Sullivan & Tripp, 2024). Cognitive biases associated with catastrophising include interpretive bias, attentional bias and attentional fixation – in other words negatively interpreting situations, attending to the negat ..read more

One of the words that has been in my vocabulary for decades is ‘management.’ No, I don’t mean the proliferative middle management layer infesting healthcare for about as long as I’ve been working in health. I mean ‘pain management’ or ‘supported self-management.’ As ever, what pops up for me is about what, exactly, is being managed? Is it pain? Well – not exactly. After all, pain does what it does, and if we focus on pain reduction alone just look where that gets us (Ballantyne & Sullivan, 2015; Cutler & Glaeser, 2021). And quickly, lest anyone think I’m anti-medication and don’t know ..read more

*Persistent didn’t alliterate so well! I’ve been pondering what makes persistent pain so complicated? What is it about this problem that means clinicians use terms like ‘heart-sink’, or ‘problematic’, or ‘difficult’ when they talk about people living with pain? While nociception and all the associated neurobiological processes associated with pain are undoubtedly complex (and poorly understood), I don’t think this is what people mean when they describe chronic pain is complex. After all, there are loads of body systems and disease processes that are complex. I come back to ourselves. Yep. You ..read more

This is a landing page for pain resources from Occupational Therapy Australia – click ..read more

No, I’m not going to assemble a bunch of papers and point out the effect sizes of exercise on pain and disability! In fact, I’m not even going to point to much research in this post. I want to pose some questions and put some thoughts out for discussion. See, the people I’ve seen over the years who live with pain have, by and large, not been great ‘exercisers’ before their pain came on, and many haven’t really changed their lifestyle a heap since their pain either. In fact, there is research showing that people with chronic pain don’t change the overall quantity of their activity very much – b ..read more

and what a shame there was no ACT alone group… No secret here, I like ACT (Acceptance and Commitment Therapy) as an approach for living well with chronic pain. I like it for many reasons, but probably the most compelling ones are that the hierarchy between therapist and person living with pain is minimised (we’re both humans finding our way through life) and that it doesn’t require the person to delve into challenging or disputing thoughts – this in turn enhances adherence to the core elements of ACT: living a life aligned with what really matters to this person. People seem to find using ACT ..read more

Over the past year or so I’ve kept returning to ‘the social’ part of our multifactorial pain experience.* Pain can be extraordinarily isolating, and our current sociopolitical emphasis maintains a focus on ‘what the individual should do.’ In New Zealand, our accident compensation legislation is a no-fault, 24/7 everywhere, all-the-time innovation but it falls short in critical areas. One is the continued focus on ‘physical findings’ to validate a diagnosis (and to show that the resultant impact on an individual is entirely due to a personal injury caused by accident), and the other is the atte ..read more