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I would first of all like to say thank you to NEMS and Pain Cloud for a fantastic opportunity this weekend, I’ve really enjoyed myself! The whole weekend has had a really relaxed feel about it without any real conflict maybe because I think the kind of people who were attending were quite similarly minded. They used the phrase preaching to the converted a few times!

Kieran O’Sullivan was the 1st speaker of the second day with his talk about why trying to prevent LBP could be a bad idea. The first thing he did was get us to all download Kahoot! so that we could all answer his questions interactively. This worked really well and really got the group engaged.

The talk was similar in theme to his interview available on the web ‘Revolutionising back pain treatments’, an article which I regularly give out to patients:

The philosophy of this is based around the concept that back pain is such a normal part of life (like constipation, headaches or feeling a bit sad) and that maybe there are a few sensible things we can do, like be physically active and get enough sleep, but that maybe we shouldn’t spend too much time, money or energy trying to prevent it, as we have a lack of high quality evidence showing that any form of prevention actually works. And that really, if we have a sore back for a few days it’s not the end of the world, but what is more of an issue is back pain which persists and/or causes disability.

He then chatted about the recent studies showing limited benefit of prevention of back pain with exercise and education (e.g. TOPS trial) as well as how the BPS of pain may not mean that current BPS treatments work well (O’Keeffe et al, Traeger et al 2017). A useful analogy was made to treatment of obesity where we know that diet is important but that does not mean every diet intervention will be successful – and just because it didn’t work doesn’t mean that diet is not an important factor of obesity. Difficulties and differences in studies was also discussed, for example, in how prevention of LBP was defined as an outcome (3/10 pain for >24hrs vs sick leave from work for example).

A common theme through the weekend and this talk was about the professions involved and the MDT. Discussions arose about our roles and the overlap between professions and how we should all have the same message and focus on the treatment/philosophies used rather than our specific profession. A case example was used of a patient talking about picking up a box being the cause of her LBP but not mentioning her recent divorce, house move and new job as she did not think that relevant. If we do not ask then we would never know. It’s about having a plan about how to deal with issues and where our boundaries lie in talking about sleep, mood and weight for example. Kieran suggested a useful 3 point method of firstly acknowledging that the issue (e.g. sleep) could be a factor in the person’s pain, secondly, asking someone if they would like some information on that topic (e.g. a sleep hygiene PIL to give them) and lastly, onward referral if needed to someone who could better help.

We then discussed treatment options, with wait and see at the top as a valid method of treatment once the patient has been assessed and understands what that means (the median recovery of LBP is 6 weeks – normalising this point).  And if there is evidence of poor coping/distress step up support to include 3 key aspects to care:

  1. Accurate education on pain

  2. Encourage exercise/physical activity

  3. Lifestyle change (sleep, diet, stress management etc)


The talk finished on addressing the bigger issues we face in the future; government policy, funding, research and society in general, the real decision makers. We all play a part in getting the message across.

The middle of the day involved discussions and group chats which were interesting. One topic was whether or not us becoming very specific about the type of exercise we prescribe meant we were starting to become a bit more biomedical again and was that our place or useful for our patients.

The second speaker of the day was Bronnie Lennox Thompson, an OT and Academic who spoke about Exposure Therapy and ACT for persistent pain. One really interesting thing I found about Bronnie was that she described that her practise hadn’t really changed in the past 30 years, which really made me think if OTs were quite ahead of their time!  She used a case study of one of her patients to talk about the process she goes through to assess and manage people with persisitent pain. The questioning techniques she used were backed up with a pack of photos which she would get patients to look through. The photos were varied and included functional activities such as driving, shopping and cooking, relationships with partners, children and different locations such as the beach or a park. The patient would look through the photos and pick out the top 8-10 and then put them in a list of importance. This would really help to generate conversation about their values as well as help identify specific. I really liked this idea.

She used the patient’s values to engage and motivate them to do what it was that was important to them and really took the focus away from the pain. She also discussed using mindfulness with a biker (not your typical meditative type!) and how this could be being aware of the feelings when riding a motorbike of the grip on the handles for example, rather than lying on the floor humming, and how accessible it could be for anyone.  Another method I found interesting was if the patient had damaging thoughts not to try to push them away but to be very aware of them and to diffuse these thoughts by getting the patient to repeat them over and over to diminish their power.

Overall this was a really enjoyable and relaxing weekend with lots of really useful nuggets of information and I was really pleased I got the chance to attend, thanks NEMS and Pain Cloud!

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