Health Education in Practice: Journal of Research for Professional Learning, 2020
Purpose Active pain self-management (PSM) for patients with chronic pain is assumed to require mu... more Purpose Active pain self-management (PSM) for patients with chronic pain is assumed to require multidisciplinary care, leaving prescribing analgesics the most accessible option for general practitioners (GPs). We sought to upskill GPs in multimodalPSM with a harm minimisation approach for any opioid prescribing. Design and Methodology Having developed an educational training resource, a multidisciplinary team delivered the program to attendees at a GP conference in 2017. The educational package comprised pre-readings, a 6-hour interactive, skills-based workshop, and post-workshop resources. The single-group intervention was evaluated with an original and unvalidated pre/post-test (three months) survey of four domains: knowledge; attitudes; utilisation of strategies involving PSM and opioid harm minimization. Paired t-tests were conducted on each domain score and overall, with effect sizes assessed with Cohen’s d. A sensitivity analysis was performed on the data lacking a post-test s...
Women and birth : journal of the Australian College of Midwives, Jan 20, 2018
The pain experience associated with labour is complex. Literature indicates psychosocial and envi... more The pain experience associated with labour is complex. Literature indicates psychosocial and environmental determinants of labour pain, and yet methods to support women usually target physiological attributes via pharmacological interventions. To provide an update of our understanding of labour pain based on modern pain science. The review aims to help explain why women can experience labour pain so differently - why some cope well, whilst others experience great suffering. This understanding is pertinent to providing optimal support to women in labour. A literature search was conducted in databases Medline, Cumulative Index to Nursing and Allied Health Literature and PsycINFO, using search terms labor/labour, childbirth, pain, experience and perception. Thirty-one papers were selected for inclusion. Labour pain is a highly individual experience. It is a challenging, emotional and meaningful pain and is very different from other types of pain. Key determinants and influences of labo...
Opioids have important roles in the time-limited treatment of acute and cancer pain, end-of-life ... more Opioids have important roles in the time-limited treatment of acute and cancer pain, end-of-life pain or dyspnoea, and in opioid dependency. Maintaining focus on biomedical treatments, including drugs, has limited success in chronic pain. Active self-management and healthy lifestyle choices are fundamental to addressing multisystem complexity and harnessing neuroplasticity in chronic pain. Addressing psychosocial maladaptations and physical deconditioning requires a variety of approaches, frequently involving multiple care providers. In practice, most pain care is delivered outside specialist centres by GPs and other non-pain specialists. Although they are well placed to provide multimodal care, they often lack training and confidence in delivering this care. GPs do not feel that treating chronic pain simply requires a choice between prescribing opioids or referring to specialist care. Multimodal, multidisciplinary chronic pain care can be translated into time-poor primary care settings. Practice policies, holistic assessment then drug and non-drug approaches need to be explored. Practice policies A proactive pain management approach that begins at the reception desk can encourage optimum care. Suitable practice policies include refusing phone scripts, ensuring continuity of care with one doctor, displaying a sign about the opioid policy, and using Medicare items that support complex and collaborative care. Ongoing holistic assessment Even in acute pain, standard care is enhanced by a broad, 'whole person' assessment. The psychosocial dimension includes assessment of mood, cognitions, trauma, suicide risk and the social context of the presenting problems (e.g. workers' compensation, family issues). Additional components incorporate physical activity, sleep patterns, nutrition, and past or current use of addictive substances including prescription drugs. Practice nurses can play a role in implementing time-efficient assessments of chronic pain.
S u m m a r y p o i n t s • There are concerns about the effectiveness of health professionals wh... more S u m m a r y p o i n t s • There are concerns about the effectiveness of health professionals when they are working with people who have pain. • Health professionals have reported a lack of confidence when working with people with complex pain conditions. • Review of pain education in health professional training may improve clinical practice. • The International Association for the Study of Pain curricula can be useful in developing pain education initiatives. • The updated IASP core curriculum appears to be a useful resource for curriculum designers of preregistration physiotherapy programmes, while the IASP discipline-specific curriculum is in need of revision.
This brief contribution discusses the mechanisms of pain in light of current concepts. The author... more This brief contribution discusses the mechanisms of pain in light of current concepts. The author also highlights an emerging liaison between the Association of Chartered Physiotherapists in Women's Health and the Physiotherapy Pain Association.
The International Classification of Functioning, Disability and Health (ICF) was adopted as one o... more The International Classification of Functioning, Disability and Health (ICF) was adopted as one of the key models to support early health professional learning across a suite of new preregistration health science courses. It was decided that an online resource should be developed to enable students, course designers and teaching staff, across all disciplines, to have access to the same definitions, government policies and other supporting information on disability. As part of the comprehensive curriculum review, enquiry-based learning was adopted as the educational approach. Enquiry-based learning promotes deeper learning by encouraging students to engage in authentic challenges. As such, it was important that the online resource was not merely a site for accessing content, but enabled students to make decisions about where else to explore for credible information about the ICF. The selection of a host location that all students and staff could access meant that the resource could not be located in the existing online learning management system. Construction using software being trialled by the library at La Trobe University allowed for the required access, as well as alignment with an enquiry-based learning approach. Consultation for the content of the online resource included formal and informal working groups on curriculum review. The published version included resources from the World Health Organization, examples of research completed within different disciplines, a test of knowledge and a preformatted search page. The format of the online resource allows for updating of information, and feedback on the utilisation of the software has been used to enhance the student experience. The key issues for the development of this online resource were accessibility for students and staff, alignment with the adopted educational approach, consultation with all disciplines, and ease of modification of information and format once published.
Objective: labour pain is unique and complex. In order to develop a more sophisticated understand... more Objective: labour pain is unique and complex. In order to develop a more sophisticated understanding of labour pain this exploratory study aimed to examine women's experiences of labour pain within the perspective of modern pain science. An improved understanding of labour pain will assist in informing and enhancing pain management approaches. Design: a qualitative study was performed using phenomenology as the theoretical framework. Data were collected from telephone interviews. Thematic analysis of transcripts was performed. Setting: Melbourne, Australia. Participants: a diverse sample of 19 women who gave birth in a large maternity hospital was interviewed in the month following labour. Findings: the data suggest that a woman's state of mind during labour may set the stage for the cognitive and evaluative processes that construct and give meaning to her pain experience. Women's descriptions of their pain experiences suggested two states of mind. The first was characterised by the mind remaining focussed, open and accepting of the inner experience, including pain. This state tended to be accompanied by a more positive reporting of the labour experience. The second was characterised by the mind being distracted and thought processes featured pain catastrophising, self-judgment and a negative evaluation of pain. Although these two mind states appeared to be distinct, women could shift between them during labour. Women's evaluations of their pain were further influenced by their personal beliefs, desires, the context and the social environment. Key conclusions: women's state of mind during labour may set the stage for the cognitive and evaluative processes that construct and give meaning to their pain experience. Implications for practice: developing interventions for labour pain that promote positive evaluative processes and cultivate a state of mind focussing on the present may improve women's experiences of labour pain.
This study aimed to evaluate the implementation of a same-year peer-assisted learning (PAL) schem... more This study aimed to evaluate the implementation of a same-year peer-assisted learning (PAL) scheme, introduced in the first year of an undergraduate degree. The students participated in voluntary timetabled PAL sessions which encouraged a cooperative approach through student-directed activities. An action research design was used, and evaluation at each stage led to subsequent modifications over three years of implementation. Evaluation showed that the majority of students agreed that PAL helped with social aspects of learning but not that PAL contributed to improved study skills or assignment preparation. Between stages 1 and 2 small yet significant improvements in satisfaction occurred, and these continued in stage 3 when clearer guidance was provided. Based on our experience, PAL may provide effective learning environments; however, those interested in implementing it should be warned that it is not an easy option, and students need help to structure sessions effectively.
New mothers frequently experience breastfeeding problems, in particular nipple pain. This is ofte... more New mothers frequently experience breastfeeding problems, in particular nipple pain. This is often attributed to compression, skin damage, infection or dermatitis. To outline an integrated approach to breastfeeding pain assessment that seeks to enhance current practice. Our clinical reasoning model resolves the complexity of pain into three categories: local stimulation, external influences and central modulation. Tissue pathology, damage or inflammation leads to local stimulation of nociceptors. External influences such as creams and breast pumps, as well as factors related to the mother, the infant and the maternal-infant interaction, may exacerbate the pain. Central nervous system modulation includes the enhancement of nociceptive transmission at the spinal cord and modification of the descending inhibitory influences. A broad range of factors can modulate pain through central mechanisms including maternal illness, exhaustion, lack of support, anxiety, depression or history of ab...
A literature review was undertaken to determine the instruction, technique and dosage described f... more A literature review was undertaken to determine the instruction, technique and dosage described for antenatal perineal massage in research trials. Relevant databases were searched and nine relevant studies were identified. The methodol- ogy of each study was reviewed and compared. Common approaches were found for the description of the technique, and the training of women and their partners. There was some variation in the dosages and frequencies recommended. A key feature of an early study, the incorporation of Kegel exercises, appeared to be lacking in subsequent studies. Furthermore, plans for effective learning, including accurate feedback, and strategies to enhance com- pliance were mostly absent. A supervised, patient-centred approach may address this.
Health Education in Practice: Journal of Research for Professional Learning, 2020
Purpose Active pain self-management (PSM) for patients with chronic pain is assumed to require mu... more Purpose Active pain self-management (PSM) for patients with chronic pain is assumed to require multidisciplinary care, leaving prescribing analgesics the most accessible option for general practitioners (GPs). We sought to upskill GPs in multimodalPSM with a harm minimisation approach for any opioid prescribing. Design and Methodology Having developed an educational training resource, a multidisciplinary team delivered the program to attendees at a GP conference in 2017. The educational package comprised pre-readings, a 6-hour interactive, skills-based workshop, and post-workshop resources. The single-group intervention was evaluated with an original and unvalidated pre/post-test (three months) survey of four domains: knowledge; attitudes; utilisation of strategies involving PSM and opioid harm minimization. Paired t-tests were conducted on each domain score and overall, with effect sizes assessed with Cohen’s d. A sensitivity analysis was performed on the data lacking a post-test s...
Women and birth : journal of the Australian College of Midwives, Jan 20, 2018
The pain experience associated with labour is complex. Literature indicates psychosocial and envi... more The pain experience associated with labour is complex. Literature indicates psychosocial and environmental determinants of labour pain, and yet methods to support women usually target physiological attributes via pharmacological interventions. To provide an update of our understanding of labour pain based on modern pain science. The review aims to help explain why women can experience labour pain so differently - why some cope well, whilst others experience great suffering. This understanding is pertinent to providing optimal support to women in labour. A literature search was conducted in databases Medline, Cumulative Index to Nursing and Allied Health Literature and PsycINFO, using search terms labor/labour, childbirth, pain, experience and perception. Thirty-one papers were selected for inclusion. Labour pain is a highly individual experience. It is a challenging, emotional and meaningful pain and is very different from other types of pain. Key determinants and influences of labo...
Opioids have important roles in the time-limited treatment of acute and cancer pain, end-of-life ... more Opioids have important roles in the time-limited treatment of acute and cancer pain, end-of-life pain or dyspnoea, and in opioid dependency. Maintaining focus on biomedical treatments, including drugs, has limited success in chronic pain. Active self-management and healthy lifestyle choices are fundamental to addressing multisystem complexity and harnessing neuroplasticity in chronic pain. Addressing psychosocial maladaptations and physical deconditioning requires a variety of approaches, frequently involving multiple care providers. In practice, most pain care is delivered outside specialist centres by GPs and other non-pain specialists. Although they are well placed to provide multimodal care, they often lack training and confidence in delivering this care. GPs do not feel that treating chronic pain simply requires a choice between prescribing opioids or referring to specialist care. Multimodal, multidisciplinary chronic pain care can be translated into time-poor primary care settings. Practice policies, holistic assessment then drug and non-drug approaches need to be explored. Practice policies A proactive pain management approach that begins at the reception desk can encourage optimum care. Suitable practice policies include refusing phone scripts, ensuring continuity of care with one doctor, displaying a sign about the opioid policy, and using Medicare items that support complex and collaborative care. Ongoing holistic assessment Even in acute pain, standard care is enhanced by a broad, 'whole person' assessment. The psychosocial dimension includes assessment of mood, cognitions, trauma, suicide risk and the social context of the presenting problems (e.g. workers' compensation, family issues). Additional components incorporate physical activity, sleep patterns, nutrition, and past or current use of addictive substances including prescription drugs. Practice nurses can play a role in implementing time-efficient assessments of chronic pain.
S u m m a r y p o i n t s • There are concerns about the effectiveness of health professionals wh... more S u m m a r y p o i n t s • There are concerns about the effectiveness of health professionals when they are working with people who have pain. • Health professionals have reported a lack of confidence when working with people with complex pain conditions. • Review of pain education in health professional training may improve clinical practice. • The International Association for the Study of Pain curricula can be useful in developing pain education initiatives. • The updated IASP core curriculum appears to be a useful resource for curriculum designers of preregistration physiotherapy programmes, while the IASP discipline-specific curriculum is in need of revision.
This brief contribution discusses the mechanisms of pain in light of current concepts. The author... more This brief contribution discusses the mechanisms of pain in light of current concepts. The author also highlights an emerging liaison between the Association of Chartered Physiotherapists in Women's Health and the Physiotherapy Pain Association.
The International Classification of Functioning, Disability and Health (ICF) was adopted as one o... more The International Classification of Functioning, Disability and Health (ICF) was adopted as one of the key models to support early health professional learning across a suite of new preregistration health science courses. It was decided that an online resource should be developed to enable students, course designers and teaching staff, across all disciplines, to have access to the same definitions, government policies and other supporting information on disability. As part of the comprehensive curriculum review, enquiry-based learning was adopted as the educational approach. Enquiry-based learning promotes deeper learning by encouraging students to engage in authentic challenges. As such, it was important that the online resource was not merely a site for accessing content, but enabled students to make decisions about where else to explore for credible information about the ICF. The selection of a host location that all students and staff could access meant that the resource could not be located in the existing online learning management system. Construction using software being trialled by the library at La Trobe University allowed for the required access, as well as alignment with an enquiry-based learning approach. Consultation for the content of the online resource included formal and informal working groups on curriculum review. The published version included resources from the World Health Organization, examples of research completed within different disciplines, a test of knowledge and a preformatted search page. The format of the online resource allows for updating of information, and feedback on the utilisation of the software has been used to enhance the student experience. The key issues for the development of this online resource were accessibility for students and staff, alignment with the adopted educational approach, consultation with all disciplines, and ease of modification of information and format once published.
Objective: labour pain is unique and complex. In order to develop a more sophisticated understand... more Objective: labour pain is unique and complex. In order to develop a more sophisticated understanding of labour pain this exploratory study aimed to examine women's experiences of labour pain within the perspective of modern pain science. An improved understanding of labour pain will assist in informing and enhancing pain management approaches. Design: a qualitative study was performed using phenomenology as the theoretical framework. Data were collected from telephone interviews. Thematic analysis of transcripts was performed. Setting: Melbourne, Australia. Participants: a diverse sample of 19 women who gave birth in a large maternity hospital was interviewed in the month following labour. Findings: the data suggest that a woman's state of mind during labour may set the stage for the cognitive and evaluative processes that construct and give meaning to her pain experience. Women's descriptions of their pain experiences suggested two states of mind. The first was characterised by the mind remaining focussed, open and accepting of the inner experience, including pain. This state tended to be accompanied by a more positive reporting of the labour experience. The second was characterised by the mind being distracted and thought processes featured pain catastrophising, self-judgment and a negative evaluation of pain. Although these two mind states appeared to be distinct, women could shift between them during labour. Women's evaluations of their pain were further influenced by their personal beliefs, desires, the context and the social environment. Key conclusions: women's state of mind during labour may set the stage for the cognitive and evaluative processes that construct and give meaning to their pain experience. Implications for practice: developing interventions for labour pain that promote positive evaluative processes and cultivate a state of mind focussing on the present may improve women's experiences of labour pain.
This study aimed to evaluate the implementation of a same-year peer-assisted learning (PAL) schem... more This study aimed to evaluate the implementation of a same-year peer-assisted learning (PAL) scheme, introduced in the first year of an undergraduate degree. The students participated in voluntary timetabled PAL sessions which encouraged a cooperative approach through student-directed activities. An action research design was used, and evaluation at each stage led to subsequent modifications over three years of implementation. Evaluation showed that the majority of students agreed that PAL helped with social aspects of learning but not that PAL contributed to improved study skills or assignment preparation. Between stages 1 and 2 small yet significant improvements in satisfaction occurred, and these continued in stage 3 when clearer guidance was provided. Based on our experience, PAL may provide effective learning environments; however, those interested in implementing it should be warned that it is not an easy option, and students need help to structure sessions effectively.
New mothers frequently experience breastfeeding problems, in particular nipple pain. This is ofte... more New mothers frequently experience breastfeeding problems, in particular nipple pain. This is often attributed to compression, skin damage, infection or dermatitis. To outline an integrated approach to breastfeeding pain assessment that seeks to enhance current practice. Our clinical reasoning model resolves the complexity of pain into three categories: local stimulation, external influences and central modulation. Tissue pathology, damage or inflammation leads to local stimulation of nociceptors. External influences such as creams and breast pumps, as well as factors related to the mother, the infant and the maternal-infant interaction, may exacerbate the pain. Central nervous system modulation includes the enhancement of nociceptive transmission at the spinal cord and modification of the descending inhibitory influences. A broad range of factors can modulate pain through central mechanisms including maternal illness, exhaustion, lack of support, anxiety, depression or history of ab...
A literature review was undertaken to determine the instruction, technique and dosage described f... more A literature review was undertaken to determine the instruction, technique and dosage described for antenatal perineal massage in research trials. Relevant databases were searched and nine relevant studies were identified. The methodol- ogy of each study was reviewed and compared. Common approaches were found for the description of the technique, and the training of women and their partners. There was some variation in the dosages and frequencies recommended. A key feature of an early study, the incorporation of Kegel exercises, appeared to be lacking in subsequent studies. Furthermore, plans for effective learning, including accurate feedback, and strategies to enhance com- pliance were mostly absent. A supervised, patient-centred approach may address this.
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Papers by Lester Jones