It’s not – it’s the politicians and policy-makers who are making this situation, not the model. I don’t think I’m saying that I can determine how another person should think, feel or be treated (except to say that people should be respected – even if I don’t agree with them!). “A substantial percentage of patients do not respond favourably to treatment with tricyclics, as is also true of the other medications recommended for the treatment of neuropathic pain, with no more than 40-60% of patients obtaining partial relief of their pain.” Dworkin, RH et al: “Review & recommendations: Pharmacologic management of neuropathic pain: Evidence-based recommendations”; Pain: 132 (2007), 237–251 Things like ‘confidence’, ‘options’, ‘self-efficacy’, etc can sound nice, but really power and money is where it’s at, and these other words can be, and have been, used as a smokescreen to cover harming people where it matters most. To my mind, and having met Gordon Waddell, I think the book chapter you’ve linked to emerges from a sincere desire to help improve the lives of people who have often been sidelined, labelled as malingerers, or diagnosed as having mental health problems. [1]:135, technique for managing fatigue or pain levels in people with chronic illnesses or disabilities,, Short description with empty Wikidata description, Articles with unsourced statements from May 2020, Creative Commons Attribution-ShareAlike License, choosing activities based on available energy, This page was last edited on 1 October 2020, at 08:51. I ought to add the following:

Your activity goal may be reached at a slower speed than you would like but the important point is to set realistic goals and to pace yourself so that these goals can be met. [Nijs et al.

Change ), You are commenting using your Google account. The flowers are intended to represent people who killed themselves because of the stress and poverty resulting from the new system, or those who had died soon after being classed as not deserving disability benefits. I hope that these and other findings from biological research can soon be used to inform our recommendations to patients on pacing and exercise. Or is that paternalistic?

@ John Quintner: Thanks for mentioning your paper. And then we’re back to the old idea of “let pain be your guide” which hasn’t worked so well, especially for people with chronic pain. Some people may not find these approaches helpful – but to dismiss them without trying them in good faith seems short-sighted. * using exposure therapy. The data seems to support this, and it’s been my experience with people who have chronic pain that it is also highly important to them, but they lack confidence that they can manage work. And the model CAN and has been used for so much good, I don’t want to see the baby thrown out with the bathwater. I have no alternatives. Even if welfare reforms integrating the biopsychosocial model had led to more people entering employment, it seems unlikely that those with health problems who had only just reached the point of being able to gain some employment would be particularly likely to suddenly be competing at the top end of the labour market, making it difficult to (honestly) claim that such reforms are intended to help those with health problems. When an individual successfully uses pacing, the expected outcomes are pain management, self-direction and improved self-efficacy, avoidance of pain exacerbation, balanced activity/rest, increased functional ability, and increased knowledge and skills in activity planning and prioritising (p. 210). Light AR et al. That’s what I’m aiming to promote, and I’m learning from people with the “lived experience” of coping. Things that need to be done, but might be carried out over a longer period of time than a single session. Andrews, Strong & Meredith (2012) completed a systematic review of activity pacing in relation to avoidance, endurance and functioning.

I am saying that I don’t have to agree with people, and that maybe I can give an indication of some of the logical consequences that can occur if particular choices are made (because I’ve seen it again and again, and so have other researchers – who have reported on the experience of 1000’s of people with chronic pain who have given their time to contribute to research).

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