Pippa Nicolson
Pippa is a physiotherapist and researcher at the University of Oxford, focusing on the management of musculoskeletal conditions which affect older people.
Location Oxford, UK
Activity
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Pippa Nicolson made a comment
These 4 videos do a fantastic job of explaining the complexity of pain:
Enjoy!
Prof. Lorimer Moseley TEDxAdelaide Snake Story
https://www.youtube.com/watch?v=gwd-wLdIHjsAssoc Prof David Butler ‘Explaining Brain Smudging’
https://www.youtube.com/watch?v=3QVAY5stO3UDr Tasha Stanton Successful Ageing Seminar Presentations 2013...
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Pippa Nicolson made a comment
As we mention, the book titled Explain Pain by David Butler and Lorimer Moseley is a fantastic resource.
Further information and reading about pain and pain education can also be found on a number of great websites:
https://www.tamethebeast.org/
https://www.paintoolkit.org/resources/for-professionals -
Pippa Nicolson made a comment
We have tried to strike a balance between research evidence and making the course accessible to all. References and links have not been included within the text of the course due to copyright complexities - below are links to two reviews that may be of interest relating to the role of psychological factors in low back...
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Pippa Nicolson made a comment
This video from Prof. Lorimer Moseley at TEDxAdelaide does a fantastic job of explaining why things hurt!
https://www.youtube.com/watch?v=gwd-wLdIHjs -
Pippa Nicolson made a comment
We would really like to see how the Back Skills Training Course is being used around the world - completing the short questionnaire link on this page will allow us to do that, and make changes to improve the training moving forward. Your thoughts are very much appreciated!
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Pippa Nicolson made a comment
Hello and a big welcome to anyone who is starting the course this week! We certainly hope you find it interesting and look forward to discussing topics with you as we move through the weeks.
As we have mentioned, the course was designed for training health professionals, but it is great to see people signing up for their own interest as well, and we... -
Hi Suzanne, the course was designed for health professionals interested in completing the training to deliver the course, however you are more than welcome to complete it for your own interest - I am sure you will pick up some helpful tips along the way!
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@GauravPhull I am glad you enjoyed the course and found it useful. You can email us at backskillstraining@ndorms.ox.ac.uk
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Hi Congying, there is often a physical cause that accounts for some of the pain, the point is more that the physical cause may not account for all of the pain, and only addressing the physical cause may not rid the person of their pain at all.
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Pippa Nicolson replied to Lesley B
Hi Lesley, for the purpose of the videos these are actors, but their 'characters' are based on the types of scenarios that commonly presented in our trial and implementation work. Obviously the population will differ depending on you setting and area, but the techniques and approaches are still applicable.
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Hi Eva-Lotta. Great point. When we ran the original trial with the programme there was no formal follow-up after the group sessions finished. But if time and resources allow we would certainly recommend follow-up - whether that be via phone call at intervals, via an individual session perhaps 3 months later, or by the group keeping in touch if they wish (via...
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Pippa Nicolson replied to helen barnett
@helenbarnett Hi Helen, apologies I missed your comment last week. In this context we are not referring to deconditioning as the primary cause of low back pain, but as a common contributor to the perpetuation of back pain, and as Abby mentions above, contributing to increase in disability.
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Pippa Nicolson made a comment
Welcome to Week 4! This week we will cover the remaining content of Group session 2: learning the key skills of pacing and goal setting. We will also cover the content of Group session 3: exploring thoughts, feelings and behaviours. This week includes two short quizzes which are a great way to gauge your understanding as you progress through the course.
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Pippa Nicolson replied to Tracy Bourke
Hi Tracy, we have lots of people joining the course each week, so definitely start from the beginning - we are trying to check in throughout the week, so feel free to ask any questions!
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Hi Esther, thank you for raising a really important point! These concepts can all be delivered purely in a speaking format, perhaps with the clinician delivering the programme noting down the patient's goals - to prompt them to ask how they are going with them. Some people find it useful to keep a picture related to their goal as a reminder, and visual instead...
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Pippa Nicolson replied to Aisling Freir
Hi Aisling - that is a really good point, and tricky to manage as you say! In Week 4 we go into more detail on baseline setting, graded activity and goal setting - so hopefully you will find some helpful tips there, if not feel free to ask!
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Pippa Nicolson replied to Sue Baddeley
Hi Sue, there is a lot to take on in these first few weeks - as we cover the 'heavy' pain info - but you can always come back to it, and download the prompt sheets and info at the beginning and end of each week. You will notice that the information that would be presented to patients is much simpler, but we thought it important to ensure that therapists who...
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Pippa Nicolson replied to Aisling Freir
Hi Aisling - I have added the link to Lorimer's snake bite story in Step 3.4, it is certainly a great, clear way of explaining pain!
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@AaronFrazer-Morris Hi Aaron. The content above is intended for training clinicians, this online programme was not designed for patients. As we mentioned earlier, we go into more detail in this training than you would with a patient group. A much simpler version for patients is included in the session materials that you can download at the beginning or end of...
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Pippa Nicolson made a comment
These 4 videos do a fantastic job of explaining the complexity of pain:
Enjoy!
Prof. Lorimer Moseley TEDxAdelaide Snake Story
https://www.youtube.com/watch?v=gwd-wLdIHjsAssoc Prof David Butler ‘Explaining Brain Smudging’
https://www.youtube.com/watch?v=3QVAY5stO3UDr Tasha Stanton Successful Ageing Seminar Presentations 2013...
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Pippa Nicolson replied to David Higgs
@CatherineSweet Hi Catherine, a randomised trial comparing a group to individual cognitive behavioural intervention has not been conducted specifically among people with low back pain, however a number of studies have been conducted comparing group to individual CBT in other populations, consistently demonstrating both are equally effective.
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Hi Sarah, thanks for raising that very valid point! Often people ask about how participants feel sharing information in a group setting with strangers, but as you say in small populations it is also difficult because people know each other! Regarding group numbers, evidence suggests that the benefits of group interventions decrease with less than 4...
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Hi Zaid - we go into the homunculus in more detail in the coming weeks, but in short, yes it is sensory and motor representation.
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Great point Peter! The 0-10 pain scale that is commonly used is a source of much debate, and as you say does not even begin to cover the complexity of the pain experience! So in short, yes the scale is definitely relative!
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Pippa Nicolson replied to David Higgs
@DavidHiggs you raise a very valid point! Lack of available consultation time to best manage ongoing low back pain was part of the reason we worked on developing the intervention originally! From a time management perspective the group format is very effective, as rather than seeing 8-10 patients separately for 30mins each for each follow-up session, the...
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Very good point David! We know that forming habits is not easy, and takes time - this is part of the reason that the programme is ideally delivered over 8-12 weeks, to enable people to form positive habits, deal with setbacks/changes of plan and stick with the positive behaviours.
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Hi Catarina - you raise a very important point, and one that we have discussed with many clinicians during training and implementation! Our advice has been to explain to patients 'let's try this for now, there is evidence that it can really help etc, then we can re-evaluate further down the line'. With some patients it is tricky to get 'buy-in' to the...
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Hi Carolina, not at this stage, sorry!
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Pippa Nicolson made a comment
As we mention, the book titled Explain Pain by David Butler and Lorimer Moseley is a fantastic resource.
Further information and reading about pain and pain education can also be found on a number of great websites:
http://www.noigroup.com/en/Resources (this website is led by A/Prof Butler)
https://www.paintoolkit.org/resources/for-professionals -
Hi Esther, thanks for asking! What we mean is that if you are a therapist who is going to deliver the programme the pain education that you give to patients will be at a simpler level, but we wanted to provide more detailed information in the training to help therapists feel confident to answer questions from patients.
I hope that helps! -
Pippa Nicolson made a comment
We have tried to strike a balance between research evidence and making the course accessible to all. References and links have not been included within the text of the course due to copyright complexities - below are links to two reviews that may be of interest relating to the role of psychological factors in low back...
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Pippa Nicolson made a comment
This video from Prof. Lorimer Moseley at TEDxAdelaide does a fantastic job of explaining why things hurt!
https://www.youtube.com/watch?v=gwd-wLdIHjs -
Hi Reema - we go into much more detail in the next couple of weeks of the course, if you still have questions then feel free to ask!
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Pippa Nicolson made a comment
Chronic low back pain is certainly complex isn't it?!
As we move through the course content we will delve more into the multitude of factors that can influence our pain experience. These factors are different for each individual, and the pain is certainly real, and can have a huge impact as some of you have mentioned. -
Pippa Nicolson made a comment
We would really like to see how the Back Skills Training Course is being used around the world - completing the short questionnaire link on this page will allow us to do that, and make changes to improve the training moving forward. Your thoughts are very much appreciated!
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Great point Philippa! Each time we run the course we have many comments about the participants (and Zara's) posture - you have responded perfectly thank you!
Also as an aside to learners - the participants in the class on the videos and in the photos are all actors - so are 'playing a part', although we think their responses and postures are a good reflection... -
Hi Abigail, you are right, the control group received 'best practice advice' - which was derived from what is considered best practice in primary care (ie in a GP visit). The aim of the original RCT was to compare the programme to how back pain is most commonly managed in primary care. There has been subsequent implementation work conducted (and trials by...
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@MaryWillieson Hi Mary. Anyone is welcome to complete the course - you will find that some aspects are not relevant to you as they relate to practicalities of running the programme - but we certainly hope that you will learn plenty, and pick up ideas and tips to help you manage your back pain. I hope you enjoy the course!
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@laurencebutler Hi Laurence. Apologies for the confusion - in this context patients with sciatica are noted as an additional group to those with NSLBP. The programme includes a comprehensive individual assessment, during which the clinician fully assesses the individual, and can of course decide that the group sessions of the programme may not be the best...
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Don't feel that way at all David! You are more than welcome to complete the course - yes there will be parts that are not relevant to you, but we would certainly hope that you can pick up lots of techniques and tips to try that may really help!
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Hi Philippa, you raise a very good, and super common, problem that I think we all experience to some extent as clinicians. Changing people's beliefs is really hard, ultimately all we can do is our best to put forward the options and the evidence, and make people feel comfortable to ask us questions. I hope you might pick up some tips throughout the course that...
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Pippa Nicolson made a comment
Hello and a big welcome to anyone who is starting the course this week! We certainly hope you find it interesting and look forward to discussing topics with you as we move through the weeks.
As we have mentioned, the course was designed for training health professionals, but it is great to see people signing up for their own interest as well, and we... -
Hi Shizuka. Certainly within the context of our trial and implementation work the format of the course is explained thoroughly to participants prior to them agreeing to take part. But they are of course free to discontinue attendance if they wish, and within our implementation work we investigated reasons for people discontinuing so we might adjust the course...
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Hi Shizuka. PTSD would be considered the most extreme end of the scale of memory-associated pain. Commonly someone who has first felt pain in their back after lifting a certain object will feel pain when they go to lift the same object, but may not feel pain when lifting something of similar weight/size that they do not associate with the experience of back...
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Hi Sandeep. We go into more detail about the physiology of pain and the brain over the next couple of weeks, but in short, yes, the pain we experience is not necessarily reflective of the tissue damage that has occurred.
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Pippa Nicolson replied to adam hill
Great point Adam - for some people discussing how common it is to find 'abnormalities' on scans despite no symptoms is really useful and reassuring, but for others it worries them more! It is a tricky one to navigate, and taking the time at the first appointment to try to get a gauge of the person is the only way to help decide.
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Hi Makiko. The programme is used relatively widely in the NHS, although we seem to have clusters of places where it is used, and has been used successfully for some time, and other areas where it has not been used. Do feel free to email me if you are wanting to set the programme up in your NHS trust - we have a number of sites who are happy to chat about how...
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Hi Philipa. We delve more into pain and the brain in Week 3. Certainly functional MRI studies have shown that people with chronic low back pain have increased representation of the area in the homunculus, but exactly why this occurs is not entirely clear.
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Hi Julia - I hope you enjoy the course and can take away some useful tips!
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@SoniaDewan Hi Sonia, welcome! The course is explained as you go along - do feel free to post any questions you have and we will try to answer them. As we mention, the course was designed to train health professionals who manage patients with low back pain, but we welcome anyone to take part and hope that they will learn some useful skills! Enjoy.
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Pippa Nicolson replied to Elizabeth Henderson
This is a very good point Elizabeth! What works for one person may not work for someone else as we are all so different! It is really important to encourage people to at least try different relaxation techniques, to find what works for them.
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Good point Mary, thanks for reminding us!
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No no, the participant's GP should review meds.
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Great point David - a number of sites that have implemented the programme have used a 'buddy' system with junior therapists and a senior therapist, and this has worked really well!
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Hi Brooke. Very good point. Some patients are not at all receptive to these approaches, but the individual session, and small size of the group sessions allows for plenty of tailoring to suit each person. Group discussion can also be super helpful at 'bringing people around' to ideas that they may otherwise dismiss!
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Pippa Nicolson replied to Miriam De Souza
Hi Miriam. You are certainly welcome to adapt the materials to use within a single session or online if that is a limitation in your area. We have not looked into the effectiveness of a very 'light touch' version of the programme, but would be more than happy to chat if you would like to discuss - just send an email through.
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Pippa Nicolson replied to john sharvill
Hi John. Good point, we have certainly had a huge range of people take part in the programme. The group setting works well in that people who may be more negative have the chance to chat with others in a similar situation who might have a really positive outlook. The individual session prior to the group sessions also allows the clinician leading the programme...
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Hi Victoria. Absolutely, we have had a number of physio assistants / therapy assistants train and deliver the programme using a buddy system with an experienced physio as you say. This seems to work really well.
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There have been a number of studies that have found scan findings among asymptomatic people - this review of studies is a good summary: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4464797/
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Hi Meenakshi, thanks for your question. There is evidence for CBT for a huge range of conditions, not just those that include pain. This review of trials found evidence to support the inclusion of CBT in treatment of adults with asthma: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6457695/
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Pippa Nicolson made a comment
Hello and welcome to anyone joining the course this week! We have learners at all stages of the course - if you have any questions for us please do tag me so I don't miss it!
We do hope you enjoy the course and have plenty to 'take away', whether you are a clinician, someone with back pain, or purely interested in learning! -
Good point Mary, it is very important to ensure that everyone participating understands what the programme is and what it is not. The individual session at the beginning provides an opportunity to identify anything that may benefit from onward referral or advice.
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Hi Tracey, apologies for the delay in replying, I missed your comment last week.
Maintaining long term effects is very difficult as you say. We did not continue longterm follow-up with the participants in this study, but we have found in other studies that the use of 'booster' sessions can be really helpful to keep people on track and maintain motivation. -
Pippa Nicolson made a comment
Welcome to anyone who is joining the course this week! We are in our 4th week of this course run, and we hope you find it interesting and learn plenty as we move through the weeks.
As we have mentioned, the course was designed for training health professionals, but it is great to see people signing up for their own interest as well, and we certainly hope you... -
Pippa Nicolson made a comment
Welcome to Week 4! This week we will cover the remaining content of Group session 2: learning the key skills of pacing and goal setting. We will also cover the content of Group session 3: exploring thoughts, feelings and behaviours. This week includes two short quizzes which are a great way to gauge your understanding as you progress through the course.
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Pippa Nicolson replied to Jennifer L
Hi Jennifer. Good point! Just to clarify, for the videos the participants are actors and the filming was done in a meeting room, hence the matching chairs. Depending on the setting in which the class is delivered participants will have a number of options for seating - we also encourage people to get up, move around, stand or sit on mats on the floor if they...
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Pippa Nicolson replied to Peter Moller
Hi Peter. Good point - there are a number of variations on the SMART acronym! You are more than welcome to use whichever people feel most familiar with. Some recent research has suggested that the SMART system is not always best in a health setting, so it is only a suggestion to use.
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Pippa Nicolson replied to Malcolm Wilson
Thank you for spotting that Malcolm, error corrected!
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Hi Givens. Great point, group dynamics are super important in the success of the programme. We have found that taking 5 minutes at the end of each session to check in with group members and go over anything that they might want to clarify or discuss further works really well. The same can also be done if you have a short break in the middle of the session.
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Hi Mary. This assessment is an extension of what should be a standard physiotherapy initial assessment. While it includes psychological elements this is an important aspect of physiotherapy and well within a physiotherapists scope.
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Pippa Nicolson replied to June Micklethwaite
Hi June. The initial one-to-one session is to assess the patient, and allows the clinician to gather information about their history, and if necessary then gain further information from medical records.
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Hi Tim, we delve into pain and representation in the brain in more depth in Week 3. We are not able to include references directly due to copyright but are more than happy to send through additional reading if you would like after Week 3.
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Pippa Nicolson made a comment
These 4 videos do a fantastic job of explaining the complexity of pain:
Enjoy!
Prof. Lorimer Moseley TEDxAdelaide Snake Story
https://www.youtube.com/watch?v=gwd-wLdIHjsAssoc Prof David Butler ‘Explaining Brain Smudging’
https://www.youtube.com/watch?v=3QVAY5stO3UDr Tasha Stanton Successful Ageing Seminar Presentations 2013...
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Pippa Nicolson made a comment
As we mention, the book titled Explain Pain by David Butler and Lorimer Moseley is a fantastic resource.
Further information and reading about pain and pain education can also be found on a number of great websites:
https://bodyinmind.org/resources/ (this website is run by Prof Moseley)
http://www.noigroup.com/en/Resources (this website is led by A/Prof... -
Pippa Nicolson made a comment
We would really like to see how the Back Skills Training Course is being used around the world - completing the short questionnaire link on this page will allow us to do that, and make changes to improve the training moving forward. Your thoughts are very much appreciated!
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Hi Catherine. Absolutely, we recommend that clinicians modify the exercise programme as they think appropriate for each patient. So feel free to substitute exercises, or add on as you see fit!
