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Ouch! The Occupational Therapy Role with Chronic Pain

Guest Blogger Jessica VandenBussche, 2015

Pain is a common occurrence following an injury, illness, or traumatic event like a motor vehicle accident. While pain does play an important role in alerting us to potential dangers, injury, or an impending problem, it can also become a significant barrier to function as it can often continue long after the dangerous situation resolves.  Our brain can also change such that the pain message gets so used to being sent, these can start being sent faster and easier, even in non-threatening situations.

Chronic pain is difficult to treat and manage because of all the different factors that contribute to its intensity, frequency, and the many variables that can make it better or worse. Stress, depression, feelings of loss of control, pressures at work or home, and other mental or emotional factors affect pain perception.  Further, currently there is no objective way for medicine to quantify pain which can make it even more difficult to measure, treat, and to understand the pain experience that varies between people.

The experience of pain then remains subjective.  And as this changes frequently under the presence of other factors such as secondary injury, low mood, stress and other environmental pressures, pain can still increase even in the face of conservative therapeutic or medical management.  Whether or not tissue damage is found, it is difficult for someone who is experiencing pain to complete activities of daily life and to fulfill the roles that make them who they are (e.g. mother, father, worker, student, athlete).  For any of us that lose the ability to manage in an important life role, this can cause significant mental and emotional losses and anguish.  If the change in roles is sustained for too long without resolution, people can develop an altered sense of self, causing more psychological hardship which can lead to higher perceptions of pain.  Then the cycle continues.  The current best practice for addressing chronic pain is a multi-method approach that addresses mental, physical and emotional issues plus the effect of pain on daily function, roles and identity.

Occupational Therapists play a pivotal role in the assessment and treatment of physical and psycho-emotional issues including chronic pain. Through our involvement, we analyze function, work to provide solutions, and help break the pain-disability cycle.  We connect people to other providers that are necessary and impactful members of the treatment team.  Occupational therapists are also well-versed in strategies to help people sleep better, move differently, and adapt to disability to reduce the limitations that result from any condition, including pain.

In short, any injury, including a car accident, can cause pain. Whether this pain is primarily physical or emotional, visible or invisible, it is important to remember that the pain experience is real and can be debilitating.  Occupational therapists are qualified to identify psychological, cognitive and physical needs of the individual and to provide treatment to improve function in daily activities. With appropriate treatment, pain and daily function can improve, helping the individual participate in meaningful activities and to regain or maintain their sense of self.

Useful Resources

Michael G. DeGroote Pain Clinic (Formerly Chedoke Chronic Pain Management Unit), treatment option for multidimensional approach to chronic pain

The American Academy of Pain Medicine, videos to understand pain, its reasons and its effects

Entwistle Power Occupational Therapy:  Chronic Pain a Problem?  Try OT

4 Comments

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  1. Mike says:

    I do a lot with pain management both acute and chronic. I use a variety of techniques to do this, the primary is frequency specific micro current. It truly is a life changing modality for many. (www.frequencyspecific.com) I love doing what I do in OT! Thanks for posting.

    1. Erin Ridpath says:

      Thank you Mike!

  2. Ingrid Tozer says:

    I am a community based Occupational Therapist and seem to be coming across an increasing number of people struggling with chronic pain. Some have an ‘official’ diagnosis of poly or fibromyalgia. Although I can put in equipment and arrange for homes to be altered to help these clients achieve some measure of normality, I am at a loss at how to help these people manage their symptoms better. The general consensus from the GP’s I speak with is to issue higher and higher levels of painkillers. One client told her GP she was concerned about becoming addicted to Oramorph, and his response was “you are already addicted”; a response that doesn’t sit comfortably with me. Do you have any further suggestions as to how I can help these people more?

    1. Erin Ridpath says:

      Thanks for your comment! Yes, helping people with chronic pain is a challenge that many health care professionals face. In my experience when things become chronic “symptom management” is really about “living well with chronic pain” versus “making pain disappear”. Living well usually involves that true OT balance of Person Environment and Occupation. You seem to tackle the person and environment well, but the “occupation” part is so important. ROUTINE and CONSISTENCY are the best ways to help people avoid the “ups and downs” of doing too much then suffering for two days after. Doing a little bit each day, and expanding this over time until they reach the best balance of manageable symptoms with acceptable function is the most effective. Personally, I love doing this through a structured program like the Progressive Goal Attainment Program (or PGAP) as it helps people to sleep better, function better, improves mood, and builds some light physical activity into the day. I have also used this program to help people lose weight, recognizing the relationship between heavier weight and increased pain. Volunteering, socializing, and doing things that matter during the day are the best way for people to focus on living versus pain and that helps life to be more enjoyable. I guess my point is, focus on FUNCTION and how TIME IS SPENT to find out how to help these clients even more. I hope that helps!