Article

The role of occupational therapy in pain management

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Abstract

Occupation is central to human behaviour. Occupational therapy is based on the premise that there is an intrinsic relationship between occupations, health and wellbeing. Chronic pain restricts the performance of activities that individuals need to, want to and are expected to perform. As activity performance is central to an individual's identity, these restrictions can further impact the person's psychological health and wellbeing. Occupation is not performed in isolation and the inability to fulfil valued family and social roles has a further impact on the person's social environment. The focus of occupational therapists working in pain management is therefore to enable individuals with chronic pain to participate in the activities that have value and meaning to them, despite their pain. The occupational therapy intervention will include the use of strategies such as activity management, activity adaptation, the development of coping strategies and vocational rehabilitation and may involve working with patients at home, school or workplace in addition to clinical settings. The aim of this article is to explain the role and value of occupational therapy within the pain management team.

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... Occupational therapists provide a wide range of pain management interventions across the domains of physical, emotional, and spiritual occupational performance and have the knowledge, skills, and expertise to address CP management in all its complexity at individual clients and community and policy levels [11]. Occupational therapists' core skill, analyzing and adapting the physical, emotional, cognitive, and social demands of activities and occupations, allows them to identify and intervene on barriers to participate in specific life situations while considering environmental and personal factors [12][13][14][15]. ...
... Moreover, studies which describe the OT approach provide a deep understanding of the links between CP and occupation [16,17] and suggest that engaging in occupation has the potential to mediate the pain experience and to alter biological, psychological, and social factors that are known to influence the pain experience [18,19]. In addition to addressing the disruptions in occupational performance caused by CP [19,20], occupational therapists are concerned with the occupational identity [12,21] of their client. e Model of Human Occupation [22] states that "occupational identity" constitutes the values, beliefs, roles, and interests which drive a person to perform daily activities [12]. ...
... In addition to addressing the disruptions in occupational performance caused by CP [19,20], occupational therapists are concerned with the occupational identity [12,21] of their client. e Model of Human Occupation [22] states that "occupational identity" constitutes the values, beliefs, roles, and interests which drive a person to perform daily activities [12]. Indeed, occupational therapists recognize that CP affects all areas of a client's life and their competency and identity, and they are trained to use a holistic approach to address the occupational needs of clients living with this problem [12,13,21]. ...
Article
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Occupational therapy (OT) makes a unique contribution to chronic pain (CP) management due to its overarching focus on occupation. The aim of this scoping review was to describe current knowledge about this contribution by documenting OT roles, models, assessments, and intervention methods used with adults living with CP. A systematic search exploring 10 databases and gray literature from 2006 to 2017 was conducted. Fifty-two sources were retained and analysed. Results bring forward the main role of OT being improving activities and participation (76.9 %), the Canadian Model of Occupational Performance (9.6 %), and the Canadian Occupational Performance Measure (21.2 %). Within the 30 reported interventions, 73.3% related directly to the person, 20% pertained to occupation (activities and participation), and 6.7% addressed environmental factors. The distinction and complementarity between the bottom-up and the top-down approaches to OT intervention were discussed. This review highlights OT specificity in adult CP management.
... The focus of occupational therapists working in pain management is therefore to enable individuals with chronic pain to participate in the activities that have value and meaning to them, despite their pain. In many cases a good idea is combining occupational therapy with physical therapy for the rehabilitation [17,18]. According to literature, chronic pain is common among individuals with physical disabilities. ...
... Goals of interdisciplinary programmes (occupational therapy, exercise, relaxation training, psychotherapy) include: increased physical functioning, reduction of pain intensity, improvement of mood, return to work, school, or daily activities [11,20,21]. The occupational therapy may involve working with patients at home, school or workplace, activity adaptation, the development of coping strategies and vocational rehabilitation [17]. ...
... Occupation is central to human behaviour. Occupational therapy is based on the premise that there is an intrinsic relationship between occupations, health and wellbeing [17]. Chronic pain restricts the performance of activities.Regardless of the various sources and origins of activities directed at supporting an individual in increasing his functional capabilities, numerous doubts remain. ...
Article
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The aim of the present work is to present the problems connected with occupational therapy that make the major part of the programmes for the treatment for mobility limitations connected with different dysfunctions. In many cases, the obstacle in performing the comprehensive programme for the treatment for mobility is pain of a musculoskeletal character. This difficult problem is still connected with many questions and requires further research. In this paper some aspects of the problem are presented. Many occupational therapists, psychologists, physiotherapists, find the employment in this tough area of musculoskeletal pain is a very difficult challenging.
... Further, this might require the practitioner to use alternative non-pharmacological therapies (see 4.3) whose costs might not be covered by the health system (May et al., 2018;Webster et al., 2019). The intervention of occupational therapists and medicine is an interesting alternative for allowing adaptation to the patient's workstation and avoid professional disinsertion or allow one to return to work (Désiron et al., 2011;Hesselstrand et al., 2015;Hill, 2016;Lagueux et al., 2018). ...
Article
Chronic pain is a major public health issue that frequently leads to analgesic opioid prescriptions. These prescriptions could cause addiction issues in high-risk patients with associated comorbidities, especially those of a psychiatric, addictive, and social nature. Pain management in dependent patients is complex and is yet to be established. By combining the views of professionals from various specialties, we conducted an integrative review on this scope. This methodology synthesizes knowledge and results of significant practical studies to provide a narrative overview of the literature. The main results consisted in first proposing definitions that could allow shared vocabulary among health professionals regardless of their specialties. Next, a discussion was conducted around the main strategies for managing prescription opioid dependence, as well as pain in the context of opioid dependence and associated comorbidities. As a conclusion, we proposed to define the contours of holistic management by outlining the main guidelines for creating a multidisciplinary care framework for multi-comorbid patients with chronic pathologies.
... This loss can cause a shift in perspective, as one experience the transition from a competent occupational being to a 'disabled' being. This shift in perspective can cause stress, decrease physical and mental health as well as significantly impact the social environment [4,5]. To minimize the impact of such a great loss, studies have illustrated how people diagnosed with CP enhanced their quality of life through coping strategies [6][7][8]. ...
Article
Background Chronic pain (CP) affects a large part of the population worldwide, decreasing physical and mental health and causing a shift in occupational roles. This has created a need for a better understanding to address this problem. Objectives To explore possible changes in occupational roles and the participation levels within among people diagnosed with CP over time. Material and methods The study used a qualitative, narrative methodology. Five people with CP were included in the study. They participated in a single-life story interview coupled with timeline drawings. Data analysis was conducted using a narrative analysis. Results The results revealed that occupational roles and the participation therein changed over time. Employee was considered the most important role, whereby the participants tried to maintain this role by sacrificing other roles within their lives. Moreover, CMP forced a change in their occupational identity. Conclusion CP can disrupt a person’s life and demand a change in occupational roles and the participation levels within. This process was accompanied by possible changes in their occupational identity.
Article
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Introduction: Previous studies into Low Back Pain (LBP) assessed the effects of physical interventions or face-to-face (FTF) education mostly in western cultures. The present study aimed to compare the effects of multimedia and FTF pain management education (PME) on pain intensity and pain catastrophizing among participants with chronic LBP. Methods: This double-blind randomized controlled clinical trial was conducted on ninety participants with chronic LBP randomly allocated to either multimedia, FTF, or control groups. Participants in the multimedia group received PME through watching seven educational CDs at home and their counterparts in the FTF group received the same educations in seven weekly FTF educational sessions. Pain intensity (using a numerical rating scale) and pain catastrophizing (using the Pain Catastrophizing Scale) were assessed before, immediately after, and one month after the study intervention. The effects of the interventions were assessed using the repeated-measures multivariate analysis of variance (MANOVA). Effect size and minimal detectable change (MDC) were reported for both variables. The regression model used in the present study was Generalized Estimating Equations (GEE). Findings: The findings of MANOVA showed the significant effects of time on pain intensity and pain catastrophizing (P<0.001). The Tukey's test showed that before and immediately after the intervention, the mean scores of pain intensity and pain catastrophizing in the FTF and PME groups were significantly different from the control group (P<0.001 and P = 0.001, respectively). MDC did not show clinically significant changes in the mean score of pain intensity and GEE revealed significant difference among the groups. Conclusion: The findings suggested that multimedia PME is as effective as FTF education in reducing pain intensity and pain catastrophizing among participants with LBP. Future studies into the effects of education on LBP are recommended to consider longitudinal designs, a reliable cutoff score for pain catastrophizing, and participants' physical ability. Irct registration code: IRCT20180313039074N1.
Article
Background Chronic pain and sleep disturbances are often co-morbid. Sleep disturbances can negatively affect self-care occupations, cognition, mood, emotional functioning and physical wellbeing. Aim To explore occupational therapists’ experience working with clients with chronic pain and sleep difficulties. Method Semi-structured interviews were conducted with 11 occupational therapists with experience working with clients with sleep disturbances and chronic pain. Findings The relationship between sleep disturbances and chronic pain was described as being complex and multifaceted. Participants believed they were uniquely placed to work with clients experiencing these two conditions. They felt inadequately equipped to treat sleep disturbances and chronic pain. Participants indicated that best practice required multiple interventions and a team-based approach. Finally, the participants noted that sleep disturbances and chronic pain are a growing area of practice. Conclusion The findings suggest that occupational therapists tailor their intervention strategies to be early, multi-pronged and individualised. Institutional barriers need to be addressed to further develop occupational therapists’ skill set when working in the areas of sleep and chronic pain. Further research to support the interventions currently used in practice to treat these two conditions is needed.
Article
Background People with chronic pain conditions such as fibromyalgia may experience occupational limitations and imbalances in their basic and instrumental occupations of daily living, leisure, work, and social participation. Objective To describe occupational balance in persons with fibromyalgia and to analyze whether it is associated with self-reported disability and self-efficacy to manage symptoms. Methods A cross-sectional study was carried out. Individuals with fibromyalgia were invited to participate. Occupational balance was assessed with the Occupational Balance Questionnaire; self-reported disability was assessed with the World Health Organization Disability Assessment Schedule, WHODAS 2.0-12; and self-efficacy was evaluated with the 8-item version of the Arthritis Self-Efficacy Scale. Data were analyzed using multiple linear regression with a forward stepwise procedure. Results One hundred women with fibromyalgia were included. Occupational balance was 26.96 ± 12.09; however, scores differed between the mild disability group and the moderate disability group (33.11 ± 9.99 vs. 20.29 ± 10.61, p < 0.001). Multiple linear regression analyses revealed that self-reported disability and self-reported pain management explained 58.1% of the variance in occupational balance. Conclusion Women with fibromyalgia showed low occupational balance. Self-reported disability and self-reported pain management were associated with occupational balance. Significance Occupational therapy practitioners can design intervention programs focussing on occupational balance and self-efficacy to manage symptoms.
Occupational therapy is based on the premise that there is an intrinsic relationship between occupations, health and wellbeing. Chronic pain restricts the performance of activities that individuals need to, want to and are expected to perform, including working or studying. Young people who have a chronic pain condition may be restricted in their participation with school or higher education which can result in them being disadvantaged regarding their future potential for employment. Work is central to most adults’ occupational identity and is therefore a key focus for occupational therapy intervention. In addition to the strategies used generally with patients, such as activity management, activity adaptation and the development of coping strategies, occupational therapy with young people and adults who want to access work and/or education will address the biological, social and psychological barriers to returning or remaining at school or work. The aim of this article is to explain the role and value of occupational therapy within the pain management team in relation to enabling patients return or remain in work or education.
Article
Background: When a parent has chronic pain, family communication can become strained. Clinicians are encouraged to identify and support families struggling with open communication. Occupational therapists are commonly involved in the provision of pain management services but their role in facilitating open communication in families affected by this condition has not been clearly articulated. Objective: To develop a comprehensive understanding of what is being done and/or thought to be helpful for facilitating open communication in families affected by chronic pain, in order to articulate the role of occupational therapy in this area of care. Methods: A scoping review was conducted and 24 items analyzed using qualitative content analysis. Results: The facilitation of open communication in families affected by parental chronic pain is dependent on a variety of factors, including the skills that members possess and occupations which they perform individually and together. It can also be prompted by relationship tension or a family accessing professional support. Occupational therapy literature on the matter is currently limited and focused on assertiveness training. Conclusion and significance: There is scope for occupational therapist to extend their role beyond assertiveness training and use occupation-centered interventions to facilitate communication within families affected by parental chronic pain.
Article
There is limited research on the relationship between chronic pain and occupation. This phenomenological research study explored the lived occupational experiences of people who have chronic pain. Via demographic questionnaires, semistructured interviews, and field notes, data were collected on 13 participants with various types of pain. Thematic analysis yielded one main theme: "Chronic Pain Is Life Changing." The following subthemes also emerged: "Chronic Pain Triggers Emotional Distress"; "Chronic Pain Reveals the Strength of Relationships"; "Chronic Pain and Occupation Are Reciprocally Related Forces"; and "Chronic Pain Elicits Innovative Adaptive Responses." Study participants reported experiencing myriad troubling emotions; however, they resourcefully modified their routines and tasks and found enhanced meaning in favored occupations. This study illuminates the importance of therapeutic listening, the innovativeness of people who have chronic pain, and the possible therapeutic potential of occupation.