The Role of Occupational Therapy in Pain Management

Occupational Therapy is one of the lesser understood roles of the Allied Health

community. There is a general understanding of what physiotherapists and

psychologists do to help those in need, but when it comes to occupational

therapy, unless there has been past experience with one, people are often in

the dark. It is not surprising then, that there is little understanding

of the role of occupational therapy in the oft misunderstood area of persistent

pain. Let me attempt to demystify it for you.

What does an Occupational Therapist do?

Occupational Therapists use the word ‘occupation’ to describe any activity that a person

might find themselves doing. This can include work, sleep, hobbies, relaxing,

personal care, caring for children or others, the list goes on. A more

self-explanatory title might be, ‘Activity Therapist.’ Occupational

Therapists become involved when someone is experiencing dysfunction in any of the activities or ‘occupations’ that make up their life.

The undergirding philosophy of occupational therapy is the belief that the activities we do give us a sense of identity and meaning in life. Without valuable activity engagement, humans suffer a range of physical and mental health issues. As such, it is a high

priority to assist people to continue to engage with meaningful activity. This

is where occupational therapy fills a unique role.

Why is Occupational Therapy important for treating persistent pain?

You may have noticed that some multidisciplinary pain programs do not include

occupational therapists, opting for a physiotherapist and psychologist team

instead. As an occupational therapist with experience working in a

multidisciplinary pain program, I believe this is a disservice to the

client. Many of my physiotherapist and psychologist colleagues with

persistent pain experience would agree.

Occupational therapists have a distinct and valuable perspective to offer those with

persistent pain, complementary to these other disciplines. There is

always overlap between the Allied Health professions, but each of us have

differing focuses and intents which uniquely benefits the client.

Many pain programs base their foundations on the proven Bio-Psycho-Social approach

to pain management. This approach understands that pain impacts the body, mind

and how we interact with the world, and that this relationship is

bi-directional. The bi-directional nature of this model indicates that

the body, mind, and interactions with the world are affected by the pain

experience but, equally as important, the pain experience is impacted by the

body, mind and world. It is widely acknowledged that each of these

influencing areas need to be addressed appropriately to effectively manage

persistent pain. When considering Allied Health input for persistent pain

sufferers; physiotherapists look at the body in relation to pain, while

psychologists address the mind as it relates to the pain experience. What

is distinct in the role of the occupational therapist, is the focus on the way

pain intersects with our interactions with the world, namely, our activity

participation.

Persistent pain almost always results in limitation to activity of some kind. Pain

Australia statistics indicate that people with persistent pain are five times

more likely to experience significant limitations in daily activities than

those without. According to these same statistics, persistent pain

accounts for forty percent of early retirement in Australia, and represents a

sixty-eight billion dollar financial burden related to reduction in quality of

life costs. An experienced, specialising physiotherapist or psychologist

will certainly touch on matters related to activity limitation however, this is

not their sole focus, nor should it be. Occupational Therapists provide

this missing piece of the puzzle.

Physiotherapy and psychology provide a vital contribution to pain management, but the

contribution of the occupational therapist is just as crucial. When

occupational therapy is missing from the treatment regimen, one third of the

bio-psycho-social assessment and intervention process is missing, rendering the

overall treatment of the pain problem less impactful. Like a three-legged

stool, physiotherapy, psychology and occupational therapy support and reinforce

one another, providing distinct, yet complementary value for the client with

persistent pain.

This is why Occupational Therapy in pain management is so important.

What do Occupational Therapists do for people with persistent pain?

Occupational Therapists aim to improve one’s quality of life by problem solving and offering

strategies to make engagement with meaningful activity more manageable for

people with persistent pain. We look at how we can:

1.Adapt the activity to compensate for the difficulties experienced.

2.Modify the environment in which the activity is undertaken to reduce the difficulties

associated and.

3.Improve the skills, education or physical parameters of the person attempting to

engage with the activity.

Take personal care for example. Not everyone with persistent pain experiences

difficulties with personal care, however limitations in this area can have

underappreciated impacts on mental health, causing a feedback loop into

worsening pain experienced. These small barriers are easily overlooked yet can

have significant effects over time. An occupational therapist would seek to

remove the barriers to participation in personal care, restoring meaningful

activity engagement and circuit-breaking the associated feedback loop. In

effect, improving quality of life and dampening the pain experience with one

fell swoop.

Typically, common personal care difficulties include; reaching to put shoes and socks on, donning bras, standing in the shower to wash, or holding one’s arms up to wash/groom one’s

hair or face. This is not an exhaustive list, as functional difficulties always depend on the specifics of the person’s condition and environment.

Considering the three-point framework above in relation to these example difficulties:

1.An occupational therapist might suggest the client washes their hair with their elbows against the shower wall for support (adapting the activity).

2.Alternatively, if that same person also struggles to stand for lengthy

periods in the shower due to pain or dizziness, they may offer a shower chair

as a solution (modifying the environment).

3.If the issue is related to donning items of clothing such as a

bra, shoes and socks, perhaps the occupational therapist may offer education on pertinent assistive devices or upskill the client with alternative techniques that may bypass the problematic movements.

During the assessment process an occupational therapist will focus on identifying the

meaningful activities that make up one’s life and how the experience of

persistent pain has implicated dysfunction. Each activity is usually made

up of a number of tasks so each task will need to be dissected and investigated

to pinpoint exactly where the dysfunction originates. In most cases, the

dysfunction arises from a number of sources at the micro level. The

occupational therapist will tackle the sources of dysfunction for each task

that makes up each activity of one’s life as demonstrated above.

An occupational therapist is trained to address the dysfunction, not just on a

micro level (activities and tasks), but also on a macro level. They will

observe how your pain experience has affected your schedule, routine, lifestyle

balance, and your activity levels throughout the day and week. These

might not seem like particularly essential areas for treatment for improved

pain management, however as pain limits activity engagement, these areas often

suffer significant impacts. Like all areas of persistent pain management,

the relationship is bi-directional. This means that poor lifestyle

balance, routine and activity level can perpetuate the problem of pain often resulting

in a worsening pain experience. Once again, the occupational therapist

will look to treat these areas of dysfunction in order to break the cycle of

pain associated.

When evaluating the impacts of persistent pain, for those who experience it, activity

limitation is where the rubber hits the road. Many people find reduced

participation in the activities they value just as insufferable as the pain

itself. When understood properly, it is clear that the mental health and

physical health consequences associated with reduction in activity

participation perpetuates the pain problem resulting in poorer pain outcomes.

Occupational therapists understand this relationship and are well equipped to

address the barriers that present due to persistent pain. In many cases,

they close the gap between the clinic and life on the ground for the

client.