Occupational Therapy’s Role in Pain Management – A Therapist’s Perspective

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April is a month known for growth and rebirth, making it the perfect host for Occupational Therapy Awareness Month! So often our clients come to us after an illness, injury, or condition has disrupted their life. Whether they expect to get back to their prior level of functioning or are working to adapt to a “new normal,” the transition can be a challenging one. But the more I engage with the rehabilitative process, both as a patient and as an occupational therapist, the more I see the beauty and opportunity in these times. There’s so much room for growth, for satisfaction, for thriving. Those with chronic pain may go through critical periods of transition many times as their condition waxes and wanes or they seek new avenues of treatment. Working with an occupational therapist as part of a multidisciplinary pain management team can help you adapt your environment, activities, and yourself in a way that promotes optimal functioning, improved comfort, and personal wellness.

What is Occupational Therapy?
Not sure what occupational therapy is? Don’t worry, you aren’t alone! Occupational therapy is an incredibly broad field with many areas of specialty and focus, so it’s sometimes hard to define. You can find OTs who specialize in hand therapy, neurological rehabilitation, pediatrics, vocational rehabilitation, home health, public health, and so many more areas of practice. You will find OTs working in hospitals, outpatient clinics, schools, and out in the community. No matter the setting or specialty, at its core, occupational therapy seeks to empower patients to comfortably and effectively do the things they want and need to do.

OTs look at people holistically and understand the importance of environment and contexts. We value teamwork with our clients and seek their feedback on everything from the goals we work on to how they are implementing interventions in their life outside the clinic. We are an optimistic bunch, always looking for how our clients can succeed. One of the most common things I hear when OTs discuss cases is, “How can we make this happen?”

Adapting Your Environment
One of the ways we “make it happen” is to critically examine the contexts that are relevant to our clients and make changes that are supportive of their goals. We know that supportive environments can have significant impact on pain management outcomes.

This may look like:

OTs advocating for accessibility in city planning meetings, lobbying congress for more affordable healthcare, or speaking out against social injustice.
Assisting clients in connecting with local resources like free yoga classes through the library, low-cost paratransit, or compassionate local specialists who treat your chronic pain condition(s).
Providing education to family, caregivers, coworkers, or educators so they can understand our patients’ health conditions and better support them.
Recommending home modifications so that your living space is safe and physically accessible.
Adapting your living, working, or learning environment to support your sensory comfort. Some people feel best around bright colors, commotion, and noise. Other people prefer soft, muted colors, a stark space, and quiet. OTs help people investigate their sensory preferences and apply them to their environment.
Assisting with organizing your space so that it better supports good body mechanics. One example of this would be storing your most used items at heights that don’t require bending, twisting, or reaching.
Adapting The Activity
There are often ways that activities can be adapted to better support participation and pain management goals.

This may look like:

Recommending assistive technology to allow more comfortable participation. Technology can be low tech – like using clay to make a grip for a crochet hook, or high tech – like installing an elevator so someone can access all levels of their house.
Addressing the timing of activities is often important in pain management. It can be helpful to plan to do difficult tasks during the best part of your day. Some people may find that allowing more time for certain activities, such as cooking, helps them be more mindful of their movements and less prone to injury or pain exacerbations.
Recommending attention to pacing and rest breaks during challenging activities. Tired muscles or reduced cognitive alertness can lead to painful movements, injuries, or accidents. Someone who is incapacitated after completing a difficult task all at once may find that they only have minor soreness if they take breaks and work on the task in small increments.
Organizing task delegation with helpers. This is when part of the activity is completed by a caregiver/therapist and part is done by the patient. This allows more participation with less risk of causing pain and fatigue. For example, if someone wants to plant a garden, but certain aspects would cause increased pain, a helper may do the weeding and hoeing, and the patient plants the seeds, fertilizes, and waters the garden.
Introducing adaptive activities. Many with chronic pain have had to give up activities that they enjoy and find meaningful. Often there are safe ways to participate in these activities with some adaptations. Someone who had to stop skiing after a leg injury can get back on the slopes through an adaptive ski sled. Someone who misses getting on the ground to play with their grandchildren, can stay involved by playing on a bed instead. It’s vitally important to stay as active and engaged as possible!
Adapting The Person
Humans are a wonderfully adaptable species. We can heal, learn, and create in response to changes and challenges. OTs can be a great source of guidance and support in this process of personal transformation.

This may look like:

Educating patients about their condition, treatment options, and how to implement interventions. One of the most empowering things we can offer our clients is knowledge! With a better understanding of their situation, our clients can make more informed pain management decisions and have more control over the process. When I work with chronic pain clients, the first step is providing education about what pain is, why we have it, and factors that impact pain.
Introducing joint protection strategies such as using larger/stronger joints instead of smaller/weaker ones.
Promoting good body mechanics. This can help prevent or lessen the severity of conditions such as repetitive movement injuries. Good body mechanics can also help to prevent pain or future injuries.
Promoting safe movement patterns. Sometimes pain can lead to altered movement patterns that can reinforce the pain or cause secondary complications. For example, someone who limps from nerve damage in their foot may find their back starts to hurt from the asymmetrical movement.
Designing customized splints to protect body structures such as hypermobile joints or a healing surgical site.
Recommending a home exercise program to improve strength, coordination, and range of motion. Body structures that are well supported by strong muscles and that move in optimal ways are less likely to be injured or cause pain.
Promoting healing after injury through wound care, manual therapy, or education about precautions.
Providing physical agent modalities like ice, heat, ultrasound, and TENS that can interrupt pain signals and reduce inflammation.
Educating about cognitive and emotional practices that can improve pain and quality of life. Pain is a complex sensory-emotional process so it’s important to address all areas that contribute. Patients have better pain management outcomes when they have hope, goals, and a sense of control. Mindfulness, artistic expression, and engagement can improve outcomes as well. What and how we think truly does matter!
Establishing habits and routines that support your pain management goals. When something becomes a habit, you don’t have to spend as much cognitive energy doing it. When your habits and routines involve things like good sleep hygiene, medication management, and self-care, you can do more to reduce pain using less energy.
Supporting self-advocacy skills. In a society or a system, like healthcare, that is not always supportive of those with chronic pain, patients often must speak up to get their needs met. OTs can help our clients learn to set boundaries, be assertive, and communicate with others in an effective manner.
These are just some ways OTs have an important role in pain management. As you already know, it’s rare that any single medication, procedure, or intervention is curative or chronic pain. But the cumulative impact of a multidisciplinary, diverse, and in-depth pain management plan can greatly improve your pain and quality of life.

About The Author
Emily is an occupational therapist with Ehlers-Danlos Syndrome living in the beautiful Bay Area, CA. She works with clients who have chronic and complex diseases, focusing on achieving better comfort and improved functioning in important areas of their life. Emily loves to travel, crochet, and listen to podcasts that make her laugh out loud.

Occupational Therapy’s Role in Pain Management – A Therapist’s Perspective

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