pain and OT

PAIN AND OCCUPATIONAL THERAPY – THE EVIDENCE

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Evidence about pain and OT: 

This is a review of treatments for pain provided by OTs. Let me know how if this information helps you!

The best treatments found in a recent systematic review (1):  looking at the work environment, changing the work environment, and grading work activities.  In another recent study about pain, physical activity training, mindfulness with cognitive behavioral (C-B) interventions, and client education showed the best outcomes (2).

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Common treatment for chronic pain (3):

Motivational interviewing (MI) :  MI allows a therapist to determine what motivation a client has to change their relationship with pain.   The therapist and client discuss explore readiness to change (pre-contemplation, contemplation, preparation, action, and maintenance).  The OT provides treatment based on the stage of the client.  Here is a link to an MI training video for nurses.  And here is a link to specific MI strategies.  MI is also useful with clients who have problems with substance use.

 

 

 

 

Behavioral approach:

  • First, don’t let your client focus on pain.  Acknowledge the pain, then continue with treatment.  Ignore pain behaviors.
  • Next, increase the client’s activity level.  Bronwyn Thompson is  an OT who works with clients who have chronic pain.   In her blog, she discusses activity levels and why clients with chronic pain limit their activity.  She provides tips on how to help clients with pain increase their activity.
  • Use a quota program.  A quota program is a way to increase activity levels.  First, the therapist finds the baseline amount of time a client can perform an activity, without increasing pain.  Each day, the client adds 30 seconds to that activity, but only if there is no increase in pain.  The client receives a reward if they meet their quota for the day or week.  They continue adding time until they reach their goal.
  • As activity level increases, restore healthy behaviors (return to desired and needed activities).
  • Finally, limit symbols of pain (for example, do not use adaptive equipment).

Cognitive behavioral (C-B) approaches:

Biofeedback:  Biofeedback has good outcomes in research, but the evidence is old.  A 2010 study (4) showed no difference between two groups using EMG biofeedback.

Finally, multiple studies suggest that regular physical activity reduces pain.

A structure:  MOHO for the treatment of pain (5):

Stage one – physical phase:

  • Relaxation training
  • Adaptive equipment
  • Modifying the environment
  • Body mechanics, work simplification, and energy conservation
  • Increasing activity levels.

Next – intrapersonal phase: 

  • Promote occupational balance
  • Practice work skills and explore leisure
  • Adapt the environment.

Finally – the interpersonal phase

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References about pain and OT:

  1. Hesselstrand, M., Samuelsson, K., and Liedberg, G. (2015) Occupational Therapy Interventions in Chronic Pain – A Systematic Review. Occupational Therapy International22, 183–194.
  2.  Jay, Brandt, Hansen, Sundstrup, Jakobsen, Schraefel, Sjøgaard, & Andersen (2015).Effect of individually tailored biopsychosocial workplace interventions on chronic musculoskeletal pain and stress among laboratory technicians: Randomized controlled trial.  Pain Physician, 18, 459-471
  3.  Engel, J.M. (2010) Pain Regulation. In C. Brown & V. Stoffel (eds.), Occupational therapy in mental health: A vision for participation (358-370). Philadelphia : F.A. Davis Co.
  4. Ehrenborg C, Archenholtz B (2010). Is surface EMG biofeedback an effective training method for persons with neck and shoulder complaints after whiplash-associated disorders concerning activities of daily living and pain – a randomized controlled trial. Clinical Rehabilitation, 24, 715–726.
  5. Taylor, R.R. & Fan, C.W. (2012) Managing pain in Occupational Therapy: Integrating the Model of Human Occupation and the Intentional Relationship Model. In E. Cara & A. MacRae (eds.), Psychosocial Occupational Therapy: An evolving practice (573-595).  Clifton Park, NY:Delmar Cengage Learning.

Cover photo by Seniju (Image Source)

 

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