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3 Articles in this Series
Introduction
Migraine: Neurologic and Psychiatric Management
Occupational Therapy in Pain Management
Opioid Prescribing: Calculating Risk in the Context of Today's Crises

Occupational Therapy in Pain Management

A PAINWeek 2021 Meeting Highlight, featuring Megan O. Doyle, MS, OTR/L, FPS, Cert-APHPT, and Gary W. Jay, MD

Occupational therapy is both recognized and recommended as a restorative therapy and nonpharmacological pain treatment, targeting acute and chronic pain, by many governmental health institutions. Yet, occupational therapy, sometimes called the "other therapy" to seemingly understate its importance, continues to be underused and underrepresented.

That was the premise behind a presentation at PAINWeek 2021 delivered by Megan O. Doyle, MS, OTR/L, FPS, Cert-APHPT, an occupational therapist (OT) and fellow of pain science at St. Luke's Health System in Boise, ID, who aimed to educate clinicians on the benefits of OT for pain. "Doctors who add OTs to their clinic find a huge benefit," she told PPM after the session. Currently, she noted, ''the treatment of pain is very siloed" but occupational therapy is based on a biopsychosocial model of pain management and encompasses the physical, cognitive, psychosocial, sensory-perceptual and other areas – it can produce substantial benefits.

Occupational Therapy as Part of Pain Management

In pain management, occupational therapy can guide patients to integrate new skills and routines into their lived experiences – a benefit not often found in other healthcare specialties, Doyle said. Occupational therapy, for example, can help individuals engage in things they need and want to do. They can ''learn skills where the pain goes into the background."

OTs take a broad scope when addressing a patient's goals, explained Doyle, including sensory, cognitive, emotional, and physical. They use a responsive approach that helps clients “engage in activities which have been shown to reduce pain and increase endorphins… And we know that is one of the most natural painkillers of all, to engage, be present."

Occupational therapy also embraces the value of occupational engagement to mental health and overall wellbeing.Under that umbrella, therapists encourage good rest and sleep, and provide training to address sleep hygiene and decrease pain. They educate and implement relaxation and mindfulness strategies. They recommend environmental modifications to reduce pain onset.

Also important in an OT's approach, Doyle said, are to:

  • Set goals that are client-centered and occupation based
  •  Encourage positive health habits, roles, and routines
  • Encourage proactive problem solving; prevent pain onset by self-management techniques
  • Teach ways to avoid fear-avoidance, avoiding tasks due to fear of pain
  • each energy conservation
  • Consider whole body exercises such as yoga and tai chi to reduce pain2

"OTs can look at barriers [to engaging in activities]," Doyle added, and focus on problem solving and how to live with the pain.

Specific occupational therapy health action plans aim to improve function and engagement in physical activities.3 The Lifestyle Redesign program, for example, can be integrated into a patient's treatment plan to improve functioning, self-efficacy, and quality of life.As Doyle pointed out, the most common diagnoses targeted with the Lifestyle Redesign program – eg, lumbago, myalgia, including fibromyalgia, and complex regional pain syndrome (CRPS) – are common conditions challenging pain specialists and other physicians daily.

Other research points to the benefits of interdisciplinary pain management including an OT.5 For instance, one 3-week outpatient program using such an approach to treat people with chronic pain included physical and occupational therapy, cognitive behavioral therapy (CBT), and medication management. While the physical therapy groups focused on moderate exercise despite symptoms, OTs taught moderation, time management, and activity modification. CBT groups addressed psychosocial comorbidities of pain. Medical staff oversaw tapering of opioid analgesics and other symptom-targeted treatments. 

At the end of the program, average scores on the Canadian Occupational Performance Measure (COPM-PER) increased from 3.4 to 7.5; on the satisfaction measures, from 2.4 to 7.5.

Mindfulness and the Pain Experience

Mindfulness, in recent years, has been promoted for seemingly everything from stress reduction to weight control, but it definitely has a place in pain treatment as well, said Doyle. Among the key themes, mindfulness as part of pain control can help patients:6

  • Learn ''non-reactivity," leaning into bodily sensations and pain.
  • Learn a responsive approach to pain management, making a conscious choice.
  • "Rest into the pain," don't battle through it.
  • Learn the concept that "suffering caused through emotional responses to it can be reduced with mindful awareness."

Interdisciplinary Pain Management Should Include Occupational Therapy

"Doctors know what  PT does but they don't typically know what an OT does," said Gary W. Jay, MD, clinical professor of neurology at the University of North Carolina Chapel Hill, and a member of the PPM editorial board. Many physicians, he suspects, assume that OTs are mainly concerned with ''how much can a person lift, carry."

For 40 years, he has been a pioneer in the concept of including OTs in the management of pain; having set up such programs and worked with OTs for four decades.

In his review of Doyle's talk, Dr. Jay said he agrees with Doyle’s points about occupational therapy being beneficial to those in pain. “She explains what OTs can do for patients’ pain 'and that's a real takeaway."

Dr. Jay strongly believes that OTs ''need to be part of an interdisciplinary team at a pain center." That is key, he said, to obtaining maximum benefit, that the OTs work as part of a team. "If you [a physician] just sent a patient to an OT or a PT, you have no control. You have no idea what they will do. They need to be part of your team. You want everyone working together."

 

Sources

  1. Lagueux E, Depelteau A, Masse J. Occupational Therapy's Unique Contribution to Chronic Pain Management: A Scoping Review. Pain Res Manage. 2018:5378451. 
  2. Hofmann, AO. American Occupational Therapy Association. Managing Chronic Pain with Occupational Therapy.2019. Available at: www.aota.org/About-Occupational-Therapy/Professionals/PA/Articles/Chronic-Pain.aspx
  3. Arbesman M, Mosley L. "Systematic review of occupation-and-activity-based health management and maintenance interventionsfor community-dwelling older adults." American J Occup Ther. 2012; 66(3):277-83.
  4. Simon AU, Collins CER. "Lifestyle Redesign® for Chronic Pain Management: A Retrospective Clinical Efficacy Study." Am J OccupTher. 2017:71(4)7104190040. 
  5. Kurklinsky S, Perez RB, Lacayo ER, Sletten CD. The Efficacy of Interdisciplinary Rehabilitation for Improving Function in People with Chronic Pain. Pain Res Treat. 2016;2016:7217684. doi: 10.1155/2016/7217684.
  6. Goodman V, Wardrope B, Myers S et. al. Mindfulness and human occupation: A scoping review. Scandinavian J Occup Ther. 2019;26(3):157-170. 
Next summary: Opioid Prescribing: Calculating Risk in the Context of Today's Crises
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