Ashley Opp Hofmann
Persons with chronic pain face more than their fair share of obstacles. In addition to continual discomfort, they may also confront a lot of frustration, difficulty obtaining proper medications, and in some cases, the skepticism and suspicion of others.
Pain is infinitely complex, and occupational therapy practitioners understand its many dimensions. They also understand its subjectivity and respect a client’s self report. By evaluating the various physical, cognitive, and psychological elements simultaneously at play in someone with chronic pain, occupational therapy practitioners can help clients to cope with and manage their pain so they can accomplish the activities most important to them.
Defining Chronic Pain
“Chronic pain is subjective; it is what the patient says it is,” says Signian McGeary, MS, OTR/L, FAOTA, assistant professor of occupational therapy at Quinnipiac University in Hampden, Connecticut. “Chronic pain is pain that continues beyond its usefulness as a warning to someone that there is a problem.” There are countless sources of chronic pain, including amputation procedures, arthritis, fibromyalgia, traumatic injuries, and disorders such as herniated discs or surgeries on the back that leave residual hypersensitivity.
“Pain is multi-factorial,” explains McGeary. “It affects an individual’s cognitive ability because of the stress. Intensity and location are other variables. Or, a client might be so anxious and fearful of the pain that it affects his or her pain response.” Occupational therapy practitioners appreciate and can address the full complexity of a client’s chronic pain.
“Interestingly, it used to be that someone was defined as having chronic pain if that pain lasted more than 6 months,” McGeary says. “Now, pain that lasts more than a month is put into that category, after the potential for tissue repair might normally occur.” This shift indicates that health providers are recognizing chronic pain earlier, and, as McGeary points out, “The sooner we acknowledge it, the sooner we can stop [negative] attitudes and behaviors towards the pain and hopefully redirect the client’s own ability to cope with it.”
How Can Occupational Therapy Help?
Broadly, occupational therapy helps clients to live and function productively. Within the context of chronic pain, occupational therapists evaluate the pain’s impact on a client’s desired activities and quality of life, and equip him or her with the skills and strategies to manage the pain.
First, therapists validate the client’s pain and work to establish trust. They identify the client’s own attitude towards the pain and the degree to which the client believes he or she can control or affect it. “If a client has high self-efficacy, or a belief that they can affect their pain, then an occupational therapy practitioner would work with them in a certain way. If a client has low self-efficacy, then we would need to work with them in a different way, working slowly to build the client’s own belief system,” McGeary says. “Clinical studies in self-efficacy for pain control showed folks with arthritis had greater control after cognitive behavioral education. But it takes time.”
Occupational therapy practitioners can show clients how to redirect their pain so that it interferes less in their daily lives. Relaxation and visualization activities cognitively redirect pain. Because of chronic pain, clients are often physically deconditioned, and the practitioner will work on gentle exercises to increase clients’ strength and stamina. They might also use such activities as self-hypnosis, meditation, and yoga, all of which can be effective ways of coping with pain.
The effectiveness of these activities, however, depends largely on the client’s attitude and beliefs about the pain. According to McGeary, a lot of current research and data suggest that chronic pain occurs because the dorsal horn cells of the spinal cord actually change and exacerbate the pain response. Dorsal horn cells are the first site for integrating and processing incoming sensory information, providing ascending information to the higher centers of the brain that influence the awareness and interpretation of pain.
“For some clients, helping them to see that there is an organic cause of some of the pain helps them to appreciate that they can indeed make a change in the pain response. If the brain changes when we have one message that we give ourselves, then there’s just as much potential for the brain to change with other messages,” says McGeary.
Why Occupational Therapy?
“Occupational therapy practitioners have a much broader view of the person [than other disciplines]. They understand the sensory, cognitive, and emotional dimensions of multi-factorial pain,” McGeary says. “Sometimes there’s a climate of distrust—the idea that people are malingering. But occupational therapy practitioners are much more willing to accept that attitudes and belief systems have a strong, powerful impact on how people see themselves and their ability to cope.”
Accessing occupational therapy specifically for pain can be a bit complicated. Often in a rehabilitation environment, clients receive both physical and occupational therapy. Pain clinics generally provide a multidisciplinary approach to pain management, including occupational therapy. A physician can refer an individual to occupational therapy, but clients must always be prepared to advocate for themselves and for what they want.
What Can You Do?
McGeary recommends that persons with chronic pain educate themselves by reading the literature on pain (see suggested reading below). But the most important thing is to seek assistance. “Clients should ask for what they want, in regards to both pain medications and therapy. “They have a right to be free from pain, or to at least have their pain symptoms controlled,” she says. “Don’t suffer in silence. There’s a lot that can be done.”
Suggested Resources and Reading
American Pain Foundation
Stanford University School of Medicine: Chronic Pain
International Association for the Study of Pain
AOTA’s Chronic Pain Tip Sheet
“My Pain, My Brain”
By Melanie Thernstrom, New York Times Magazine, May 14, 2006.
Group Wellness Programs for Chronic Pain and Disease Management
By Carolyn McManus, 2003. Boston: Butterworth-Heineman.
Pain: A Textbook for Therapists
Edited by Jenny Strong, 2002. Oxford: Churchill Livingtstone.
Find an Occupational Therapy Practitioner
Physicians, case managers, and other medical professionals can refer you to occupational therapy practitioners in your area. Other sources for locating an occupational therapist include colleagues, family members, and friends who have received occupational therapy services, as well as your local telephone directory.