Hey there! I am Rhodé and I am thrilled to dive into a topic that is not only close to my heart but also highly relevant in healthcare: chronic pain. Currently I am in my last year of the European OT master’s program while working in primary care as an occupational therapist. I help people with managing aspects like their occupational balance, energy and pain. In my practice, I encounter a diverse range of individuals, from burnouts, prolonged concussion symptoms, neurological disorders, cancer and, as you might have guessed, people with chronic pain.
Addressing chronic pain is a complex but extremely meaningful challenge for occupational therapists. It involves physical, psychological, and social aspects. Let us explore this topic together!
Chronic Pain
First off, what is chronic pain? In this blog chronic pain is defined as physical pain lasting over three months, often without a clear biomedical cause. Unlike acute pain, which resolves with healing, chronic pain persists. Sometimes starting from an injury or condition, or with no known cause (Merskey & Bogduk, 1994).
This condition is more common than many realize, affecting about 20% of the global population. In the Netherlands alone, over 3.5 million people are experiencing chronic pain, causing the nickname: the ‘pain epidemic’ (International Association for the Study of Pain, n.d.; Van der Schelde et al., 2024).
OTs in Action
So, what do we OTs bring to the table? Chronic pain affects every aspect of life: work, relationships, hobbies, you name it. Each person’s experience is unique. Many people may feel unseen and frustrated after cycling through specialists without relief.
Despite our important role, the evidence base for OT in chronic pain management is limited (Griffiths et al., 2021), and the number of OTs in pain management is unfortunately declining (Lewis et al., 2019).
With our unique, holistic approach as occupational therapists, we focus on helping individuals regain control over their lives! And these are some examples of approaches.
Focus on what is meaningful
Chronic pain might not (fully) disappear, but guiding individuals toward meaningful activities can improve their quality of life. Focusing on active participation, rather than just pain reduction, empowers individuals and promotes well-being (Townsend & Polatajko, 2007).
Be patient
People often live with pain for extended periods, developing routines that are hard to change. Recognizing the time needed for change and encouraging gradual adjustment is key.
One size does not fit all
Build a deep, trusting relationship to tailor interventions to each person’s unique circumstances, preferences, and values. What works for one may not work for another.
Holistic approach
Our approach is holistic, considering not just the pain but the person’s entire life.
Incorporating the Person, Environment, and Occupations
Analyse the situation on all diverse levels to be aware of the interaction between all.
Building resilience
Resilience involves adapting to challenges by using a toolbox of strategies tailored to different contexts.
Problem-solving approaches
Collaborating with individuals and their social systems to identify barriers and develop solutions empowers them to take control of their journey.
Examples for OT interventions
1. Pain education
Understanding pain is key. Providing clear, relatable information helps people understand how chronic pain works. Especially understanding that it is more about how the brain interprets signals, and that the body is not in danger. Taking time for proper education is essential!
2. Recognizing triggers
Identifying pain triggers (physical, psychological or social) helps create a plan for managing activities and needed strategies. It allows a stable foundation to progress from.
3. Energy conservation and daily routine
Helping people pace themselves, prioritize tasks, and include breaks in their routines manages fatigue, common in chronic pain. A helpful approach is ‘pacing’ which breaks activities into manageable chunk with rests, like splitting cleaning into sections to avoid overstrain.
4. Meaningful activities and rest
These activities are unique to each person. Together, you can explore meaningful activities and effective ways of rest, such as music, mindfulness, yoga, breathing exercises, or painting.
5. Activity and environmental modification
Analysing daily tasks and the environment, and making necessary modifications, helps people to engage in meaningful activities with less discomfort. This might involve adjusting posture or incorporating strategies like mindfulness. All are aimed at building resilience and promoting participation without changing the function of the activity.
6. Cognitive-behavioural strategies
The psychological aspect of pain is important. Approaches like ACT (Acceptance and Commitment Therapy) help reframe negative thoughts and improve coping mechanisms.
7. Routine integration
We can guide people to integrate new strategies into their routines, making them habitual and personal, even when incorporating strategies from other professions.
8. Sleep hygiene
Many people have poor sleep, which can worsen pain sensitivity. Improving sleep through e.g. sleep hygiene interventions can reduce pain perception and boost mood and energy.
9. Other interventions could include: graded activity, graded exposure, goal setting, ergonomics, and collaborations with other professionals!
Conclusion
Our holistic approach aligns with the biopsychosocial model of pain, addressing body, mind and social context. By focusing on meaningful activities and personalized strategies, we help people reclaim their lives!
For more info on how occupational therapy can help with chronic pain, these are some articles I would recommend:
Occupational Therapy’s Unique Contribution to Chronic Pain Management: A Scoping Review by E. Lagueux, A. Dépelteau and J. Masse (2018).
Articulating occupational therapy’s unique contribution to pain management by B.L. Thompson and C. Ramanauskas (2024).
Website for pain education: retrainpain.org
I hope this gives you inspiration for working with (among others) people with chronic pain. This list is ongoing, and I am eager to learn about more interventions and approaches from all of you as well!
References
Griffiths, G. S., Robinson, R., & Tokolahi, E. (2021). Occupational therapy interventions for persistent pain: A systematic review. New Zealand Journal of Occupational Therapy, 68(1), 15-22.
International Association for the Study of Pain. (n.d.). Unrelieved pain is a major global healthcare problem. International Association for the Study of Pain. http://www.iasppain.org/AM/Template.cfm?Section=Home&Template=/CM/ContentDisplay.cfm&ContentID=2908
Lagueux, É., Dépelteau, A., & Masse, J. (2018). Occupational therapy’s unique contribution to chronic pain management: A scoping review. Pain Research and Management, 2018, 5378451. https://doi.org/10.1155/2018/5378451
Lewis, G. N., Bean, D., & Mowat, R. (2019). How have chronic pain management programs progressed? A mapping review. Pain Practice, 19(7), 767-784. https://doi.org/10.1111/papr.12805
Merskey, H., & Bogduk, N. (1994). Classification of chronic pain (2nd ed.). IASP Task Force on Taxonomy. IASP Press. http://www.iasppain.org/Education/content.aspx?ItemNumber=1698
Thompson, B. L., & Ramanauskas, C. (2024). Articulating occupational therapy’s unique contribution to pain management. New Zealand Journal of Occupational Therapy, 71(1), 26–32. https://search.informit.org/doi/10.3316/informit.T2024101800011901847594647
Townsend, E., & Polatajko, H. J. (2007). Enabling occupation II: Advancing an occupational therapy vision for health, well-being and justice through occupation (p. 494). CAOT Publications ACE
Van der Schelde, A., Van de Koppel, M., & Kanne, P. (2024). Ervaringen van Nederlanders met chronische pijn (2024/244) [Experiences of Dutch people with chronic pain]. Ipsos I&O. https://206.wpcdnnode.com/ipsos-publiek.nl/wpcontent/uploads/2024/10/rapportpijnervaring-def.pdf
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