Occupational Therapy’s Role in Chronic Pain
Chronic pain is more prevalent now than ever before, making us wonder, “What is occupational therapy’s role in chronic pain?” It is no secret that chronic pain is a complex condition which can make many OTs feel daunted about assessing and treating chronic pain in their work setting.
It is estimated that globally 20% of the population experiences chronic pain, and I believe that we as occupational therapists and OT assistants are such an integral piece of the team for helping to treat this condition (1).
Our goal for this article is to help you to feel more confident in understanding your role in working with people of all ages with chronic pain. We will highlight what chronic pain is, what areas of difficulty we commonly treat in people with chronic pain, and how we can assess them. We will also be including a free printable that you can use to help explain chronic pain to your patients.
My experience working with chronic pain:
I work as an occupational therapist in an outpatient rehabilitation setting with an interdisciplinary team that offers a service dedicated towards helping individuals with chronic pain.
I do individual sessions with my patients, but have also started group therapy this year and I have really noticed the incredible benefits of running groups for people with chronic pain. I believe that step one in helping a patient with chronic pain is empowering them with the knowledge of understanding what chronic pain is so that they can gain greater understanding of what is happening with their body.
I’d like to make a disclaimer that before you provide education on chronic pain, it is important that they have had a medical checkup with their primary doctor identifying that there are no new injuries or conditions that are the source of the pain. Once you feel confident about that you begin with defining chronic pain.
What is chronic pain?
I often start off with explaining the difference between acute and chronic pain. Acute pain is a sudden onset of pain that generally lasts less than 6 weeks and is often a warning sign, usually caused by a recent injury or specific disease.
Chronic pain is pain that is continuous or intermittent and lasts more than 3 months. It is pain that continues even after wound healing has completed and sometimes doesn’t have a biological cause for it. Examples of chronic pain conditions include: fibromyalgia, arthritis, migraines, complex regional pain syndrome, phantom limb pain and chronic lower back pain. Pain is complex and biopsychosocial in nature, so we know that there are many different areas that may be contributing to a person’s persistent pain.
Common areas of difficulty that people with chronic pain have:
Many people with chronic pain experience difficulty with:
- Sleep
- Anxiety
- Depression
- Fatigue
- Mobility
- Strength and range of movement
- Cognitive skills
- Social isolation
- Self-esteem
- Quality of life
- Most importantly (to us at least) their independence in their ADLs, IADLs, leisure activities, and work.
Based off of this list I am sure you can understand why an occupational therapist is an essential team member in managing chronic pain. A holistic approach is crucial in managing these individuals, and that is exactly what we have been thoroughly trained in.
The question my patients often ask me is, “Which came first? Did my pain contribute to my sleeping difficulties or did my sleeping difficulties contribute to my pain?” It’s the whole ‘chicken and egg’ scenario isn’t it? There is often a bi-directional relationship between most of the areas of difficulty and chronic pain. For example, one’s anxiety can be a driving factor in their chronic pain, but the life changes that chronic pain creates can also cause anxiety!
As an OT, what sort of assessment can I use with people with chronic pain?
Now that you know the areas of difficulty that people with chronic pain generally experience you should already have some ideas on what kinds of assessments you would typically do.
I am going to start first with the areas of occupation. Sometimes we can become too focused on assessing impairments or areas of difficulty that we lose sight of the bigger picture. So, first and foremost, you need to assess an individual’s level of independence and satisfaction in their ADLs, IADLs, leisure, social participation, work or education and sleep just like you always do. This is where you as an OT must analyze what are the underlying difficulties that may be contributing to their reduced independence in an activity. Could it be their pain? Their fatigue? Their concentration difficulties?
Gathering subjective information from the person with chronic pain is the most important part of your assessment, as this will give major clues as to what needs to be prioritized in their treatment. It is very important to gain an understanding of what they feel is driving their ongoing pain. For example, many patients believe that if they still have pain this must be because their fracture hasn’t healed or there is a new injury, and this then alters their behavior.
It is important to use your skill of observation and activity analysis, but I will also suggest some outcome measures you can use to measure the areas of difficulty commonly seen in people with chronic pain as it is helpful to objectively track their progress. Here are some outcome measures that I use.
Anxiety
There are two self-reported outcome measures that I use for measuring symptoms of anxiety, these are:
- Generalized Anxiety Disorder 7-items (GAD-7)
- Hospital Anxiety and Depression Scale (HADS)
Depression
There are two self-reported outcome measures that I use for measuring symptoms of depression, these are:
- Patient Health Questionnaire (PHQ-9)
- Beck’s Depression Inventory
Please note that outcome measures measuring symptoms of anxiety and depression contain questions that are heavy in nature, such as suicidal ideations. Be mindful of this when administering these questionnaires and please ensure that you are available for counselling and support, and to make a referral to a Psychologist and Psychiatrist if needed. It may also be beneficial to consider what access to support they have at home after they leave your appointment.
Fatigue
There are two self-reported outcome measures that I use for measuring fatigue, these are:
- Fatigue Severity Scale
- Fatigue Impact Scale
Mobility
Make use of your skills of observation and other outcome measures, such as the
- 6 Minute Walk Test
- 5 Times Sit to Stand Test
Strength and range of motion
Time to get out your goniometer, a hand held dynamometer and use the ‘Oxford Scale’.
Cognitive skills
Assessing cognition functionally is very important. Should you require an outcome measure to assess cognition, you can use the following:
- Montreal Cognitive Assessment (MOCA)
- Saint Louis University Mental Status (SLUMS) (helpful if you’re not MOCA trained)
- The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS)
Loneliness
This is particularly helpful to measure before your patient starts group therapy, to note whether group attendance impacts on their feelings of loneliness.
- The Revised UCLA Loneliness Scale can be used
Self-esteem
- Rosenberg Self-Esteem Scale
Quality of Life
- EUROQOL-5D
- Short Form-36
Sleep
The Pittsburgh Sleep Quality Index is a very helpful self-reported measuring tool.
I like that it assesses the different areas that may be contributing to poor sleep. You can also find out more about assessing sleep in our article, Don’t Sleep on Occupational Therapy’s Role in Sleep.
What is occupational therapy’s role in treating chronic pain?
I always tell my patients that unfortunately I cannot make their chronic pain disappear, but that together we can work on improving their quality of life by getting them back to doing the tasks that they value.
After assessment, it is time for goal setting WITH your patient. I cannot emphasize enough the importance of setting SMART goals to help guide your intervention, and to ensure that your therapy sessions are truly focusing on what your patient wants. If you don’t feel very confident on setting goals you can find tips in our goal writing article, OT Goal Writing Tips for Adults & Older Adults, to help guide you.
If you have done a thorough assessment and set clear goals, then you’re ready for treatment. All the areas that you’ve just assessed are well within the scope for OT to treat. Occupational therapy interventions for chronic pain is a huge topic on its own, so let us know in the comments if you would be interested in an article on OT intervention for chronic pain.
It is obviously helpful to have continued education on chronic pain (we use and recommend Medbridge for online CEUs for a wide variety of OT interventions) as well as post-graduate training in chronic pain, but we want all OTs to feel empowered and less daunted by working with people with chronic pain.
Just remember to do a thorough assessment, listen to what your patient is REALLY saying, aid them in setting goals and you’re already heading in the right direction.
You can also use our printable to help you explain to your patient what chronic pain is, as this is the first and most important step in treating chronic pain. Remember that occupational therapy’s role in chronic pain is of paramount importance as we are the activity specialists at the end of the day.
References:
Funeka Faith Pandelani, Louisa, S. and Thanyani Pandelani (2024) ‘Chronic pain: The prevalence of chronic pain in patients attending Soshanguve Community Health Centre’, Canadian Journal of Pain, 8(1). Available at: https://doi.org/10.1080/24740527.2023.2284152.
