1

EFFECTIVE OT INTERVENTIONS FOR DECREASING CHRONIC PAIN

TO RESTORE OCCUPATIONAL PERFORMANCE IN OLDER ADULTS

Presented by:

RAISSA JEWELL SMITH, OTSThe Auerbach School of Occupational Therapy

Spalding University

2

OBJECTIVES

• To differentiate between chronic & acute pain.

• Describe categories & common causes of chronic pain among the geriatric population.

• Depict detrimental psychological/emotional & physical impact of chronic pain to occupational performance.

• Explain how Occupational Therapy can assist with alleviation of chronic pain and promote increased independence, participation, & quality of life.

• Reveal current evidence based research regarding OT interventions for treatment of chronic pain.

• To illustrate appropriate application of treatment interventions utilized for pain management while at Level 2 fieldwork sites.

• Portray the importance of advocating & advancing the profession of OT

3

Acute vs. Chronic Pain

Acute Pain• Rapid onset

• Serves biological/adaptive purpose - “Something is wrong”

• Associated with tissue damage & inflammation

• Responds to medication & tx of underlying cause.

Chronic Pain • Recurring

• Serves no biological purpose

• Associated with nerve &/or tissue damage.

• Exist when stimulus is absent.

• Responds to medication, CBT, OT/PT, & Interventional therapy

4

Chronic Pain Trivia

• WHY CHRONIC PAIN?

TRUE or FALSE

1. Chronic pain is defined as any pain lasting more than 8 weeks in duration.

2. 75 – 85% of elderly residing in healthcare facilities suffer from chronic pain.

5

KEY POINTS: CHRONIC PAIN

• 2 Categories of Chronic Pain • Neuropathic – nervous system

• Nociceptive – other body tissues

6

KEY POINTS: CHRONIC PAIN

• Common causes in elderly population: • Arthritis

• Spinal Stenosis

• Neuropathy -“diabetes”

• Shoulder Tendonitis

7

RELEVANCE TO THE PROFESSION OF OCCUPATIONAL THERAPY

• Occupational Performance (example)

• Independence with ADL’s/IADL’s

• Addressing psychological factors

• Prevention

• Adaptation

• Quality of Life

• Participation

8

Research Evidence • Non drug therapies for pain management among rural older

adults– Objective: evaluate effectiveness of pain self management edu program

utilizing non-pharmacological modalities. • Intervention: 30 min edu session (safe use otc analgesics) paired with 30 min

session on safe/appropriate use of “Mother Earth” flax seed moist heat/cold packs & relaxation breathing techniques.

• Control: 30 min edu session (safe use otc analgesics).

Findings: *Statistical significance in use of all 3 non drug therapies (experimental group).

*2 week conclusion: Significance in mean pain severity levels for (least, average, current) pain.

*Mean ratings for pain related distress were significant for frequency & intensity.

Limitations: Small sample size (N=53), Lack of blinding, Lack of generalization, & Recall bias for pain memory

9

Research Evidence Cont’d • Treatment for chronic pain for adults in the seventh and eighth decades of life: A preliminary study of acceptance and commitment

therapy (ACT)– Objective: evaluate effectiveness of ACT (emerging form of CBT) for chronic pain

among older adults.

• Intervention: ACT tx in group format X 5 days wk (6.5 hrs daily for 3-4 wks)– Tx included: 2.25 hrs physical conditioning, 1.5 hrs of psychological methods, 1 hr

activity mgmt, 1.75 hrs training skills/health edu

Findings: *Statistical & clinical significance for measure of pain.

*Statistical significance in physical/psychosocial disability, pain acceptance & depression.

*Significant improvements: physical/psychosocial disability, depression, pain acceptance, & mindfulness (3 month follow up)

Limitations: Small sample size (N=40), Difficult to replicate, Lack of randomization, Lack of control group, & 55% attrition rate at 3 month follow up.

10

Practical Experience

Norton Audubon Hospital

Manual therapyUltrasoundStretching Ther ex: Strengthening ROM exercisesSuperficial modality – paraffin bath

11

Other OT treatment options for Chronic Pain

• TENS• Ionotophoresis• Progressive mobility• Education: Proper body

mechanics, posture, energy conservation, & joint protection

• Relaxation training • Guided Imagery• Distraction• Social support

12

Pain & Other Assessments

• Numeric Pain Rating Scale• Brief Pain Inventory• Symptom Distress Scale• Perceived Control Scale• Likert Pain Scale • Visual Analog Rating• Wong Baker Faces Scale • COPM• Pain Anxiety Symptoms

Scale 20 (PASS-20)• McGill Pain Questionnaire

13

Advancing the profession of OT

• Advocacy • Cost to treat chronic pain in hospitals & impact on

workforce. (Role of OT) • Implementing a multidisciplinary approach • Remain current & competent • Optimize unique attributes: TUOS, Knowledge

(task/person/environment), & Clinical/analytical skills

14

References1. Engel. J. (2003). Pain management. In E. B. Crepeau, E. S. Cohn, & B. A. B. Schell (Eds.), Willard and Spackman’s

occupational therapy (10th ed., pp. 634-637). Philadephia: Lippincott, Williams & Wilkins.

2. Fouladbakhsh, J., Szczesny, S., Jenuwine, E., & Vallerand, A. (2011). Nondrug therapies for pain management amongrural older adults. Pain Management Nursing, 12(2), 70-81. doi:10.1016/j.pmn.2010.08.005

3. Gowda. A., & Brees, K. K. (2010). The complete idiot’s guide to pain relief. New York: The Penguin Group.

4. McCracken, L.M., & Jones, R. (2012). Treatment for chronic pain for adults in the seventh and eighth decades of life: A preliminary study of acceptance and commitment therapy (ACT). Pain Medicine, 13, 861-867.

5. Tse, M., Wan, V., & Ho, S. (2011). Physical exercise: Does it help in relieving pain and increasing mobility among older adults? Journal of Clinical Nursing, 20, 634-644. doi: 10.1111/j.1365-2702.2010.03548.x

• https://www.google.com/search?q=chronic+pain+cycle&safe=active&rls=com.microsoft:en-us:IE-Address&source=lnms&tbm=isch&sa=X&ei=PingUo2pIY7EsATX94DYCA&ved=0CAkQ_AUoAQ&biw=1385&bih=737#facrc=_&imgdii=_&imgrc=FQXEahZ4_945yM%253A%3BFDPmYFvGUKT4MM%3Bhttp%253A%252F%252Fvisn22.kramesonline.com%252FHealthSheets%252F52361.img%3Bhttp%253A%252F%252Fvisn22.kramesonline.com%252FHealthSheets%252F3%252CS%252C85783%3B518%3B360