Occupational Therapy Intervention in Chronic Pain

Chronic pain is one of the most costly health problems encountered in our society today. The problems constituting the Chronic Pain Syndrome are typically composed of a complex array of sensory, perceptual, psychological, environmental and other factors which require the coordinated efforts of an interdisciplinary team. Occupational behavior provides a very useful frame of reference for the occupational therapist treating the chronic pain patient. This biopsychosocial approach focuses on well behaviors and functional role performance. This paper provides an overview of chronic pain and presents occupational therapy assessment and treatment strategies with chronic pain patients.     

Incorporating Cognitive-Behavioral Therapy with Occupational Therapy: A Comparative Study with Patients with Low Back Pain

This paper reports on the implementation of a psychoeducational program utilizing cognitive-behavioral principles. The efficacy of this psychoeducational treatment program in modifying dysfunctional attitudes in patients with chronic low back pain was examined using a two-group pretest posttest design with a follow-up at 3 months. Thirty patients (average age = 44,37, SD = 13.71) participated in the study, with 15 in the psychoeducational treatment group and 15 in the placebo control group. These two conditions were added on to an existing eclectic inpatient pain management program. After assessment on the IPAM (The Integrated Psychosocial Assessment Model), scores were reduced to multivariate composite scores on the factors of illness behavior, depressed and negative cognitions, and acute pain strategies. Results of a group × time repeated measures analysis of variance for the three pain factors revealed a significant main effect for group(F(23,1) = 5.00, p > .04), tempered by a significant interaction between group and time on the depressed and negative pain factor(F(23,1) = 4.77, p > .04). Patients in the treatment group improved significantly over time and significantly more than the placebo control group patients at posttreatment. Results provide support for the program in increasing patients' feelings of control over their pain and the use of positive coping strategies, while reducing perceived helplessness, depression, disability, and pain intensity.     

The Use of Biofeedback Techniques in Occupational Therapy for Persons with Chronic Pain

The use of biofeedback in occupational therapy to aid the person with chronic pain in the resumption of his daily functional activities is discussed. The chronic pain syndrome and how it disrupts performance of activities is examined, as well as occupational therapy strategies for assessment and treatment using biofeedback, and indications for evaluating treatment outcomes. The authors assume readers have basic familiarity with biofeedback theory, equipment and its operation.     

The Role of Occupational Therapy in the Treatment of the Forensic Psychiatric Patient

Forensic psychiatry provides a challenge to occupational therapists to define the way in which their contribution to the assessment and treatment of forensic psychiatric patients is unique. Occupational therapy facilitates the engagement of individual patients with their environment. An essential feature of treatment planning is the creation of an environmental setting which will enable the individual to develop and refine life tasks and skills, explore alternative roles and promote competency in areas of occupational performance.     

Shoulder Pain in the Patient with Hemiplegia

Shoulder pain in the affected upper extremity of patients with hemiplegia is of fundamental concern to occupational therapists who are working for increased independence of patients. The author interviewed several other occupational therapists, reviewed recent literature and completed a survey of charts of 30 patients. The literature and the therapists' responses indicated a higher frequency of pain than the author anticipated. The chart review was completed (1) to determine objectively the frequency of shoulder pain or subluxation in patients with hemiplegia, and (2) to ascertain the use of the upper extremity and the performance of functional activities of those patients who had shoulder pain or subluxation. Although the number in the sample of charts was too small to yield more than an indication of problems, 3 group patterns emerged based on the differences in functional use of the upper extremity. These 3 patterns of function were compared with findings in the literature. Further study is suggested to assess pain and its responses to occupational therapy, during both the acute and chronic phases of care. The goal of research would be to better predict which patients would develop shoulder pain, thereby helping to prevent long-term complications.     

Managing the Patient with Atypical Chest Pain

Since angina and heartburn can feel the same, excluding cardiac disease may be the first order of business. That done, clinical findings and laboratory tests can help identify the esophageal disturbance. Gastric acid reflux, motility disorders, and visceral nerve hypersensitivity—alone or in combination—can cause chest pain, and each may call for a different pharmacologic regimen.     

Occupational Therapy Interventions in Chronic Pain – A Systematic Review

The use of interventions based on the best available evidence in occupational therapy is essential, and evaluation of research is part of an evidence‐based practice. The aim of this study was to assess the quality of studies describing and evaluating the effects of occupational therapy interventions on chronic pain. A systematic review of studies with diverse designs was carried out. A quality assessment was conducted, and the level of evidence was defined using the Research Pyramid Model. Of 19 included studies, three received the highest evidence level, and three were considered to be of high quality. The clinical recommendations that can be derived from this study are the following: occupational therapy interventions should start from the identified needs of the person with chronic pain; no support exists for the effectiveness of electromyographic biofeedback training as a supplement, more studies are needed to confirm this result; the efficacy of instructions on body mechanics was significant during work‐hardening treatment; and occupational therapists need to perform and present more clinical studies of high quality and high‐evidence level to build up a trustworthy arsenal of evidence‐based interventions, for example, in persons with chronic pain. Copyright © 2015 John Wiley & Sons, Ltd.     

Occupational Therapy

Occupational therapists prevent dysfunction and maintain and restore function for people with HIV/AIDS in the areas of work, selfcare and play/leisure. These occupational areas are assessed and treated from psychosocial, physical and environmental perspectives. This article examines occupational therapy assessment and treatment for people with HIV/AIDS with the primary focus on adaptive equipment, energy conservation, habits and time management, and work.