EFFECTIVE OT INTERVENTIONS FOR DECREASING CHRONIC PAIN TO RESTORE OCCUPATIONAL PERFORMANCE IN OLDER ADULTS Presented by: RAISSA JEWELL SMITH, OTS The Auerbach School of Occupational Therapy Spalding University

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

Acute vs. Chronic Pain Acute Pain Chronic Pain Recurring 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

Chronic Pain Trivia WHY CHRONIC PAIN? TRUE or FALSE Chronic pain is defined as any pain lasting more than 8 weeks in duration. 75 – 85% of elderly residing in healthcare facilities suffer from chronic pain.

KEY POINTS: CHRONIC PAIN 2 Categories of Chronic Pain Neuropathic – nervous system Nociceptive – other body tissues

KEY POINTS: CHRONIC PAIN Common causes in elderly population: Arthritis Spinal Stenosis Neuropathy -“diabetes” Shoulder Tendonitis

RELEVANCE TO THE PROFESSION OF OCCUPATIONAL THERAPY Reduce discomfort & disability Occupational Performance (example) Independence with ADL’s/IADL’s Addressing psychological factors Prevention Adaptation Quality of Life Participation

Non drug therapies for pain management among rural older adults 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

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.

Norton Audubon Hospital Practical Experience Norton Audubon Hospital Manual therapy Ultrasound Stretching Ther ex: Strengthening ROM exercises Superficial modality – paraffin bath

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

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

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

References 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. Fouladbakhsh, J., Szczesny, S., Jenuwine, E., & Vallerand, A. (2011). Nondrug therapies for pain management among rural older adults. Pain Management Nursing, 12(2), 70-81. doi:10.1016/j.pmn.2010.08.005 Gowda. A., & Brees, K. K. (2010). The complete idiot’s guide to pain relief. New York: The Penguin Group. 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. 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