1. 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

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 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

4. 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.

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
Reduce discomfort & disability
Occupational Performance (example)
Independence with ADL’s/IADL’s
Addressing psychological factors
Prevention
Adaptation
Quality of Life
Participation

8. 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

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. Norton Audubon Hospital
Practical Experience
Norton Audubon Hospital
Manual therapy
Ultrasound
Stretching
Ther ex: Strengthening
ROM exercises
Superficial 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. 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 ). 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), doi: /j.pmn
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,
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, doi: /j x