Pain Management

PAIN

MANAGEMENT

Lisa Turner is a specialist OT working in a community pain management service. She explains her role within the multi-disciplinary team and the interventions used to help patients manage their chronic pain

Chronic or persistent pain has been estimated to affect around 43% of the UK population

Iam an occupational therapist, working within a community pain management service for the NHS in Staffordshire. I have worked in this interesting and challenging role for over ten years. Not all pain management services have occupational therapists and I personally feel that we add an enormous amount of value to this area of practice. Chronic or persistent pain has been estimated to affect around 43% of the UK population. Along with the impact this has on the individual, it also places a huge burden on health services and more widely on society. Persistent pain is complex - affecting the physical, social, vocational, cognitive, and psychological elements of a person’s life. In my role I focus on the impact of pain on a patient’s ability to function, activities that are meaningful to them and their quality of life. Activity performance is central to an individual’s identity and restrictions on these can have a huge impact on an individual’s psychological health and wellbeing. Due to the multi-factorial nature of chronic pain, I work in a multidisciplinary team with physiotherapists, psychologists and a pharmacist. We all look at pain from different perspectives and use the biopsychosocial model of practice to assess and treat the impact that pain has on an individual. The aim of pain management is not to get rid of the pain but to improve a person’s ability to live well with it, moving towards more acceptance of their condition. Our team goal is to empower patients to take control of their own pain, to take responsibility for their own health and build confidence to self manage. I carry out joint assessments with my physiotherapy colleagues. Each patient is encouraged to share their pain narrative, which is often therapeutic in itself. We use a collaborative approach to negotiate a treatment plan. Our group work focuses on interactive pain education and teaching patients a range of self-management strategies. Group work is particularly important in pain management as sharing experiences normalises

sharing experiences normalises the impact of chronic pain

the impact of chronic pain. This can help patients to move forward accepting their pain condition and understanding how to go about improving meaningful activities. We also offer patients individual support with strategies, as well as small relaxation or mindfulness groups. As an occupational therapist, I provide practical support to facilitate recovery. I help patients overcome barriers and find ways of participating in activities that matter to them. The self-management strategies that I focus on are activity management (pacing), goal setting, sleep, stress management, relaxation and mindfulness. In pain management there is an interesting relationship between physical health, the ability to carry out activities and mood. Pain education is crucial within my role. Often just explaining the complex interplay of how chronic pain impacts mood, function and physical ability is key to helping patients improve their quality of life. During my work with patients, I have noted many times how their understanding shifts and they learn to deal with some of their fears. My experience shows that giving patient’s time to discuss their pain experience, and listening, is key in helping with positive change. The pandemic has, of course, impacted our service; limiting the number of face-to-face contacts and group work that we are able to offer. It has, however, given our team an opportunity to adapt and I am actively involved in service developments. We have moved mostly to telephone assessments and reviews and have developed an online version of our pain management programme. We have used the ‘flipped learning’ model of giving patients education information, and then arranging virtual sessions for small groups of patients to discuss and individualise the self-management strategies they have learnt remotely. In the long term this has made the service more accessible to patients, and has opened up new opportunities for our team. Occupational therapists add a lot of value to any pain management service. Our dual training in physical and mental health sets us in good stead to help patients improve their quality of life. I feel that occupational therapy - founded on the relationship between occupation, health and wellbeing - is of particular value in pain management. Patients often come to our service after living with chronic pain for many years and it is sometimes a real revelation for them to learn new strategies for improving their life with pain. I get a lot of job satisfaction when I see our patients make positive changes to their lives. As an occupational therapist in this role, there is always something new and interesting to learn. My knowledge and understanding of pain has been enhanced with training courses in cognitive behavioural therapy, acceptance and commitment therapy, compassion focused therapy and mindfulness. There has been an explosion in research and training also available in pain science and education which is fascinating. As a result, I am constantly updating treatment material in line with new evidence which motivates me to continue and develop in this role. I would recommend more pain management teams to consider opening up opportunities for occupational therapists.

There has been an explosion in research and training