Authored by Jenna Donati, OTS, D’Youville College
What is Pain?
Pain is an individualized feeling described by many as an unpleasant sensory or emotional experience. It can be described as a shooting, burning, aching, or throbbing sensation. Each person deals with pain differently; based on previous pain experiences, mood cognition, gender, or culture and belief systems. Some people can tolerate painful experiences, while others feel pain that interrupts their lives. This is a result of what are called pain thresholds and levels of pain tolerance. Pain can last for a short time (acute pain) or last for years at a time (chronic pain). Did you know that 116 million people in the United States deal with chronic pain? Pain lasting for hours, days, or months can interfere with independence in mobility, meaningful activities, and roles over time.
Pain can result from several reactions within the body. Damage to nerves inside your body can lead to what is called neuropathic pain. This results in pain in the area of nerve damage as well as surrounding areas. If receptors in the body are more sensitive to pain, people can experience what is called hyperalgesia, or an increased amount of pain. A medical disorder or previous trauma can result in what is called allodynia, or pain for something that should not cause a pain sensation. When you experience pain, the body often changes in response. For example, pain may result in dilation (enlargement) of pupils or widening of eyelids, increased breathing rate, changes in heart rate or blood pressure, sweating, or changes in body temperature. When this happens, your body is attempting to alert you to pain and regulate your body through physiological responses. These different responses from the body explain the varying presentations of symptoms and sensations while experiencing pain.
How is Pain Managed?
- Yoga (improves chronic pain and overall mobility)
- Participate in activities you enjoy (enjoyment and engagement provide a distraction from the pain you are experiencing)
- Exercise regularly (to release more serotonin, dopamine, and endorphins in the brain that promote well-being)
- Track your activities and pain level every day (use a log or diary to keep track of movements that cause pain)
- Deep breathing exercises
- Medication management
Surgery is a LAST resort! Explore movement-based rehab!
How can outpatient occupational therapy assist with pain management?
- Kinesiology Tape (therapeutic tape that supports joints and muscles without restricting body movements and uses the skin to assist with healing) CLICK HERE for more information on KT Tape.
- Basic Modalities (cold and heat) (Heat Modality-increases blood flow, relaxes muscles, and relieves joint pain through a warm shower or bath, a warm towel, or a heating pad to relieve pain from sprains, arthritis, muscle tightness, headaches, etc.) (Cold Modality- decreases nerve activity that can be the cause of pain, decreases irritation, swelling and bruising, and lowers skin temperature through gel eye masks, ice packs, or a cold therapy machine to relieve pain from sprains, tendonitis, runner’s knee, etc.)
- Neuromuscular Re-education (used to restore normal body movement patterns and re-train our nervous systems to communicate with muscles appropriately, how much force or strength is required to create movements, or maintaining balance and postural during daily activities)
- Muscle Tension Reduction Training (a form of mindfulness that aids in coping with the emotional aspects of the pain and muscle relaxation to relieve tension; use of guided imagery and use of imagination to reorganize thoughts to assist with pain)
- Home Exercise Program (personalized to each patient, assists with muscle weakness, poor posture, or poor movement patterns that may be contributing to feelings of pain)
- Activity tolerance (gradual increase in activity levels over time)
- Education regarding sleep hygiene (establishment of a nighttime routine, going to bed and waking up at the same time every day, how the bedroom environment should look and feel, avoidance of daytime napping, etc.)
- Body Mechanics and Posture Training (practice safe and effective use of the body in natural environments to address pain)
- Energy Conservation and Joint Protection (teaching patients when to rest as a preventative strategy for pain, gradually increasing activity and decreasing rest over time, protection of joints done for patients with rheumatoid arthritis)
- Make recommendations for adaptive equipment to reduce pain during mobility or during daily activities
Helpful Page Definititions
Instrumental Activities of Daily Living (IADLs)
Instrumental Activities of Daily Living (IADLs) are essential for independence in life roles and required for aging in place. There are 8 activities core activities for independence including cooking, cleaning, communication, taking and managing medication, handling your personal finances, transportation and community mobility, shopping
Cooking - The ability to follow a recipe and having the stamina to prepare a meal for yourself and/or your family
Cleaning - The ability to perform light housekeeping including making your bed, doing your laundry, washing the dishes, taking out the trash, vacuuming, sweeping, cleaning your bathroom, etc.
Communication - The ability to use the telephone, the computer, have conversations with people (familiar and strangers), communicate your needs clearly.
Taking medication - The ability to sort and organize your medication or determine a compensatory method to do so as well as taking the appropriate dosage at the appropriate time.
Personal Finances - The ability to establish an organization method to understand financial responsibilities and pay your bills on time.
Transportation - Whether you are driving, calling for a driving service like a taxi or Uber, or taking public education. You must have a defined action plan for community mobility and transportation.
Shopping - The ability to plan transportation, plan a grocery/clothing list of needs for yourself and your home, have the stamina to collect your items at the store, and be able to get them into your house.
Chronic Pain is pain that is ongoing and usually lasts longer than six months. This type of pain can continue even after the injury or illness that caused it has healed or gone away.
Neuropathic Pain is pain caused by damage or injury to the nerves that transfer information between the brain and spinal cord from the skin, muscles, and other parts of the body.
Dopamine is a chemical in the brain that impacts our sense of reward, motivation, and regulates movements of the body.
Endorphins are chemicals in the brain that reduce our perception of pain and increase feelings of happiness.
Activities of Daily Living
Occupational therapists are trained in occupations and activity analysis. An occupation is an activity that you believe is important to your life. There are many levels of occupations, but activities of daily living (ADLs) are the most personal activities and are usually the ones people find most important if they were to lose the ability to complete them.
- Bathing and showering
- Getting dressed
- Going to the bathroom
- Walking and getting up and down from a chair or car
- Eating and swallowing
- Sexual activity
- Personal hygiene and grooming
- Being able to use personal care devices like adaptive equipment and durable medical equipment
Acute Pain is a mild to sharp pain that comes on suddenly and lasts anywhere from a few seconds to up to a few months.
Hyperalgesia is an increased sensitivity to feeling pain and extreme response to pain. Hyperalgesia may occur when there is damage to the nerves or chemical changes to the nerve pathways involved in sensing pain.
Serotonin is a chemical in the brain that contributes to well-being and impacts our mood, memory, and ability to learn.
A pain threshold is a level at which someone experiences pain (pain is felt).
Pain Tolerance is the maximum amount of pain someone can tolerate. A high pain tolerance means that a person can tolerate lots of pain, while a low pain tolerance means that a person cannot tolerate a lot of pain.
Allodynia is the experience of pain from stimuli that isn’t normally painful. Brushing the hair may produce pain, as will other simple activities such as washing your face, laying your head on a pillow, or a gentle tap on the wrist.
Physiological Response is an automatic reaction that triggers a physical response to a stimulus.
American Occupational Therapy Association [AOTA]. (2014). Occupational therapy and pain rehabilitation [Fact sheet]. https://www.aota.org/~/media/Corporate/Files/AboutOT
Cavazos, M. (n.d.). Exercises for neuromuscular reeducation. https://www.livestrong.com
Crofford, L. (2015). Chronic pain: Where the body meets the brain. American Clinical and Climatological Association. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4530716/
Eliason, M. (2019). Alternative pain management: Chronic pain & occupational therapy. Geriatric Occupational Therapy. Alternative%20Pain%20Management%20% %20for%20Chronic%20Pain%20Research%20-%20Geriatric%20Occupational %20Therapy%20Resources.pdf
Francis, D. (2020, March 23). Pain regulation [PowerPoint slides]. [email protected] https://dyc.instructure.com/?login_success=1