Chronic pain is a major public health issue impacting around 30.3% of the global population. The experience of pain has a detrimental effect on a person’s function, quality of life, and overall well-being. Studies have shown that up to one third of individuals suffering from chronic pain experience difficulty maintaining their independence and participation in meaningful activities, or activities of daily living. Involvement in meaningful activities helps maintain an individual’s health and well-being and is a powerful therapy in itself. Meaningful activities, or occupations, include self-care, leisure activities, upholding established roles in the family and community, as well as enjoying purposeful activities, while furthermore, creating a sense of identity. For this reason, pain management interventions can significantly enhance an individual’s emotional, physical, psychological, and spiritual well-being.
What are the basic types of pain?
There are many sources of pain. One way of dividing these sources of pain is to divide them into two groups, nociceptive pain and neuropathic pain. How pain is treated depends in large part upon what type of pain it is.
Nociceptive pain is the most common type of pain people experience, and is the pain caused from physical damage to the body. Some examples are a pain from a mechanical injury, dental procedure or arthritis.
Neuropathic pain is a pain condition that’s usually chronic. It’s usually caused by chronic, progressive nerve disease, and it can also occur as the result of injury or infection. With neuropathic pain, the pain isn’t typically triggered by an event or injury. Instead, the body just sends pain signals to your brain unprompted.
People with this pain condition may experience shooting, burning pain. The pain may be constant, or may occur intermittently. A feeling of numbness or a loss of sensation is common, too. Neuropathic pain tends to get worse over time.
Informing clients about their pain, prognosis and clarifying treatment expectations and the self-management approach, prepares them for active participation in the rehabilitation process.
Functional goal setting
Clients are involved in identifying and setting goals for their own therapy. This process supports client motivation and participation while improving therapy outcomes.
Home exercise program
Self-management includes actively maintaining a healthy lifestyle, including home exercise programs. These programs are specifically tailored to meet the needs of individual clients and include physical movement, daily relaxation or meditation practice, proactive use of pain control modalities, etc.
Screening for additional referrals
Chronic pain can be accompanied by psychological, cognitive, emotional, and/or physical difficulties. When appropriate, therapists may refer clients for additional services to facilitate best practice and optimal therapy outcomes.
- Proactive Pain Control: Clients are taught to independently and proactively use pain control modalities, such as heat or cold. When used safely and proactively (vs. reactively), increases in baseline pain levels can be avoided throughout the day, enabling participation in daily activities.
- Safe Body Mechanics and Ergonomics: Clients often become fearful of pain with movement and subsequently avoid activities. Instruction in safe body mechanics, with opportunities to practice and receive feedback, promotes feelings of self-efficacy. Clients learn to safely perform basic activities of daily living, work, leisure, social, and community activities using techniques that reduce or prevent strain on body structures. Ergonomic assessments identify environmental factors that may be contributing to pain problems and that can be modified to improve function.
- Neuromuscular Re-education: Over time, persistent pain leads to abnormal movement patterns and postural deviations. We retrain clients to perform tasks with the appropriate muscle groups using adjunctive modalities, such as electromyographic biofeedback, to prepare them to participate in valued activities.
- Muscle Tension Reduction Training: Pain is a stressor on the body and mind. Learning to relax muscles and calm the mind allows the client to feel in control of his or her body while reducing pain levels.
- Proactive Problem Solving: Previously avoided activities may be accomplished when clients are taught to be proactive problem solvers. This process involves anticipating potential problems and planning for challenges ahead of time.
- Pacing Activities: Many clients with chronic pain have problems in self-regulating their activity levels. This often leads to flare ups whereby they experience higher than baseline levels of pain, for extended periods. We teach clients to pace their activities, such as taking breaks, changing the way an activity is done, or asking for help, as effective coping strategies.
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