Pain Assessment and Management, 2nd Edition _ _________________________________________________
OCCUPATION-BASED INTERVENTIONS Where interventions that support occupation and educa- tion are substantiated by evidence in the literature, they are best used to prepare a client for participation in occupations and activities that are of value to the client. There is limited evidence in the literature, however, that describes the use of occupation-based interventions for clients with chronic pain. Kallhed and Mårtensson (2018) report that clients who experi- ence chronic pain find new ways to perform activities. These include physical changes and alterations of activities. Balancing activities is a second area that includes planning time use and reprioritizing. A third category identified was using activities for other purposes and includes variation of activity and using activities as a distraction. Each of these categories addresses different approaches to allow for greater control for the client and making meaningful activities more manageable (Kallhed & Mårtensson, 2018). Nielsen et al. (2022) found limited evi- dence available on the use of engagement as an intervention. The authors identified engagement as involvement, choice, positive meaning, and commitment. Where data were limited, the results were able to support engagement only to increase short-term physical activity and long-term sleep quality for those living with chronic pain. Self-Assessment Question 5. Engagement as an intervention has support in the literature for which areas of participation? A) Sleep
Another good analogy for pacing is the “spoon theory” cre- ated by Miserandino (2010) to explain the lived experience of having a chronic disabling illness. The author uses spoons as an arbitrary concrete metaphor for amounts of energy. Her theory contends that individuals have a certain number of “spoons,” or a certain amount of energy, available to them each day, and that performing daily activities (big and small) can take away a single spoon or multiple spoons. When an individual is healthy, they have an unlimited supply of spoons, but someone with chronic pain or fatigue-related symptoms may have 12 spoons one day but only 4 spoons the next. The individual with chronic pain may use a whole spoon just by taking a shower or by rushing in the morning and forgetting to eat. The spoon analogy underscores how with pain or fatigue, each activity is no longer automatic. The exertion of energy comes at a price and must be negotiated and carefully analyzed each day according to the individual’s symptoms. Pacing and balancing activity on a daily basis is important if a person is to avoid further depleting the following day’s supply of spoons. It is natural for individuals to develop habits and routines around the performance of certain activities. For example, a client may have a routine of always cleaning the bathrooms in one day. Just because they have pain does not mean they will automatically realize that this activity could be done differently. Therefore, they may continue to perform this activity in the same manner and consequently experience an increase in pain. VIGNETTE Sherrie is a 50-year-old homemaker with a diagnosis of chronic low back pain. In discussions with her practitioner, Sherrie describes her frustration at no longer being able to clean the house thoroughly because leaning forward while cleaning aggravates her back pain. Sherrie had a routine of cleaning the entire bottom floor of the house every Wednesday and the top floor every Thursday. Now she can get through Wednesday, but her pain flares up and she is incapacitated and in bed most of Thursday. Sherrie and her practitioner discuss and analyze each cleaning activity for its physical demands according to the pacing tool discussed earlier. For chores that involve movements that are too aggravating for Sher- rie’s low back pain, they discuss alternatives (such as changing to a light mop sweeper, using a reacher, and asking for help from Sherrie’s husband for moving heavy items). Sherrie and the practitioner create a schedule that spreads the chores throughout the week. Chores are prioritized according to need. Lighter and heavier chores are scheduled to be mixed together throughout the week to balance the physical demands (e.g., mopping and vacuuming are separated by days because of the similarity in the physical demand of pushing and bending repetitively).
B) ADLs C) IADLs D) Work
ACTIVITIES OF DAILY LIVING A longitudinal study by Keiko et al. (2017) found that chronic musculoskeletal pain is associated with a decline in older adults’ activities of daily living (ADLs). In another study, functional mobility—including bending and kneeling, using stairs, and walking more than 500 m—were all found to be difficult activities for older adults who experience pain (Stamm et al., 2016). In a recent study, more than 50% of the survey participants reported some limitation in ADLs (Duenas et al., 2020). Mirror therapy was identified as a technique that promotes independent participation in ADLs (Castro Alzate et al., 2016). Educating a client in techniques to improve abil- ity to perform basic ADLs can provide an immediate impact (Kallhed & Mårtensson, 2018).
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