1. Occupational Therapy for Chronic Pain
Punita V. Solanki
Consultant Occupational Therapist
Aastha Multi Speciality Hospital
Kandivali West, Mumbai
Mobile: +91-9820621352
Email: therapistindia@gmail.com
29th ISSPCON 2014
Pad. Dr. D. Y. Patil Medical College, Navi Mumbai
7th February 2014, Friday

2. Punita V. Solanki
Occupational Therapist
29th ISSPCON 2014
Navi Mumbai
7th February 2014
Contents:
Link Between Occupation, Client and his/her
Environment: Core Concept of Occupational Therapy
Occupational Therapy
Chronic Pain Conditions where OTs have a Role.
Role of Occupational Therapy in Chronic Pain.
Importance of Integrated Interdisciplinary Team
Approach.
Preventive Approach Towards Pain Management.

3. Punita V. Solanki
Occupational Therapist
29th ISSPCON 2014
Navi Mumbai
7th February 2014
Person with
Chronic Pain
(Physical &
Psychological
aspects of
Pain)
Physical, Social ,
Emotional , Cultural
Environment
Occupation
{ADL, Work &
Productive
Activities, Play
& Leisure}
An Idle Brain
is the Devil’s
Workshop
Humans are Occupational Beings
Occupation:
Diversional
Therapy

4. Punita V. Solanki
Occupational Therapist
29th ISSPCON 2014
Navi Mumbai
7th February 2014
Occupational Therapy in Chronic Pain
Occupational Therapy:
Client centered health profession
Promotes health and well being through
occupation.
The primary goal: Enable clients to participate
in the activities of everyday life.
Occupational Therapists:
Work with clients with pain to enhance their
ability to engage in the occupations by modifying
the occupation or the environment to better
support their occupational engagement.
Reference: http://www.wfot.org

5. Punita V. Solanki
Occupational Therapist
29th ISSPCON 2014
Navi Mumbai
7th February 2014
Chronic Neck & Shoulder Girdle Pain
Chronic Mid & Lower Back Pain
Chronic Arthritic Joint Aches & Pain
Chronic Bone Aches & Pain
Complex Regional Pain Syndrome
Chronic Fatigue Syndrome
Overuse Syndrome
Chronic Pain Conditions

6. Punita V. Solanki
Occupational Therapist
29th ISSPCON 2014
Navi Mumbai
7th February 2014
Occupational Therapy Pain Interventions: Level I:
Adjunctive Methods & Level II: Enabling Activities:
I: Therapeutic
Exercises &
II: Enabling Activities
Innovative Rx: Stress
Loading in CRPS e.g.
Carrying, Scrubbing
with Dystrophile;
Mirror Therapy
Positioning with
Splinting & Functional
Bracing
Sensory Stimulations:
Desensitization in
CRPS
Biomechanical
Approach

7. Punita V. Solanki
Occupational Therapist
29th ISSPCON 2014
Navi Mumbai
7th February 2014
Occupational Therapy Pain Interventions: Level III:
Purposeful Activities & Level IV: Occupational Activities
Activities of Daily
Living Adaptive
Training & Adaptive
Equipments
Work & Productive
Activities Adaptive
Training & Adaptive
Tools & Environment
Play & Leisure
Activities Training e.g.
Arts, Crafts, Games,
Sports.
Educational Activities
e.g. Environmental
Modifications in
Schools
Rehabilitative &
Ergonomic Approach

8. Punita V. Solanki
Occupational Therapist
29th ISSPCON 2014
Navi Mumbai
7th February 2014
Occupational Therapy Pain Interventions:
Joint Protection
Techniques
Work Simplification &
Energy Conservation
Techniques
Time & Stress
Management e.g.
Relaxation Techniques,
CBT
Pain Health Literacy &
Self Management
Programs.
Behavioral Learning Approach
for Client Education

9. Punita V. Solanki
Occupational Therapist
29th ISSPCON 2014
Navi Mumbai
7th February 2014
Importance of Integrated Interdisciplinary
Team Approach
Of all approaches to the treatment of chronic
pain, none has a stronger evidence basis for
efficacy, cost-effectiveness & lack of iatrogenic
complications than interdisciplinary care.
Most critical is the understanding that chronic
pain is a disease of the person, and that a
traditional biomedical approach cannot adequately
address all of the pain-related problems of this
patient population.
Reference: 1. Interdisciplinary Chronic Pain Management: International Perspectives.
Pain Clinical Updates by International Association for the Study of Pain. December 2012.
Vol. XX, Issue 7.
2. Ludeke C Lambeek et. al. Randomised controlled trial of integrated care to reduce
disability from chronic low back pain in working and private life. BMJ 2010;340:c1035.
doi:10.1136/bmj.c1035

10. Punita V. Solanki
Occupational Therapist
29th ISSPCON 2014
Navi Mumbai
7th February 2014
Occupational Therapist’s valuable efforts are geared
towards preventing disability due to acute & sub
acute pains - from becoming chronic disability due
to chronic persistent pain, by 2° & 3° preventive
approaches, online/offline client education and
timely return to ADL, Work and Leisure with Work
Conditioning & Work Hardening Programs.
Preventive Approach Towards Pain
Management
Reference: B. del Pozo-Cruz et al. J Rehabil Med 2012; 44: 581–587.

11. Punita V. Solanki
Occupational Therapist
29th ISSPCON 2014
Navi Mumbai
7th February 2014
Take Home Message
From an Occupational Therapist’s Perspective: Occupation
of a Person includes Activities of Daily Living, Work &
Productive Activities, Play & Leisure.
Occupational Therapists are important Team Members in
an Integrated, Interdisciplinary Team Approach towards
Chronic Pain Management. (~ International Association for
the Study of Pain)
Integrated Interdisciplinary Care has a stronger evidence
basis for efficacy, cost-effectiveness & lack of iatrogenic
complications in the management of Chronic Pain than
Traditional Biomedical approaches.
Secondary & Tertiary Preventive Approach & Timely
return to everyday activities helps prevent acute/sub-acute
pain becoming chronic in nature.
Do not treat the pain alone but treat the person suffering
from pain {Physical, Psychological, Social & Emotional Care}

12. Punita V. Solanki
Occupational Therapist
29th ISSPCON 2014
Navi Mumbai
7th February 2014
References:
 The Canadian Association of Occupational Therapists (CAOT)
Position Statement: Pain Management and Occupational Therapy.
2012.
 Melanie E. Swan: Treating Complex Regional Pain Syndrome: A
Guide For Therapy. Reflex Sympathetic Dystrophy Syndrome
Association. 06/2004. www.rsds.org
 Interdisciplinary Chronic Pain Management: International
Perspectives. Pain Clinical Updates by International Association for
the Study of Pain. December 2012. Vol. XX, Issue 7.
 World Federation of Occupational Therapists (WFOT):
http://www.wfot.org
 Occupational Therapy and Pain Management: Occupational
therapy - Helping people to live life their way. By College of
Occupational Therapists: www.COT.org.uk
 Recommended guidelines for Pain Management Programmes for
adults. A consensus statement prepared on behalf of the British Pain
Society. April 2007

13. Punita V. Solanki
Occupational Therapist
29th ISSPCON 2014
Navi Mumbai
7th February 2014
References:
 Chapter 3: The Intervention Continuum. In “Occupational Therapy
Intervention Resource Manual: A Guide for Occupation-Based
Practice” Eds. Denise Chisholm, Cathy Dolhi, Jodi Schreiber. 2004, 1st
Edition, 240 pages, Published by Delmar Learning, a division of
Thompson Learning Inc. New York, USA. ISBN: 1-4018-1536-7
 Ingrid Söderback - Chapter 1: Genesis of the Handbook: Materials
and Methods. In “International Handbook of Occupational Therapy
Interventions” Eds: Ingrid Söderback .1st Edition, 2nd Printing,
XXVIII, 554 pages. 2009; Springer Link, ISBN: 978-0-387-75423-9
(Print) 978-0-387-75424-6 (Online).
 Ludeke C Lambeek et. al. Randomised controlled trial of
integrated care to reduce disability from chronic low back pain in
working and private life. BMJ 2010;340:c1035.
doi:10.1136/bmj.c1035.
 B. del Pozo-Cruz et al. An occupational , internet-based
intervention to prevent chronicity in sub acute lower back pain : a
randomized controlled trial . J Rehabil Med 2012; 44: 581–587.
 Helen van Huet et. al. Occupational therapists perspectives of
factors influencing chronic pain management. Australian
Occupational Therapy Journal (2013) 60, 56–65.
doi: 10.1111/1440-1630.12011

14. Punita V. Solanki
Occupational Therapist
29th ISSPCON 2014
Navi Mumbai
7th February 2014
Acknowledgement:
I take this opportunity to thank following
colleagues for their valuable review comments on
my presentation:
Dr. Sandeep Sonone - Associate Professor in
Orthopaedics at Seth G. S. Medical College &
K. E. M Hospital
Dr. Murali Poduval - Additional Professor in
Orthopaedics at JIPMER, Pondicherry

15. Punita V. Solanki
Occupational Therapist
Occupational Therapy adds life to years.
The best kind of work can be to get others back to theirs.
Say Good Bye to Pain
29th ISSPCON 2014. Navi Mumbai. 7th February 2014