This paper discusses the role of the occupational therapist in the treatment of chronic pain. It begins with a critical evaluation of our current theoretical understanding of pain, concentrating on the link between physical and psychological factors. A unit for the treatment of patients with chronic pain is described and assessment and practical treatment approaches are outlined. Emphasis is placed on a functional approach which maximizes the individual's control over his own pain.
Get full access to this article
View all access options for this article.
References
1.
BondMR. New approaches to pain. Psychol Med1980;10: 195–9.
2.
MelzackRWallPD. Pain Mechanisms: A new theory. Science1965; 150: 971–9.
3.
WallPD. The gate control theory of pain mechanisms: A re-examination and a restatement. Brain1978; 101: 1–18.
4.
NathanPW. The gate control theory of pain: A critical review. Brain1976; 99: 123–58.
5.
OlsonGAOlsonRDKastinAJCoyDH. The opioid neuropeptides enkephalin and endorphin and their hypothesized relation to pain. In: SmithWLMerskeyHGrossSC, eds. Pain: Meaning and management. Lancaster: MTP Press, 1980.
6.
KuharMPertCMSnyderS. Regional distribution of opiate receptor binding in monkey and human brain. Nature1973; 245: 447–50.
7.
PomeranzBChiuD. Naloxone blockade of acupuncture analgesia: Endorphin implicated. Life Science1976; 19: 1757–62.
8.
HendlerN. Diagnosis and nonsurgical management of chronic pain. New York: Raven Press, 1981.
9.
BeecherHK. Pain in men wounded in battle. Ann Surg1946; 123: 96–105.
10.
ZborowoskiM. Cultural components in response to pain. J Soc Issues1952; 4: 16–30.
11.
TunksE. Psychiatric management of chronic pain. In: RoyRTunksE, eds. Chronic pain: Psychosocial factors in rehabilitation. Baltimore: Williams and Wilkins, 1982.
12.
MinuchinSRosmanBLBakerL. Psychosomatic families: Anorexia nervosa in context. Cambridge, Massachusetts: Harvard University Press, 1978.
13.
MohamedS. The patient and his family. In: RoyRTunksE, eds. Chronic pain: Psychosocial factors in rehabilitation. Baltimore: Williams and Wilkins, 1982.
14.
ChapmanRC. Pain: The perception of noxious events. In: SternbachRA, ed. The psychology of pain. New York: Raven Press, 1978.
15.
EngelG. Psychogenic pain and the pain prone patient. Am J Med1959; 26: 899–918.
16.
CraigKD. Social modelling influences on pain. In: SternbachRA, ed. The psychology of pain. New York: Raven Press, 1978.
17.
FagerhaughSY. Pain expression and control on a burn care unit. Nurs Outlook1974; 22: 645–50.
18.
FordyceWE. Learning processes in pain. In: SternbachRA, ed. The psychology of pain. New York: Raven Press, 1978.
19.
FordyceWE. Behavioural methods for chronic pain and illness. St Louis: CV Mosby, 1976.
20.
CairnsDPasinoJA. A comparison of verbal reinforcement and feedback in operant treatment of disability due to low back pain. Behav Ther1977; 8: 621–30.
21.
SwerdlowM. The pain clinic. Br J Clin Pract1972; 9: 403–7.
22.
MelzackRDennisSG. Neurophysiological foundations of pain. In: SternbachRA, ed. The psychology of pain. New York: Raven Press, 1978.
23.
GallagherEBWrobelS. The sick role and chronic pain. In: RoyRTunksE, eds. Chronic pain: Psychosocial factors in rehabilitation. Baltimore: Williams and Wilkins, 1982.
24.
MerskeyH. Psychological and psychiatric aspects of pain control. In: SmithWLMerskeyHGrossSC, eds. Pain: Meaning and management. Lancaster: MTP Press, 1980.
25.
KanferFHSaslowG. Behavioural diagnosis. In: FranksCM, ed. Behaviour therapy: Appraisal and status. New York: McGraw-Hill, 1969.
TurkDCMeichenbaumDHBermanWM. Application of biofeedback for the regulation of pain: A critical review. Psychol Bull1979; 86: 1322–38.
28.
CameronR. Behaviour and cognitive therapies. In: RoyRTunksE, eds. Chronic pain: Psychosocial factors in rehabilitation. Baltimore: Williams and Wilkins, 1982.
29.
ThorsteinssonGStonningtonHHStillwellGKElesbackLR. Transcutaneous electrical stimulation: A double-blind trial of its efficacy for pain. Arch Phys Med Rehabil1977; 58: 8–13.
30.
JonesMJayP. An approach to occupational therapy. 3rd ed.London: Butterworths, 1977.
31.
FordyceWE. Environmental factors in the genesis of low back pain. In: BonicaJJLiebeskindJCAlbe-FessardDG, eds. Advances in pain research and therapy. Vol 3. New York: Raven Press, 1979.
32.
BeckAT. Cognitive therapy and the emotional disorders. New York: International Universities Press, 1976.
33.
TurkDCMeichenbaumDGenestM. Pain and behavioural medicine: A cognitive behavioural perspective. New York: Guildford Press, 1983.
34.
HolroydKAAndrasikFWestbrookT. Cognitive control of tension headache. Cognitive Ther Res1977; 1: 121–33.
35.
BaptisteSHermanE. Group therapy: A specific model. In: RoyRTunksE. eds. Chronic pain: Psychosocial factors in rehabilitation. Baltimore: Williams and Wilkins, 1982.
36.
GilesGM. Anorexia nervosa and bulimia: An activity-orientated approach. Am J Occup Ther1985; 39(8): 510–7.
37.
CrueBLKentonBCarregalJAPinskyJJ. The continuing crisis in pain research. In: SmithWLMerskeyHGrossSC, eds. Pain: Meaning and management. Lancaster, MTP Press, 1980.
38.
MelzackR, The puzzle of pain. Harmondsworth: Penguin, 1973.
39.
RoyRTunksE, eds. Chronic pain: Psychosocial factors in rehabilitation. Baltimore: Williams and Wilkins, 1982.
40.
SmithWLMerskeyHGrossSC, eds. Pain: Meaning and management. Lancaster: MTP Press, 1980.
41.
SternbachRA, ed. The psychology of pain. New York: Raven Press, 1978.