G'day Jean,

Firstly, there are a couple of brilliant texts that may be of interest 
to you.  One is written by, and one is edited by, Jenny Strong, 
Professor of OT at Univ of Queensland (I believe the author is a member 
of the International Association for the Study of Pain).  Both texts 
have a really OT focus.

The first one is:

Strong, J. (1996). Chronic Pain: The Occupational Therapy Perspective. 
Churchill Livingstone.

The second reference is:

Strong, J., Unruh, A., Wright, A., & Baxter, G. (2002) Pain: A textbook 
for therapists. Churchill Livingstone.

This author is also widely published in OT and pain journals.  Another 
OT Maria Mullersdorf is widely published in the area of arthritis and 
pain.  Might be worth checking out.

There is also a website that may be of interest to you. It is the 
National Occupational Therapy Pain Association (British) website 
(http://jimmy.qmuc.ac.uk/usr/notpa/Default.shtml) 

I have cut and pasted part of their website for your interest:

"Occupational Therapists educate, facilitate and collaborate with 
chronic pain patients on the following topics: 

- Monitoring activity levels
- Goal setting
- Activity pacing and planning
- Baseline setting and increasing tolerances
- Reducing reliance on equipment and adaptations
- Posture/Body Mechanics/Ergonomics
- Effective communication skills
- Maintenance of pain management skills
- Work and leisure 

Occupational Therapists use a goal-focused graded approach. Our methods 
include: 

Problem solving; challenging activity avoidance; breaking over-under 
activity cycles; analysing; planning and prioritising activities; 
balancing activity schedules; encouraging time as a guide instead of 
pain to increase activity levels in a graded, systematic way; recording 
achievements (for example, a diary); applying reinforcement techniques; 
and practising activities. "

It might also be a good idea to idea to look at some psychosocial 
factors that may be impacting on her quality of life (eg fear of 
movement/reinjury/pain, self-efficacy, perceived functional capacities -
 pain is more than just a physical phenomon).  (Not sure how funding 
limitations would impact on this??) Have you been able to investigate 
her participation in occupation.  Engaging in purposeful, meaningful 
activity can have the effect of distracting her from the pain which may 
act to break the chronic pain cycle.  Just a thought.

Regarding actual hands-on treatment, have you consulted with a PT about 
this.  They tend to have alot of know how and know why in this area.

Hope this has helped.

Cheers

Michael


----- Original Message -----
From: [EMAIL PROTECTED]
Date: Friday, January 17, 2003 12:15 pm
Subject: OT Pain Management

> Hi:
> 
> Does anyone have techniques for pain management? I have a woman 
> with severe 
> arthritic pain in R shoulder. The doctors say it is the worst 
> arthritis they 
> have ever seen.
> 
> I give her massage (though I don't think massage is a reimbursable 
> intervention, but it temporarily lessens the pain). I also am 
> working on 
> increasing her trunk muscles for better postural control to help 
> take 
> pressure off of overworked extensor muscles in the back.  She 
> limits her 
> activity level since movement exacerbates the pain (10/10), so she 
> is getting 
> weaker and her quality of life is very poor.
> 
> Any help you can offer is greatly appreciated! Oh, by the way, I 
> work in home 
> health. Also, does anyone use trigger point therapy?
> 
> Jean
> 

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