Brain injury pain management and occupational therapy
There is not always a quick fix for pain brought about by brain injury or neurological conditions, but there are ways that neuro occupational therapy can help as part of a broader pain management plan.
As Pain Awareness Month is marked globally today (September 27) by wearing the colour blue, we shed light on some of the pain management techniques our expert OTs are using to ease the pain ‘blues’ for clients.
What is pain?
Regardless of how the scientists define it – short-term or acute, long-term or chronic - pain hurts. Persistent pain hurts more because of its impact on every area of life; from activity levels and sleep, to work and personal relationships.
For survivors of traumatic brain injury (TBI), studies have shown that more than half will suffer chronic, neuropathic pain - that is, pain resulting from damaged or diseased nerves – as a result of the injury.
In fact, chronic pain – specifically post-traumatic headache - is one of the most common complications of TBI, even among those with apparently minor injuries. (1)
Frustratingly, however, even though the cause of the pain may have been treated, the pain itself can persist due to nerve endings in the spinal cord and brain becoming over-sensitised by the constant pain input.
And to further complicated matters, pain is, of course, subjective; that is, people experience and describe pain differently which makes it hard to diagnose.
There is not always a quick fix for pain brought about by brain injury or neurological conditions, but there are ways that neuro occupational therapy can help as part of a broader pain management plan. 
Occupational therapy is unique within the field of health and social care in that it is the only profession that works across both physical disability and mental health.
As a result, Neuro OTs take a whole-person approach in order to understand how pain is impacting on a client’s mood, quality of life, physical functioning and occupational activities, as well as any therapy intervention or outcome.
This means they are well-placed when it comes to helping clients draw up a pain management plan, which could include strategies such as:
Medications
In line with the Royal College of Occupational Therapists’ guidelines, our neuro occupational therapists take a ‘person centred approach’ to medication which aims to:
- Improve the clients’ health and wellbeing outcomes.
- Help them take their medicines correctly.
- Avoid clients taking unnecessary medicines.
- Reduce wastage of medicines.
- Improve medicine safety.
Neuro OTs can administer certain types of drugs under a ‘patient group direction’, which is a written legal document allowing named, authorised registered health professionals to supply and/or administer specified medicines.
They often work with clients whose pain management or condition requires medication and so they are equipped with a working knowledge of the options, which include:
- Over the counter painkillers such as paracetamol and ibuprofen: these are easily available but may not be the best solution for long-term persistent pain.
- Opiates, ranging from ‘mild’ codeine, to ‘strong’ morphine: these may be prescribed as more powerful alternatives, but they can have side-effects.
- Other medications traditionally used to treat different disorders: these have also been found to help with pain, including the anti-depressant, Amitriptyline and anti-epileptic, Pregabalin.
- Topical medications, such as creams and ointments: these may be helpful in reducing localised pain, although research is on-going.
Pain diary
It is widely known that pain, anxiety and depression are linked, and that we are less able to cope with pain when we are tired.
A pain diary, therefore, which records levels and durations of pain over hours, days and weeks, can help to identify times and events that may be affecting pain levels, including:
- Work patterns
- Sleep quantity / quality
- Activity / exercise levels
- Stress factors
- Diet
- Environmental impact
- Social effects; for example, meeting new people or places
- Psychological therapies
Psychological therapies aim to improve our physical, emotional, social and occupational responses to pain rather than eradicating the pain itself.
Research is on-going into many of these techniques, with varying success, but some of the more promising methods include:
- Cognitive behavioural therapy (CBT), which focuses on our thoughts and behaviour.
- Mindfulness-based therapy, which combines CBT with meditative practices to moderate the brain’s response to incoming stimuli, such as pain.
- Hyponosis, which redirects attention away from the pain.
- Virtual Reality; a new technique being tested that aims to distract participants from their pain by immersing them in a VR world.
Physical therapies
There are a number of physical therapies, not least physiotherapy, which aim to mobilise and strengthen muscles and joints in a bid to reduce pain in those areas. They include:
- physiotherapy;
- hydrotherapy;
- manipulations;
- massage;
- electrical stimulation (TENS machine)
- acupuncture;
- hot and cold treatment; and
- ultrasound.
Pain clinic
People with chronic pain may benefit from attending a pain clinic which offers a ‘one-stop shop’ for physical, psychological and practical help from a range of healthcare disciplines, including occupational therapy.
How does a Neuro OT draw up a pain management plan?
A pain management plan (PMP) is usually a group treatment involving other health care professionals who also support the client. This is known as a multi-disciplinary team (MDT).
Due to their whole-person approach, however, Neuro OTs will often be tasked to co-ordinate the PMP. Their focus will be on helping clients to:
- Understand the causes and reasons for pain.
- Develop skills that help them cope with and manage the pain.
- Avoid overdoing activity that increases pain.
- Develop strategies to manage everyday activities, such as hobbies and work.
- Explore gentle types of exercise.
- Consider therapies that may relax both mind and body.
- Address the psychological effects of persistent pain.
- Improve confidence in coping with persistent pain.
Pain Awareness Month
Pain Awareness Month is organised by the International Association for the Study of Pain which declared 2019 as ‘Global Year Against Pain in the Most Vulnerable’.
The campaign focuses on alleviating pain in vulnerable people, such as those with cognitive impairments and psychiatric disorders, the elderly and children, and is backed by the World Health Organisation.
References:
Watanabe T.K., Bell K.R., Walker W.C., Schomer K. Systematic Review of Interventions for Post-Traumatic Headache. Physical Medicine and Rehabilitation. 2012.
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