Lifestyle Redesign for chronic pain

Dr Susan McNulty came to speak to the Lifestyle Redesign(LRD) class about the LRD programme for chronic pain that she developed. She has since modified it and also runs a separate programme for chronic headache, usually migraine. Dr McNulty's clinical background is in Mental Health, she has worked in the US and in Ireland.

We have been doing a lot of background reading on he complex issue of pain, how it is measured and how it is experienced in different ways by different people. A cause of pain is not always 'diagnosable' i.e. it doesn't always show up on tests, XRays etc. This can contribute to the idea that pain is 'all in your head' when in fact it is much more complex than that.


Chronic pain is very prevalent (estimated over 130 million people in the US). Those who experience it are 'high healthcare seeking', they may be unable to continue with work or other occupations or may stop doing things due to fear of making pain worse. Very few get to see a pain specialist.

Dr McNulty's programme operates within a multi-disciplinary team that specialise in pain. The team includes a pain physician, psychologist, OT, physiotherapist and yoga instructor.

Why OT for pain management?

• Chronic nature of this condition

• Lifestyle factors have great impact on engagement in occupation

• Works to change beliefs, attitudes, habits & routines
• Lifestyle components influence pain levels
• Role deprivation or overload  have an impact

The programme is flexible and can last 6-8 weeks to several months if required. The Lifestyle Redesign process of  didactic content, occupational self analysis, discussion, problem-solving, self-reflection and goal-setting is followed. Dr McNulty stated that she is not sure that OT can reduce pain, but can help to manage it, which in itself can reduce the perception of pain. OT aims to enable the person to create a routine that prevents flare-up and allows a balanced level of activities that allow the individual to manage pain and enhance their quality of life.

The talk was brought to life with case studies:

Elizabeth
 
42 yr old female, single, fast-paced career in entertainment industry with long hours and unpredictable workload
•Perfectionist with cleaning and her appearance
•Dx: trigeminal neuralgia (face pain) and headaches
•OT once per week for several months over 2 years

Strategies included:
Pacing
•Energy conservation
•Assertive Communication
•Increase leisure activities
•Relaxation - yoga
•Analysis of daily routine
•Increase temporal structure
•Time use
•Balance of activities
•Support/Socialization
•Ergonomics for computer work station and other home tasks

Outcomes:
Elizabeth was able to shift her social life to more day time activities with friends
–Reported less alcohol consumption
–Reported healthier eating routines
–Became consistent with a daily walk most days
–Organized her home office and paced her self with admin/financial tasks
–Asked for help more from friends and family


Tom

Experiences constant pain, activity does not make it better or worse.

Strategies included:
Stress Management
• Social Skills
• Communication
• Leisure activities
• Analysis of daily routine
• Sleep and morning
routines
• Time use
• Balance of activities
• Support/Socialization
• Identify community activities

Outcomes:
Toms pain is unchanged but his reaction to it is very different. The approach taken was one of emphasising quality of life and creating a routine that allowed Tom to have a good balance of activities that included productivity, leisure, rest and self care.