Occupational therapist's perspectives of factors influencing chronic pain management

Aim: This article explores factors that contribute to clients’ chronic pain management from an occupational therapy perspective. Method: Nine occupational therapists from Australia and New Zealand who worked in this practice area were interviewed. Qualitative method of narrative inquiry was used to analyse the therapists’ practice narratives to determine their view of how clients manage their chronic pain. Results/Conclusions: Among many themes, significant agentic (positive management) themes and victimic (negative themes related to non-management) emerged. Agentic themes were related to conceptual categories of being: the importance of maintaining valued roles and having good social support; to knowing: accepting the long-term nature of pain and being ready to change thinking about pain, and to doing. These categories included strategies such as setting realistic goals, pacing activity and using relaxation. Victimic themes were also related to being: losing valued roles, having depression and receiving compensation and to knowing: being fearful, looking for a cure or not knowing what to expect. Victimic doing themes related to: being unable to set goals and being unable to use strategies. These themes and categories form the basis of proposed agentic and victimic conceptual models of factors for occupational therapists to address in pain management programs. As acceptance and readiness for change were consistently mentioned in all narratives, the place of contextual cognitive-behavioural approaches to pain management is also raised as a viable alternative to standard cognitive-behavioural therapy (CBT), currently used in most chronic pain practice.