Occupational therapy is the art and science of daily living. Occupational therapists assist people of all ages to be as independent as possible in the things they need or want to do every day. This may mean developing new skills, remediating/rehabilitating past skills, adapting with the use of alternative techniques or equipment, or in some cases transitioning to new levels of assistance or activity choices. Prevention and wellness are also important aspects of occupational therapy. A satisfying quality of life and sense of empowerment are always components of how occupational therapists define independence in daily function [1, 2].

Occupational therapy may be provided by occupational therapists (OTs) or occupational therapy assistants (OTAs) . Occupational therapy students may also provide direct care under supervision during their fieldwork training.

Occupational therapists function independently and perform all elements of the OT evaluation and treatment. They are responsible for supervision of all care delivered by OT assistants. Occupational therapy assistants deliver services based on the assessment completed by the occupational therapist, under their supervision, and always in collaboration.

Occupational therapy is provided to individuals, groups, and populations in a wide variety of settings including hospitals (inpatient, acute, rehabilitation, and psychiatric), nursing homes, assisted living, group homes, day programs, schools, home-care, hospices, community mental health centers, work programs, industry, and wellness centers as well as private offices, clinics, and research centers [2].

Many individuals receiving occupational therapy services have complaints of pain. For some, this is acute and short-lived, responding quickly to therapy. For others, it is of greater duration often with an exacerbation-reduction quality. In both situations, pain can limit therapeutic outcomes, disrupt daily functioning, and decrease general wellness. Since it permeates one’s life, avoidance of pain can become the primary life goal and area of focus.

Pain is a subjective and highly individualized experience. Individuals develop varying degrees of tolerance based on their unique physiology, functional demands, life experiences, coping abilities, and support networks. The subjectivity of pain is due also to its highly complex, protective nature, which remains relatively poorly understood. Two implications of pain are clear. First, the presence of pain is a protective warning signal to the person that “something is wrong”, although current medical knowledge and technology may not be able to identify a problem source. Because of this, all pain complaints must be respected and validated for their meaning and impact on the individual person. Second, pain has both components and significant effects that are physical, psychosocial, and functional. For best results, each of these factors must be evaluated and addressed.

Assisting people with pain presents both a challenge and an opportunity to occupational therapists. The usual challenge of finding the best , most effective combination of therapeutic techniques often feels more imperative when pain is present. The pervasive effect of pain on an individual’s overall life demands a comprehensive and holistic approach that incorporates both physical and psychosocial interventions. As such, pain complaints and those people with them require special consideration.

General guidelines and areas to consider are offered in the following outline. Philosophically, these considerations are holistic and systems-oriented, incorporating the following theoretical bases: Rehabilitation Model, Model of Human Occupation [3], Biomechanical Model, Bio-psychosocial Theory, Behavioral Medicine techniques, Learning Theory, Osteopathic Medical traditions, Self-Management approaches, and Relational Theory [4].

Acute and chronic pain can be caused by both organic and non-organic forces, which are often not completely understood by the medical community. Pain is experienced differently by each individual and therefore requires an individualized approach to treatment planning and intervention. Whenever possible, a multidisciplinary team approach is recommended to address this complex syndrome.

The purpose of an occupational therapy program for pain is to ameliorate the effects of pain by teaching self-management techniques and by providing direct therapies. This approach is unique. Unlike many pain programs that primarily focus on pain management , with the expectation that pain will be a lifelong concern, this approach also provides for direct treatment for pain reduction. The overall goal of this combined focus is functional independence and an improved quality of life.

Functional outcomes are determinants of successful therapy. General goals include independence or modified independence in activities of daily living (ADLs) , home care, work/school, leisure, socialization , stress management, and self-management. It is expected that pain will be eliminated or reduced to a level that can be self-managed and does not interfere substantially with function.