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As a healthcare profession that views health and wellbeing through a holistic lens, occupational therapy provides support to individuals in addressing both physical and mental health.
It is estimated that between 40% and 60% of individuals who experience chronic pain also experience depression (Surah, Baranidharan, & Morley, 2014), and a survey in Europe revealed estimates that 1 in 5 adults are living with chronic pain, which leads to economic costs as high $294.5 billion per year, due to increased healthcare spending and decreased workforce performance (Robinson, Kennedy, & Harmon, 2011).
From an occupational therapy perspective, the consequences of chronic pain include significantly decreased independence and community participation, as well as significant disruptions in social participation, self-care, and leisure activities (Robinson et al., 2011). Key features of depression include “loss of interest or enjoyment in ordinary things and experiences” (Surah et al., 2014, p.85), which also results in disruptions in social participation, self-care, productivity, and leisure activities.
Taber’s Cyclopedic Medical Dictionary defines chronic pain as including “long-lasting pain, with episodic exacerbations, that may be felt in the back, one or more joints, the pelvis, or other parts of the body” and/or “pain that returns periodically every few weeks or months for many years” and “is often described by sufferers as debilitating, intolerable, or disabling” (Venes, D., 2014, chronic pain section). This definition goes on to describe the high correlation between chronic pain and depression and also describes theories that exist as to whether the depression precedes the pain, or vice versa (Venes, D., 2014).
In exploring the role of occupational therapy in treating chronic pain, Robinson et al., (2011) describe clients’ perceptions that their experience of pain is delegitimized when clinicians interpret the pain experience through a psychological model, and this leads to the utilization of interventions that are incompatible with the client’s experience of the pain and are thus ineffective.
This stigma surrounding chronic pain may be related to the larger stigma that surrounds mental illness in general, and may also lead individuals to avoid treatment or discussions with clinicians about the pain, due to the client’s assumption or previous experience with not being taken seriously or being judged as mentally ill. This might also lead to the client prematurely accepting recommendations for pharmacological treatments, due to the perception that a clinician who recommends pharmacological treatment is also viewing the pain as real and biologically-based.
As a holistic profession, occupational therapy is not concerned with which condition appeared first, but rather in how they are connected and how they both impact an individual’s functional performance. A biological model that describes the underlying mechanisms of the pain-depression association can help to explain this connection. For example, the parts of the brain that are involved in processing emotions are also involved in processing and regulating pain; thus, the overlap in duties of these brain areas may constitute a site for pathological changes that result in both depression and chronic pain (Surah et al., 2014). Furthermore, alterations in levels of neurochemicals, such as serotonin and norepinephrine, are involved in both the experience of pain and the prevalence of depression (Surah et al., 2014). Given the anatomical and physiological evidence for the basis of these theories, it would be ineffective to address a client’s experience of pain through purely a psychological or purely a biological lens, making occupational therapy a necessary component of a multi-disciplinary approach to the management of such conditions, especially when they occur simultaneously.
As established above, the experiences of chronic pain and depression each result in significantly disrupted occupational performance and the co-occurrence of both perpetuates a cycle of increased pain and decreased mood (Surah et al., 2014). “Research has suggested that engaging in occupation has the potential to mediate the pain experience and to alter biological, psychological, and social factors that are known to influence the pain experience” (Robinson et al., 2011, p.107).
Evidence for effective interventions for individuals with chronic pain, include vocational rehabilitation to assist individuals in returning to work, and cognitive-behavioral approaches to address avoidance of activity due to fear of pain (Robinson et al., 2011), and increased engagement in meaningful activity, such as work, is related to increased control over symptoms and decreased relapse in chronic mental health conditions (Argentzell, Hakansson, & Eklund, 2012).
While these interventions have been developed outside the discipline of occupational therapy, the focus on activity engagement and functional performance within these interventions fall in line with the underlying philosophy of occupational therapy. Therefore, to effectively treat co-occurring physical and mental health conditions, occupational therapists must provide evidence-based treatment through a holistic lens that adheres to the profession’s underlying belief that engagement in occupation is essential for health and wellbeing.
Sharon Vincuilla, OTR/L
Occupational Therapy Doctoral Resident
Originally posted on:
Occupational Therapy’s Holistic Perspective on Mental Health
Ken Cohen is a psychology intern at Painted Brain and student at Antioch University.
Argentzell, E., Hakansson, C., & Eklund, M. (2012). Experience of meaning in everyday occupations among unemployed people with severe mental illness. Scandinavian Journal of Occupational Therapy, 19(1): 49-58.
Robinson, K., Kennedy, N., & Harmon, D. (2011). The Issue Is—Is occupational therapy adequately meeting the needs of people with chronic pain? American Journal of Occupational Therapy, 65, 106–113. doi: 10.5014/ajot.2011.09160
Surah, A., Baranidharan, G., & Morley, S. (2014). Chronic pain and depression. Continuing Education in Anaesthesia, Critical Care & Pain, 4(2): 85-89.
Venes, D. (Ed.). (2014). Taber’s Cyclopedic Medical Dictionary. Brookings, OR: F.A. Davis Company.
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