Environment Contextual Adaptations for Management of Pain

Occupational therapists not only have the skills to effectively analyze activities but also evaluate environments and contexts to support engagement in occupations. Occupational therapists recognize that occupation takes place in a physical and social environment within a larger context of personal, temporal, and cultural expectations (The American Occupational Therapy Association 2009). Analyzing the environment provides opportunities to make simple changes such as placing commonly used items on the countertop to avoid painful reaches, adjusting the height of a computer workstation for upper extremity/neck/back comfort, or encouraging social activity choices such as smoke-free environments that enhance rather than discourage a healthy lifestyle. Contextual adaptations include such recommendations as balancing activity or exercise with rest throughout the day to promote endurance and limit painful participation, limiting face-to-face meeting or travel in lieu of phone or e-mail interaction, or using assertive social communication to avoid painful greetings via handshake. Often, the client's use of cognitive behavioral strategies and assertive communication are paramount to promoting a better quality of life. At other times the environment can be changed to promote a more comfortable and effective routine. For some clients, more specialized environmental adaptation approaches can be found through the process of home evaluations, ergonomic evaluations, and worksite job analyses conducted by occupational therapists. These consultative activities allow individuals with family members and/or employers to find the best work routines, schedules, or practices to allow the client to return to productive activity. In the case of home modification, installation of grab bars within the bathroom facilitates safety and prevents painful jarring of joints or muscles; lever-style door handles prevent increased external force on painful joints or smaller muscles of the wrist and hand. Other personal adaptive devices may be recommended, such as dressing aids, particularly during the acute pain management phase.

The client is educated by occupational therapists to use personal strategies to facilitate his/her own comfort and participation in social, home, and/or work lives. In addition, occupational therapists can be instrumental in adapting the environment and contexts to promote engagement in activities valued by each individual.

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