Patients' needs regarding chronic pain rehabilitation and management

The overall aim of this thesis is to explore and describe patients’ needs related to chronic pain rehabilitation and management from the perspectives of health care professionals and patients with chronic pain.

Study I explores indicators of need for referral to pain rehabilitation using a Delphi study with a multidisciplinary expert panel (n=23). The results show a multifaceted view of indicators, including aspects of physical and mental health, coping strategies, and work environment. Intuitive impressions of patients’ overall clinical presentations and patients’ ages are brought forward as indicators.

Study II explores specific needs for occupational therapy using focus group discussions (n=6) with occupational therapists (n=25). Limitations of occupational performance is the theme found. Explicitly, 13 indicators for occupational therapy are found; these include aspects of patients’ behaviors, level of knowledge, level of occupational balance, mental health, and the physical or environmental strains that are present in the patients’ living contexts.

In Study III, outcomes of an intervention, ‘Balance in Everyday Life’, are described and explored in terms of occupational performance and satisfaction using a single-case design (n=5). Results demonstrate that four out of five patients had improved their occupational performance (+0.1-2.3), two of which were of clinical significance. Also, five out of five patients had improved their occupational satisfaction (+0.1-5.3), and two were of clinical significance. Measures changed jointly and independently.

Study IV describes needs related to pain management of participants with chronic pain; they were portrayed in stories of daily life using individual interviews (n=10). Results describe how participants need to protect themselves from themselves and need to balance their eager mind and their painful body’s need to rest. Participants also need to transform their self-image and to discover new behaviors, routines, and perspectives. The need for affirmation through communion and enjoyment of valued occupations is also highlighted as a prerequisite for successful pain management.

Indicators that either pain rehabilitation or occupational therapy is needed involved dysfunctional behaviors of the patient with chronic pain, demographics (e.g., age), as well as tacit knowledge of health care professionals. The occupational needs of participants living with chronic pain could to some extent be met by the intervention received. Engaging in valued occupations and adopting an altered perspective of one’s priorities and occupational performance are highlighted as important for successful pain management.

List of scientific papers

I. Skjutar, Å., Christensson, K. & Müllersdorf, M. (2009). Exploring indicators for pain rehabilitation: A Delphi study using a multidisciplinary expert panel. Musculoskeletal Care. 7(4), 227-242.
https://doi.org/10.1002/msc.154

II. Skjutar, Å., Schult, M-L., Christensson, K. & Müllersdorf, M. (2010). Indicators of need for occupational therapy in patients with chronic pain: Occupational therapists’ focus groups. Occupational Therapy International. 17(2), 93-103.
https://doi.org/10.1002/oti.282

III. Skjutar, Å., Müllersdorf, M. & Schult, M-L. (2010). Improving occupational performance: A single case study of patients with chronic pain. [Submitted]

IV. Skjutar, Å. & Müllersdorf, M. (2010). Adapt, discover, and engage: A qualitative interview study with patients living with chronic pain. [Accepted]
https://doi.org/10.1111/j.1752-9824.2010.01066.x