Meeting the occupational needs of people with chronic pain

This thesis comprises eight papers that aim to explore the relationship between occupation and chronic pain, augment the evidence available to occupational therapists working with people with chronic pain, and to develop occupational therapy services for people with chronic pain in Ireland. The practice of occupational therapists with people with chronic pain appears to reflect the profession wide theory-practice gap. A lack of evidence for occupationbased practice, the use of inappropriate evidence, and the underuse of relevant evidence for occupation-based practice were identified as issues influencing this theory-practice gap. A layered analysis revealed that occupational therapy services for people with chronic pain are influenced by multiple factors, including the biopsychosocial model of health, occupational therapy philosophy and the social construction of people with chronic pain. A participatory action research (PAR) process undertaken with an all-Island group of occupational therapists found that the practice of Irish occupational therapists reflected the identified theory-practice gap and over-reliance on technique based practice. Addressing client’s vocational needs emerged as the greatest challenge faced by participants. The PAR process enabled participants to take multiple actions to address this problem including the development of a handbook to guide vocational rehabilitation. The findings of this study revealed that a participatory process has the potential to translate evidence to practice and enact occupation-based practice. Flow theory is congruent with an occupational perspective of health and an experience sampling methodology study of the flow experiences of people with chronic pain revealed that mean pain scores were lower, however not significantly, when participants were in flow, and that flow is an optimal psychological state for people with chronic pain. Thus, offering support for occupation-based interventions with this population. The occupations of people with chronic pain are influenced by dominant cultural discourses. A social constructionist study of the experience of people with chronic pain identified three discourses influencing the occupations of people with chronic pain; a moral discourse, a discourse of pain as personal tragedy and a biomedical discourse. The thesis concludes with a discussion where methodological considerations and the thesis findings are discussed, and, implications for practice and research are drawn.