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Contact:
Amy Edwards
Professional Affairs Officer
Organisation:
College of Occupational Therapists
106 - 114 Borough High Street Southwark London SE1 1LB United Kingdom
Email:
Case study:
16 October 2011
Occupational therapy: intervention for pain management and mobilisation
Key points
- Pain is a common feature in palliative care and a multidisciplinary approach to controlling pain is an important part of maintaining functional independence
- Always be guided by the patient. The strength and determination they display will set the natural boundaries for what can be achieved
- Understanding the feelings and needs of the carers – whose role is 24/7 – is as important as any intervention with the patient.
George* was 75 years old. He lived with Ruth, his wife of over 50 years, and was supported by a large extended family.
George was diagnosed with myeloma and treated with chemotherapy plus radiotherapy for chest wall pain. He had a very relaxed attitude to his illness and the problems it created, dealing with each day as it came.
About a year after diagnosis George reported pain, worse on movement, in the back, right hip, right shoulder and central chest area. Investigations showed an impacted fractured neck of right femur which was inoperable but safe to weight bear and mobilise as pain allowed.
Treatment options for myeloma were limited because of his poor response and tolerance to chemotherapy. They were therefore restricted to managing associated bone pain with analgesics and anaemia with blood transfusions.
At the point of referral for occupational therapy (OT) input George had been rapidly deteriorating in daily activities and function as a result of his pain and fatigue. However, he was determined to ‘get moving again’ and the OT worked with him to achieve this goal.
Receiving invaluable support from the medical team over the use of pre-movement analgesia, the OT was also able to work jointly with the acute care physiotherapist to consider each pain site when establishing a movement strategy.
OT intervention for pain management and mobilisation included:
- Minimising discomfort at rest, using a profiling bed and pillows for positioning. It was particularly important to prevent excessive rotation of the hip joint, which often increased pain
- Devising the best transfer technique. For George this was a standing transfer using a frame. Use of a sliding board or rotating standing frame was precluded because of his shoulder pain
- Specialist seating advice and equipment to enable him to sit out of bed for meals and social activities.
Over six months George had several additional hospital admissions. However, as he recovered from each episode he remained focused on the future and any functional improvements that could be made.
Through continuity of service in both hospital and community, the OT was able to work with George to achieve his ultimate goal of getting to and from the bathroom safely and independently despite his painful, fractured hip.
Unfortunately, the overall pattern was one of decline. Ruth focused on caring for her husband at home, which required ongoing support to cope with continually changing circumstances. She was reluctant to accept any formal help with her caring role, seeing the suggestion that she needed this help as implying she was not providing good care.
The occupational therapist was able to recognise that Ruth might be using the caring role as a coping mechanism and was able to use this experience in later practice when broaching the subject of needing to increase care support. Reactions to these suggestions can vary and the topic needs to be raised with thoughtfulness and sensitivity.
*All names have been changed to protect confidentiality
Author
Beverly Chilson, Macmillan Occupational Therapist
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