Minimum Requirements for an Occupational Therapist
Working in Pain Management

rationale | knowledge | skills | experience & seniority | training & supervision

The National Occupational Therapy Pain Association (NOTPA) was set up in 1995 for Occupational Therapists with an interest/working in pain management. It is recognised by the College of Occupational Therapy as a special interest group and is currently working towards attaining Specialist Section Status. NOTPA's objectives include the promotion of Occupational Therapy through research, treatment protocols, education and training in pain and its management.

Flor et al (1992), stated that there is evidence for the efficacy of an integrated multidisciplinary team approach. A competent pain management programme requires a range of different professionals and 'Key clinical staff'. These are defined as Pain or Rehabilitation Specialist, Clinical psychologist, Physiotherapist, Occupational Therapist and Nurse (Seers et al 1996).

Occupational Therapy "..helps people live more productive and enjoyable lives. It's a way of helping individuals to do the things they want and become much more independent. In this context 'occupation' means any way in which people spend their time, from personal care (getting dressed, cleaning their teeth, shopping); to productivity (paid or unpaid work, housework or school); to leisure (sports, games, hobbies, social life)." (ADSS/COT 1995) Occupational Therapists have a holistic training, which includes psychology, sociology, anatomy and physiology. Our skills and training overlap with other team members, such as psychologists and physiotherapists, and we have an understanding and respect for the core skills that our colleagues have.

Occupational Therapists understand how the body works in relation to function, are able to apply problem solving techniques and work with patients and their relatives to achieve solutions which are workable and realistic. The Occupational Therapy (OT) skills of evaluation, activity analysis, assessment and facilitation of functional capabilities are very relevant in the field of pain management. Our training equips us to treat a variety of disorders and gives us a wide knowledge base to work from.

References:

ADSS/COT (1995). Realising the potential. COT.

Flor, H., Fydrich, T. & Turk, D.C. (1992). Efficacy of multidisciplinary pain treatment centres: a meta-analytic review. Pain 49: 221-230.

Seers, K., Williams, A., Richardson, P., Collett, B. & Main, C.J. (1996). Desirable criteria for pain management programmes - Report of a working party of the pain society 1995.

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RATIONALE

Pain management is a specialised area for OTs to be working in. Members of NOTPA therefore believe that there should be some guidelines for OTs working in pain management programmes (PMP).

These guidelines are intended for those setting up a pain management programme, for teams wishing to appoint an OT and for OTs wishing to move into the area of pain management. Four areas have been identified for consideration for OTs working in PMP's: knowledge, skills, experience and seniority.

These guidelines should be seen as running in parallel with, and complementing, the International Association for the Study of Pain (IASP) Curricula Guidelines for Occupational and Physical Therapy (IASP, 1994), College of Occupational Therapy (COT) Curricula Guidelines (COT 1998), and Benchmarks for Health Care Professionals (currently being developed).

References

COT (1998). Curriculum Framework for Occupational Therapy - Leading to eligibility for state registration. COT.

IASP ad hoc sub-committee for occupational therapy and physical therapy curriculum (1994). Pain curriculum for students in occupational therapy or physical therapy. IASP Newsletter Nov/Dec 3-8.

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KNOWLEDGE

In order to work in a pain management programme (PMP) it is important that OTs have a certain level of knowledge about pain and its management. In producing these guidelines NOTPA recognises that, as with other professions, pain has traditionally formed a minor part of the OT curriculum in most courses. The education committee has therefore identified a minimum level of knowledge which OT working in pain management would be expected to have acquired before or shortly after employment in a PMP.

Minimum level

All occupational therapists starting work in pain management should have knowledge of:

the difference between acute and chronic pain
the difference between a biopsychosocial model and medical model
principles of assessment (both standardised and non standardised)
the roles and responsibilities of other health care professionals providing input into PMP's (as recommended by the IASP i.e. psychologist, physiotherapist, nurse and pain consultant/psychiatrist)
basic research skills (ability to read research articles and extract relevant information)
the principles of cognitive behavioural therapy
the role of OT in pain management

Advanced Level

neural mechanisms of pain and analgesia (transduction, transmission, perception and modulation)
pain syndromes
activity pacing and goal setting strategies
employment/benefit services, agencies and legislation relating to these areas.

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SKILLS

During their undergraduate training all OTs acquire a range of basic skills. NOTPA has identified the minimum skills that a therapist should be able to provide evidence of. Once employed in a pain management programme it is expected that a more advanced level of skill would be acquired in the areas identified below.

Minimum Skills

client centred working
teamworking
self reflection (ability to identify strengths and training needs)
cultural sensitivity
empathy
communication skills
basic counselling skills
identification of evidence base for practice
clinical reasoning skills
assessment (OT specific)
activity analysis
goal setting, pacing and body mechanics
therapeutic use of activity
problem solving
teaching (group/individual)
groupwork
design of teaching materials
identification of psychosocial barriers to therapy
relaxation training

Advanced Skills

additional recognised training and qualification in specific forms of therapy (e.g. cognitive behavioural therapy, family therapy, motivational interviewing)
clinical reasoning skills (particularly in relation to appropriate/inappropriate use of adaptive equipment and adaptations within a graded programme in pain management)
use of generic assessments
supervisory skills
a flexible approach to teaching and ability to provide explanations of pain and its management to a wide range of audiences
interdisciplinary teamworking
handling conflict
audit and research

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EXPERIENCE & SENIORITY

All OTs will have had experience of working with people who have acute or chronic pain either at undergraduate or postgraduate level. However the opportunities to gain experience of working in a pain management programme have, to date, been limited. NOTPA recognises that many therapists will come to pain management programmes with relatively little experience in this field. It is therefore important that therapists have established a broad range of knowledge, skills and experience prior to applying for a post in pain management and it would usually be expected that OTs would be of a Senior 1 grade.

However, in exceptional circumstances, a more junior practitioner may demonstrate that they have gained an appropriate level of knowledge and skills through experience prior to entry to the profession. Many OTs have trained as mature students, some have first degrees in relevant subjects (e.g. psychology) or have an additional health related qualification (e.g. nursing or counselling). This valuable experience should be recognised and number of years post qualification should not be taken as a rigid criterion. However, more recently qualified therapists should receive supervision from a senior OT.

In many pain management programme's there is often only one occupational therapist. It is important that the therapist is confident in their professional identity, self-directing, and aware of their boundaries/limitations. It is recommended that therapists applying for posts in pain management have the following range of experiences:

at least 3 years post graduation (preferably senior 1 grade)
a broad range of inpatient, outpatient, community, mental health work experience (several or all would be ideal)
groupwork
teamworking (preferably interdisciplinary)
giving presentations to groups
supervision of junior staff
audit and evidence based practice

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TRAINING & SUPERVISION

It is recommended that all OTs working in pain management programs should be members of NOTPA as this offers opportunities for networking within the speciality, discussion of up to date practice and information about specialist study days. Membership is also recommended for therapists working on a regular basis with people with chronic pain (e.g. people with amputations). Membership of the Pain Society is desirable and joining the IASP should be considered.

Training needs

An OT joining a pain management team should have an induction programme. Opportunities to visit other PMP's should be made available where possible.

Continuing Professional Development (CPD) is now expected of all health care groups and OTs in pain management should be looking to develop their knowledge and skills to advanced level once in post. Participation in research, conferences and study days are essential for professional development and acquiring an evidence base for practice. New practitioners may need additional training in CBT, pacing and goal setting, motivational interviewing, presentation skills and IT skills.
They will also need to identify their own personal training needs - some may be met through networking in regional groups.

Where possible therapists should consider gaining a higher degree. Options for postgraduate training and development include:

MSc level programmes
Edinburgh (Queen Margaret University College), Cardiff (University of Wales College of Medicine) and University of Leicester
MSc in Specialist Practice (Pain Management and Rehabilitation)
University of Luton. Proposed commencement, September 2001.
Short courses
Queen Margaret University College (Edinburgh), Royal National Hospital for Rheumatic Diseases at Bath, NOTPA study days
Conferences
Pain Society Annual Scientific Meeting
International Association for the Study of Pain Conference (IASP)
European Federation of IASP Chapters Conference (EFIC)
Pain Management Programme Conference

SUPERVISION

Initially this should be once a week for a formal supervision session, plus ongoing information and supervision as needed. Some issues can be addressed through group/team debrief sessions and planning meetings. OTs working in PMP's may be supervised by another health professional who is experienced in pain management if an experienced OT is not available.

Supervision is an aid to personal and professional development and therapists should identify mechanisms for meeting both these needs. This should be both professional and clinical and therefore in some instances there may be two supervisors, one being a professional head of service and the other an experienced clinician in pain management. In some teams this may be the clinical psychologist.

Various sources can be found in the Resources section of this site.