Purposeful and Occupation-Based Interventions for Chronic Musculoskeletal Pain: A Systematic Review

SIGNIFICANCE: Chronic musculoskeletal pain is a significant issue, and there is a lack of clinically useful research-based, occupational therapy resources that address purposeful and occupation-based interventions for clients with chronic pain. The purpose of this systematic review was to identify and critique existing research regarding purposeful and occupation-based interventions to develop a cohesive understanding of the most effective interventions for clients with chronic musculoskeletal pain.

INNOVATION: Preparatory interventions are common though not always effective for chronic pain management. Few comprehensive resources provide clinically useful purposeful and occupation-based interventions. To our knowledge, this is the only recent systematic review of purposeful and occupation-based interventions that provides valuable information for practice and research in the area of chronic pain.

APPROACH: What is the current state of evidence for purposeful and occupation-based interventions for people with chronic, musculoskeletal pain? Which purposeful and occupation-based interventions are most effective for persons with chronic musculoskeletal pain? Chronic musculoskeletal pain is the most common disability in the U.S. health care system (National Institutes of Health, 2010), affects 100 million Americans, and results in decreased participation in occupations as well as increased morbidity and health care costs (American Academy of Pain Medicine, 2012; Committee on Advancing Pain Research, Care, and Education & Institute of Medicine, 2011). There is a dearth of cohesive, research-based, clinically useful intervention resources for use with clients with chronic musculoskeletal pain.

METHOD: In this systematic review, we conducted a PubMed literature search using key Medical Subject Headings (MeSH) terms. The search resulted in 801 research articles that were screened on the basis of predetermined inclusion and exclusion criteria. Twenty-two articles met the criteria and were critiqued and organized with consideration for level of evidence and intervention type.

RESULTS AND CONCLUSION: This systematic review yielded evidence that points to a set of literature that varies in topic and rigor. Although it does represent the “best” evidence available, the review shows a severe lack of high-quality, replicated, and clinically useful occupation-based treatment interventions. Despite the absence of consistency in research topics, the review did reveal that programs that required a specified amount of time to be completed by subjects (and included an educational component regarding pain self-management) and consistent and frequent meetings with a designated health care professional provided better outcomes for clients with chronic musculoskeletal pain.

Limitations include varying definitions of chronic pain and use of retrospective data in existing research. There is a need for research and practice focusing on the use of purposeful and occupation-based interventions addressing chronic, musculoskeletal pain.

References

American Academy of Pain Medicine. (2012). AAPM facts and figures on pain. Retrieved from http://www.painmed.org/patientcenter/facts_on_pain.aspx

Committee on Advancing Pain Research, Care, and Education & Institute of Medicine. (2011). Relieving pain in America: A blueprint for transforming prevention, care, education, and research. Washington, DC: National Academies Press.

National Institutes of Health. (2010). Fact sheet: Pain management. Retrieved from http://report.nih.gov/nihfactsheets/Pdfs/PainManagement(NINR).pdf