Date Presented 03/28/20
Cognitive difficulties are commonly reported by individuals with chronic pain. An interdisciplinary pain rehabilitation program (IPRP) that includes OT can be an effective strategy for improving cognitive performance. This case series examines change in cognitive performance for two individuals following a three-week IPRP. OTs provide group-based education with an emphasis on function. This approach successfully enhances cognitive performance and can potentially be used as an OT treatment in other settings.
Primary Author and Speaker: Elke Lacayo
Additional Authors and Speakers: Tanya Crowder
Contributing Authors: Rachel Perez, Christopher Sletten
PURPOSE: Interdisciplinary pain rehabilitation programs (IPRPs) have been shown to significantly improve function in individuals with chronic pain. Cognitive performance difficulties are often reported in this population, and can further impact function and quality of life. Occupational Therapists provide education and resources to improve functioning in the areas of self-care, productivity and leisure. There is limited research addressing the impact of an IPRP on cognition.
DESIGN: This retrospective case series follows 2 females with chronic pain syndrome who participated in the 3 week Mayo Clinic IPRP. Participants were selected based on a below normal cognitive assessment, an oral morphine equivalent (OME) of 0 mg and subjective report of cognitive decline since onset of chronic symptoms. A 0 mg OME was selected as it indicates no confounding interference from opioid medications. Patient “A”, a 32 year old with some college education, presented with Fibromyalgia, diffuse pain, nausea, brain fog and fatigue. Patient “B”, a 46 year old with an advanced degree, presented with chronic neck and back pain, postural orthostatic tachycardia syndrome and subjective complaints of decreased cognition. Both individuals stated cognition as an occupational performance goal. The Mayo Clinic IPRP includes daily OT, PT and CBT groups. OTs provided group based instruction on moderation, modification and time management in the areas of self care, productivity and leisure. OT groups consisted of 13 topics including 1 session on cognitive strategies. Individuals received 3 biofeedback sessions focused on diaphragmatic breathing and muscle relaxation techniques. Individual OT sessions further addressed time management and return to occupational roles.
METHOD: Cognition was assessed using the Montreal Cognitive Assessment (MoCA) at intake and dismissal. Additional outcome measures included The American Chronic Pain Association Quality of Life Scale (QOLS) and the Canadian Occupational Performance Measure (COPM). The MoCA is a quick screening tool for detecting mild cognitive dysfunction. Versions 8.1 and 8.2 were used to minimize the practice effect. A score of 26 or greater is considered normal. The QOLS is a valid tool for measuring quality of life and ability to function on a scale from 0 to 10 with 10 being the highest. The COPM is a client-centered outcome measure designed to detect change in a client’s occupational performance and satisfaction over time. Client’s identify problem areas and rate performance and satisfaction on a scale from 1 to 10 with 10 being the highest.
RESULTS: Both participants exhibited improvement across all outcome measures. Patient “A” showed an 8 point increase in MoCA score, from 21 to 29. QOLS improved by 4 points from 3 to 7. COPM performance improved 7 points from 3 to 10 and satisfaction improved 9 points from 1 to 10. Cognition was identified as a specific problem area and improved by 6 points from 3 to 9. Patient “B” showed an 8 point increase in MoCA score, from 19 to 27. QOLS improved by 1 point from 6 to 7. COPM performance improved by 3 points from 5 to 8 and satisfaction improved 7 points from 2 to 9. Cognition was also identified as a specific problem area and improved by 3 points from 6 to 9.
CONCLUSION: OTs are integral to the assessment and treatment of cognitive performance deficits due to the potential negative impact on safety, function and quality of life. Cognitive difficulties are often reported by patients with chronic pain. An interdisciplinary treatment approach that emphasizes active coping strategies including moderation, modification and time management can not only improve function and quality of life in individuals with chronic pain, but consequently improve cognitive performance.
References
Ferreira K. S., Oliver, G.Z., Thomaz, D.C., Teixeira, C.T., Foss, M.P. (2016). Cognitive deficits in chronic pain patients, in a brief screening test, are independent of comorbidities and medication use. Arq Neuropsiquiatr, vol. 74 (5), 361-366. doi: 10.1590/0004-282x20160071
Kurklinsky, S., Perez, R.B., Lacayo, E.R., Sletten, C.D. (2016). The efficacy of interdisciplinary rehabilitation for improving function in people with chronic pain. Pain Research and Treatment, 2016, 1-6. doi: http://dx.doi.org/10.1155/2016/7217684
Nasreddine, Z.S., Phillips, N.A., Bedirian, V., Charbonneau, S., Whitehead, V., Collin, I., Cummings, J.L., Chertkow, H. (2005). The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. Journal of the American Geriatrics Society, 53 (4), 695-699. doi: 10.1111/j.1532-5415.2005.53221.x
