My approach has developed from a variety of clinical experiences from my time as an occupational therapist. I started in home care, then moved to an interdisciplinary chronic pain clinic and motor vehicle accident (MVA) rehabilitation. Through this work, I developed a pain science-informed approach to chronic pain, based on the concepts of nociceptive, nociplastic, and neuropathic pain.

 

I focus less on posture or physical ability of the muscles, and instead on the nervous system. Chronic pain is often tied to nervous system changes. These changes are often not visible on standard medical tests. Clients typically do not have access to research-level testing that may show these changes. So, clients are frequently told their pain is too high for what their scans show. A mild defect on imaging between L5-S1 becomes crippling. Or a long-ago healed fracture hurts to touch or bear weight. Or - they are disbelieved because their pain scores increase despite reporting improvement. However, I understand that without a stable internal reference, pain becomes very difficult to rate consistently.

 

Common approaches, like changing to an ergonomic chair or strengthening muscles, can only do so much. If the underlying nervous system is dysregulated, the effectiveness of these interventions is reduced.

 

I started using a pain science-informed approach when working at the pain clinic. I completed many hours of education. With experience, I started noticing trends in my clients. Some of our strategies, like the Boom and Bust Cycle education, were only being applied in certain situations. Yet at the same time I was trying to get my clients to maintain a constant ‘active posture’ while sitting. I reassessed and took a new approach that combined pain science with other areas of OT, like seating for people with disabilities. Together, we began breaking the mini Boom-and-Bust cycle within their workdays.

 

In my current practice, I use more than just pacing. Most workers do not have the ability to take frequent full rests during the workday. I want my clients to keep working, while at the same time regulating their nervous systems.

 

Personally, I experienced a significant illness that affected my ability to sustain muscle contractions for nearly 2 years. I continued to work through the worst of my illness and into my recovery. I had to practice my own advice daily, and I had many opportunities to problem-solve firsthand.

 

My illness led me to combine my experience in wheelchair seating with my chronic pain work. I help clients break unhelpful patterns, like muscle tension or fear of movement. I changed how the Boom-and-Bust cycle interventions were applied during their workdays. The result was more control over pain building throughout the day, more energy to do meaningful activities outside of work, and improved mood from reduced pain daily.

 

My approach is to help people with chronic pain develop nervous system regulation. Changing patterns can change a life.