Pain and Occupational Therapy: 4 Ways to Help Avoid Catastrophization

Pain and Occupational Therapy: 4 Ways to Help Avoid Catastrophization

Pain is such a limiting factor in our occupational therapy practice and must be addressed to help our patients achieve their goals and improve their quality of life. We will be looking at how the patient’s outlook and experience around pain and 4 ways we can help them overcome some of these challenges.


A psychological experience regarding pain that includes being unable to focus on anything else but the pain, rumination, magnification of pain and feeling helpless about pain. Pain catastrophizing is one of the most powerful predictors of pain suffering and the pain experience (from Less Pain, Fewer Pills: Avoid the Dangers of Prescription Opioids and Gain Control Over Chronic Pain by Beth Darnall PhD)

Do you know the most important factor in the pain experience?

It is not:

  • Injury
  • Infection
  • Disability
  • Age
  • Comorbitities


Noxious Stimuli + Fear = More Pain

While this does not mean pain is “all in your head,” it does mean we can take steps as occupational therapy practitioners to help patient’s calm their nervous systems and thereby deal with pain better.


4 ways OTs can help patients with pain focus on what's important and avoid catastrophizing | #OT #occupationaltherapy #OTtreatmentideas #SNFOT

4 Ways to Help Your Patients in Pain Avoid Catastrophization


1. Choose your facial expressions wisely

Humans have mirror neurons. We have the tendency to do what others around us are doing.

They smile, we smile. They laugh, we laugh. They tense, we tense. They cry, we cry.

So while the phrase “fake it till you make it” might benefit many in their chosen profession, it is crucial when dealing with patients experiencing pain.

  • You bring calm. Even if you are not calm. Repeat after me: YOU BRING CALM!
  • You bring confidence and kindness. You bring encouragement and steadiness.
  • Do not show pity. You recognize their struggle, but YOU BRING CALM!

Join the OT Flourish membership for help when working with older adults

2. Choose your words carefully in reference to pain

Every time you reference pain, you prime your client’s brain to think about pain.

You increase attention to the pain, the stress, the FEAR.

Stop talking about it.

When you discuss the human body reference its amazing capability to adapt, to heal, to adjust, to learn… Don’t be patronizing, but take every opportunity to reword the pain. “Yes this is hard, but healing is happening!” Or, “We are finding a new way to do things that work for your body! Isn’t that exciting?”

Reconsider pain as the fifth vital sign. It unnecessary to ask about pain. If pain is a limiting factor, your clinical reasoning and your patient’s own words will let you know.

Just by asking you are potentially intensifying the pain.

4 ways OTs can help patients with pain focus on what's important and avoid catastrophizing | #OT #occupationaltherapy #OTtreatmentideas #SNFOT


3. Suggest new rumination

We all have an inner dialogue. Help create a better script for those in pain.

If anyone you are working with is displaying catastrophization.

  • Try:
    • “Let’s rewrite that script ok?”
    • “I see you are worried. You’ve never broken a bone in your life, BUT I also see a woman who raised four boys, who has grit. From now on, every time I think you’ve forgotten, I will remind you that you are a BEAST who can do HARD things.”

Have them say it. They won’t want to, but have them say it.

Positive words have power. Don’t be afraid to be cheesy!

4. PLAY!!!

How many people with chronic pain, have lost vital aspects of their personalities? Frivolity, joking, teasing, even fart jokes… this may be the real medicine they need.

Resources: Pain Reframed Podcast

About our Guest Blogger:

Janie Oyakawa OTR, is a wife and mother of six smart kiddos. She worked in OT for a while after graduating from VCU. The SNF environment and home health, without the online support that exists now, caused severe burnout, so she became a stay at home mom with her growing family. She returned to OT in 2016.

She prides herself as somewhat of a hippy skeptic. Lover of science and research as well as meditation and yoga. She may not believe in chakras, but you just might find her in random places of the inpatient rehab she works at teaching deep breathing and mindfulness. Her special interests are pain management and helping people reduce opioid use.

Looking for more information about pain?

Check out Chronic Pain Management, Explaining Pain Cycles and Assessment of Chronic Pain in the OT Flourish Membership.

Join the OT flourish membership to help OTPs bridge classroom to clinic when working with older adults

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