Pain is not just a feeling in one part of the body. When it goes on for weeks or months, it can spread into every corner of life: sleep, mood, work, and family roles. Many people with persistent pain have seen multiple doctors, tried medications and scans, and still feel stuck. In this situation, it is easy to think, “There is nothing more to do.”
Occupational therapy (OT) approaches pain from a different angle. Instead of asking only “How do we reduce the pain?”, OT adds another question: “How can you live your day in a more workable, meaningful way, even while pain is present?” Pain management in OT is not about miracle cures; it is about helping people understand their pain, adjust the way they move and live, and build routines that support function, comfort and participation.
Pain as more than a physical symptom
For a long time, pain was seen mainly as a signal from injured tissues. We now understand that persistent pain is usually more complex. The nervous system, immune system, thoughts, emotions, sleep, past experiences and daily stresses all contribute to how pain is felt and how the body reacts.
Someone with ongoing neck and shoulder pain may also be working long hours at a computer, sleeping poorly, worrying about job security and caring for family. Over time, the nervous system can become more sensitive. Movements that used to feel safe and easy may now feel threatening, and muscles may tense even before a task begins. Avoidance, fear, frustration and loss of confidence are common and understandable reactions.
Occupational therapists do not separate pain from the rest of life. When they talk about “pain management”, they are really talking about life management in the presence of pain: how pain changes what you do, how you feel during the day, and how you see yourself.
What occupational therapy offers in pain management
Occupational therapy is concerned with “occupations” – the activities that fill your day and give it structure and meaning. These include basic self-care, household tasks, work, hobbies, social and family roles, and rest.
In the context of pain, an occupational therapist looks at questions such as:
How does pain affect your daily routine?
Which tasks are you avoiding, and which ones you are forcing yourself through?
What positions or patterns are repeated for hours because of work or caregiving?
Where in the day do you feel most drained, and why?
From there, OT helps you explore changes in how you do things, how long you do them, and what support you have around you. The goal is not only to feel less pain; it is to move towards days that are more manageable, less dominated by pain, and more aligned with your values.
Assessment: understanding your unique pain story
Two people with “the same” diagnosis – such as low back pain or shoulder pain – can have completely different lives. One may be an office worker who sits for long hours; another may be a parent lifting a child with special needs. Their stresses, supports and responsibilities are different, so the way pain shows up is also different.
An occupational therapy assessment for pain usually spends time on your story, not just your scan results. The therapist may ask about:
What a typical weekday looks like from morning to night.
Which activities make the pain worse right away, and which cause a delayed flare-up.
How you sleep, how you rest, and how you recover between busy periods.
What you have already tried – exercises, treatments, gadgets – and what felt helpful or unhelpful.
What you are most afraid of when you think about your pain and future.
Alongside this conversation, the therapist observes how you move, how you sit and stand, how you perform key tasks, and how your body responds. This builds a picture of patterns, not just isolated symptoms. Those patterns become the starting point for a personalised plan.
Activity pacing: moving away from the boom–bust cycle
Many people with persistent pain live in a “boom–bust” cycle. On better days, they try to catch up on everything – cleaning the house, finishing all the work, saying yes to every request. The next day or two are then wiped out by a pain flare, fatigue and frustration. Over time, this pattern can shrink confidence and make planning difficult.
Occupational therapy introduces activity pacing as a practical alternative. Instead of doing as much as possible whenever you feel slightly better, the idea is to do a planned, steady amount, then rest briefly before the pain spikes. Over time, this can reduce extreme highs and lows and allow a more stable level of activity.
Pacing is not about giving up. It is about learning your body’s thresholds and working with them rather than crashing through them. It often involves breaking tasks into smaller parts, spreading demanding activities across the week, and adding short recovery pauses into the day. An OT can help design this pacing plan in a way that respects your cultural, family and work responsibilities.
Adapting tasks and environments
Some tasks are genuinely demanding for a painful body: lifting heavy loads, working overhead, bending repeatedly, pushing or pulling in awkward positions. While strength and conditioning may be part of rehabilitation, there is also a lot that can be done by changing the task or environment.
Adjusting kitchen layout so that frequently used items are stored at a more comfortable height can reduce repeated bending or reaching. Using a trolley instead of carrying heavy boxes can take pressure off the spine and shoulders. Rearranging a work desk, altering chair height or changing how equipment is handled can cut down on strain that quietly accumulates over the day.
These changes may sound simple, but they often make a meaningful difference. Occupational therapists are trained to notice where small modifications can have a large impact on load and fatigue. They work alongside you to trial solutions that fit your real context – not a perfect, idealised life.
Building confidence in movement
Pain often leads to fear of movement. If bending once caused a sharp spasm, it is natural to worry that any bending will “damage” the back further. If reaching up triggered shoulder pain, the arm may be held stiff, and the body relies on compensations that actually keep the area weak and sensitive.
OT-based pain management includes graded movement practice within everyday tasks. Instead of separate exercises that feel disconnected from life, an occupational therapist might help you:
Practise lifting lighter objects with safer body mechanics, then gradually increase load.
Find more comfortable ways to reach for shelves, dress, or do housework.
Explore different positions for working on a laptop or hobby to share load across the body.
The emphasis is on movements that feel meaningful and safe enough, rather than perfect exercises performed in a clinic and then forgotten. This approach helps rebuild trust in the body and gradually reduces the sense that pain means “damage every time”.
Supporting sleep, mood and coping
Persistent pain rarely exists alone. It often travels with poor sleep, low mood, anxiety, irritability, frustration and a sense of loss. While occupational therapists do not replace psychologists or doctors, they do work directly with sleep, routines and coping strategies.
That might include looking at evening habits that make it harder to wind down, adjusting the bedroom environment, or finding positions and supports that are kinder to painful joints at night. It might also involve exploring gentle relaxation techniques, breathing strategies or calming activities that fit your personality, rather than prescribing generic “stress management”.
When pain limits social contact, hobbies or spiritual practices, OT also looks for ways to reconnect you with these sources of support – sometimes in adapted forms, sometimes with new activities that still honour what matters to you. This can soften the emotional burden that pain adds to each day.
Working as part of a wider pain management team
Occupational therapy is usually one part of a broader pain management approach. Medication, medical investigations, physiotherapy, psychology, education about pain science and lifestyle medicine can all have a role. OT helps pull these pieces together into something that makes sense in your daily life.
For example, if a doctor adjusts your medication or a physiotherapist prescribes strengthening exercises, an occupational therapist can help you integrate these changes into your routine, so they do not get lost in an already busy schedule. If a psychologist is working with you on unhelpful thoughts or fears, OT can provide practical “experiments” in daily tasks to gently test new beliefs in action.
This team-based approach respects that pain is not a simple problem with a single solution. It is a complex experience that often needs multiple forms of support.
When to consider occupational therapy for pain management
You might consider seeing an occupational therapist about pain if:
Pain has been present for some time and is clearly affecting daily activities at home, at work or in the community.
You find yourself avoiding tasks you used to do, or paying for them with long recovery periods.
You feel stuck in a cycle of short-term relief but no real change in how you live.
You want help to design a more sustainable day, rather than just another treatment session.
OT does not promise a pain-free life. But it can offer a structured, compassionate way to rebuild daily life around your current body, with room for change if and when pain shifts over time.
This article is for general education and does not replace individual medical advice. For personalised assessment and recommendations, please consult your healthcare provider or rehabilitation team.
