‘Pain and Occupation: How Pain Science Shaped My Career ‘

Throughout her growing up years, Alyssa Phillips spent time with relatives on both sides of her family who experienced pain and limited mobility. She came to equate pain as “Unable” to fully participate in life’s daily activities.

With an undergraduate degree in Psychology, her desire to understand what motivated people to engage in particular activities led to her interest in health professions, particularly Occupational Therapy. Her early Occupational Therapy training regarding pain relied on the Biomedical Model and its focus on tissue damage. The Gate Control Theory was the science then and “No pain, no gain” was the approach to treatment.

As the newer Bio-Psycho-Social Model was applied to Occupational Therapy practice, a new idea emerged—that the way we feel about/view pain affects our experiences with pain. However, her overall understanding of pain continued to see pain as a body-based experience which sends pain signals to the brain.

Dr. Phillips’ first Occupational Therapy job was at a rehabilitation facility focused on treatment of the upper extremities. Its “Work Hardening” approach taught patients to lift/carry/push/pull heavier and heavier loads using safe movement patterns, preparing them to go back to work. She struggled to understand why her patients still reported pain long after their injuries had healed.

Using her undergraduate Psychology learning, she enjoyed the multidisciplinary approach to pain treatment of another Occupational Therapy job. She was learning to go beyond its “no pain, no gain” focus and look more deeply into her patients’ perceptions and expectations regarding pain and healing and how that affects their daily activities. She started to see pain as both a “brain and body thing.”

Then she went on to work in a clinic serving underinsured patients, many of whom were experiencing chronic pain. Mulling over chronic pain and how her patients’ actual body physiology, emotions, and sense of safety shaped their pain experience, she felt a sense of scientific enlightenment.  She began to see her Occupational Therapy job as “looking at what pain is communicating” to her patients.

In this process, questions she asked herself included: (1) Is it nociceptive pain due to a cut, broken bone, or the like? (2) Do really traumatic experiences lead to central sensitization/amplification of pain signals in her patients’ brains? (3) Is the pain simply a sign that her patient isn’t feeling safe?

She was beginning to see that there are many reasons for pain and the amplification of pain: that pain is a communicator; that pain is shaped by a person’s perceptions; and that pain is not always linked to tissue damage. She also saw that a “no pain, no gain” focus pushed people into a “boom and bust” cycle that was not an effective method to comfortably and safely help her patients carry out their Activities of Daily Living.

When she experienced an on-the-job low back injury—first off work and using workers’ compensation benefits, and then, working with job accommodations—she struggled.   Despite her knowledge about pain, she would catch herself falling into a “boom or bust” activity cycle, stress, poor sleep, and fear of the loss of her Occupational Therapy profession. She knew she had to consciously “go back to the basics.” She reminded herself that her low back had healed and that she needed to “practice what I preach.” Treatment techniques she applied to herself included self-pacing activities, deep breathing, mindfulness, icing, and taking breaks.

In 2022, she and colleagues presented “Occupational Therapy’s Role in Chronic Pain Management” at the American Occupational Therapy Association Annual Conference.  In short, she believes that pain science has shaped her career in many ways. As a university professor, she is teaching Pain Science concepts to her patients and students— including the effects of psychosocial factors on peoples’ pain experiences–adapting meaningful activities; exploration of one’s roles; and identifying meaningful roles and tasks.