5 Occupational Therapy Strategies for Chronic Pain Management in Older Adults 

Chronic pain can affect much more than physical comfort. It may change how an older adult sleeps, moves, dresses, prepares meals, manages the home, participates in the community, and feels about using the body. Over time, pain may contribute to guarding, reduced activity, weakness, fatigue, fear of movement, and loss of confidence. Occupational therapy helps address these problems by connecting pain-management strategies directly to the activities the person needs and wants to complete.

A strategy should not be selected simply because someone reports pain. The occupational therapy practitioner first identifies what is directly limiting function. One person may be avoiding movement because they expect it to cause harm, while another may repeatedly overdo activities and experience prolonged flare-ups. Another may be using an inefficient movement pattern because of weakness, stiffness, altered sensation, or compensation following an injury.

This is where a precision rehabilitation approach becomes important. The therapist identifies the specific function that needs to change, selects a treatment strategy intended to influence that function, and observes whether the change improves meaningful activity. Two people with the same diagnosis and pain rating may therefore receive very different interventions. The goal is not to apply every available pain strategy, but to match the right strategy to the right person and functional problem.

Member Resources: 

• Gait Analysis Handout
• Lower Body Dull Sharp Form
• Upper Body Dull Sharp Form 
• Lower Extremity AROM 
• Upper Extremity AROM

What Is Occupational Therapy’s Role in Chronic Pain?

Occupational therapy is a holistic, client-centered rehabilitation profession focused on meaningful daily activities. In occupational therapy, the word occupation refers to the activities that fill a person’s life, including dressing, cooking, working, caring for others, managing health needs, participating in leisure, and maintaining social roles. The therapist considers not only the painful body part, but also how pain affects habits, routines, environments, relationships, and emotional well-being.

The occupational therapy practitioner’s role in pain management is particularly focused on function. Treatment may address symptom and condition management, medication routines, health-promoting habits, confidence, activity participation, and the ability to complete ADLs and IADLs. AOTA describes individualized, evidence-based, multimodal care as an important part of comprehensive pain management because each person has different self-management needs.  

A treatment may temporarily change comfort, movement, or muscle tension during a therapy session, but occupational therapy asks the next question: does that change help the person dress, prepare food, move through the home, manage health needs, or participate in a meaningful routine? Carryover into daily life is where the value of the intervention is ultimately tested. The original resource behind this article similarly emphasizes connecting clinical treatment to everyday activities and aging-in-place goals.

Chronic Pain Is Not Always a Direct Measure of Tissue Damage

Pain is a real sensory and emotional experience created through the interaction of the body, nervous system, brain, previous experiences, emotions, environment, and perceived threat. Acute pain often serves as a protective warning after an injury or illness. Chronic pain is more complicated because pain can continue even after the original tissues have healed or when the intensity of pain is greater than would be expected from current tissue findings.

For some people, the nervous system becomes increasingly responsive to potentially threatening information. This process is often called central sensitization. Sensations that were previously tolerable may begin to feel painful, pain may spread beyond the original area, or the person may experience an exaggerated response to painful stimulation. This does not mean the pain is imaginary. It means that pain processing has changed and the nervous system may be responding more protectively than necessary.

Understanding this matters in occupational therapy because treatment cannot always focus only on the painful body part. The therapist may also need to address movement avoidance, muscle guarding, stress responses, disrupted routines, reduced sleep, activity intolerance, and the person’s confidence in using the body. Pain education can help the individual understand why graded activity, self-regulation, movement retraining, and occupational participation may be included in the treatment plan.

Member Resource:

• Information about pain for pain education in occupational therapy
• Fibromyalgia resource

The following five strategies may be used individually or in combination, depending on what is interfering with the older adult’s daily function.

1. Kinesiology Taping

Kinesiology tape is a flexible tape that may be applied to the skin to provide sensory input during movement. It may help some individuals become more aware of body position, notice how a joint is moving, or feel more supported during a specific task. The tape itself does not correct every movement problem or treat the underlying cause of chronic pain. Its usefulness depends on the individual, the location and nature of the symptoms, the intended treatment target, and what the person does while wearing it.

For example, an occupational therapy practitioner may apply tape as an external sensory cue to increase awareness of shoulder position during reaching. The person may then practice dressing, grooming, placing dishes in a cabinet, or completing another task that requires use of the arm. In this situation, the direct treatment target may be body awareness, movement confidence, or reduced guarding rather than pain in general. The meaningful outcome is whether the person uses the arm more effectively during daily occupations.

Kinesiology taping may be considered to:

• Provide sensory feedback during movement
• Increase awareness of body or joint position
• Support movement cueing
• Encourage confident use of an extremity
• Temporarily influence comfort for selected individuals

Skin integrity, sensation, allergies, circulation, and the person’s ability to monitor the application should always be considered. Tape should be removed if it causes itching, burning, blistering, marked redness, or increased symptoms. It should also be treated as one ingredient within a larger intervention rather than the complete treatment plan.

2. Heat and Cold as Preparatory Strategies

Heat and cold may be used as short-term preparatory or recovery strategies before or after activity. Depending on the condition and individual response, they may temporarily influence comfort, stiffness, guarding, swelling, or tolerance for movement. They should not automatically become the entire treatment session. Their greatest value is often helping the person participate in active movement, exercise, or a meaningful occupation more comfortably.

Heat may be useful when stiffness or muscular tension is making movement difficult. For example, a warm shower or appropriately monitored heating method may help an older adult prepare for morning dressing, hand use, or a home movement routine. Cold may be considered after an activity that has increased irritation or localized swelling. The occupational therapy practitioner can help determine how the thermal strategy relates to the patient’s symptoms, health status, and functional goal.

Extra caution is required for older adults with:

• Reduced sensation
• Diabetes or peripheral neuropathy
• Poor circulation
• Fragile or damaged skin
• Cognitive impairment
• Open wounds
• Difficulty monitoring time or temperature
• Medical conditions or medications that affect temperature regulation

Older adults can be more vulnerable to temperature-related complications because chronic conditions and medications may affect how the body responds to heat and cold.   Heating devices should not be used while sleeping, and the person should be able to check the skin and remove the heat or cold source independently or with assistance. When safety is uncertain, the strategy should be reviewed with an appropriate healthcare professional.

3. Neuromuscular Re-Education

Neuromuscular re-education focuses on how the nervous system and muscles work together during movement. Many everyday actions become automatic through repeated practice. The body learns how much force to use, when to shift weight, how to maintain posture, and how to coordinate different body parts. Pain, injury, surgery, weakness, altered sensation, fear of falling, and prolonged compensation may disrupt these patterns.

For example, someone may continue walking with a limp after the original injury has improved. Another person may hold the shoulder rigid during dressing because movement has become associated with pain. A third person may use excessive trunk movement when reaching because of weakness or reduced confidence. These strategies may initially feel protective, but they can also increase effort, reduce efficiency, or limit participation.

Occupational therapy practitioners may use demonstration, tactile guidance, visual feedback, verbal cueing, repeated task practice, environmental setup, and graded reduction of assistance. These treatment ingredients provide the person with opportunities to notice errors, explore different movement options, and practice a more efficient or tolerable strategy. The proposed mechanism involves motor learning, sensory feedback, repetition, and improved coordination between the body and the demands of the task.

Helpful Resource: Neuromuscular re-education Non-CEU Course, FREE to members.

Neuromuscular re-education may be incorporated into activities such as:

• Reaching into a cabinet
• Rising from a chair
• Stepping onto a curb
• Carrying laundry
• Dressing or bathing
• Moving around a kitchen
• Getting into or out of a vehicle
• Maintaining posture during household tasks

The goal is not to force every person into one perfect movement pattern. The goal is to help the individual find a safer, more efficient, confident, and sustainable way to complete the task.

4. Muscle Tension Reduction and Self-Regulation

Chronic pain often affects the nervous system as well as the muscles and joints. A person may begin holding their breath, tightening the shoulders, bracing the trunk, avoiding movement, or constantly monitoring the painful area. These protective responses can become automatic and may increase fatigue or make movement feel more difficult. Emotional stress, poor sleep, fear, and uncertainty may further increase the body’s protective response.

Occupational therapy may use slow breathing, guided imagery, progressive muscle relaxation, body scanning, or muscle-tension awareness. These strategies may help the person notice guarding, regulate physiological arousal, and redirect attention when symptoms begin to dominate the activity. The purpose is not to suggest that pain is imaginary or caused only by stress. It is to recognize that pain is influenced by interacting physical, cognitive, emotional, behavioral, and environmental factors.

A therapist may teach an older adult to use slow breathing before rising from a chair, relax the shoulders during grooming, or complete a brief body scan when symptoms begin to increase during meal preparation. The direct target might be the person’s ability to recognize muscle tension or apply a self-regulation strategy during a flare. The functional aim is remaining engaged in the activity with greater control instead of immediately stopping or becoming overwhelmed.

Evidence for specific psychological and mind-body interventions in older adults is still developing, and the effects are not identical across individuals. However, nonpharmacological pain care commonly includes strategies that address coping, behavior, relaxation, and self-management as part of a broader plan.  

5. Activity Grading and a Personalized Home Management Program

A home program for chronic pain should include more than a list of exercises. It should help the person manage activity in a realistic, meaningful, and sustainable way. Many people with chronic pain move through a cycle of doing too much on a good day, experiencing a significant symptom flare, and then becoming inactive for several days. Occupational therapy can help interrupt this pattern through activity analysis, pacing, graded activity, environmental changes, and collaborative planning.

Activity grading means adjusting the demands of an activity so the person can participate successfully while gradually building tolerance or independence. The therapist may change the duration, resistance, position, number of repetitions, environmental setup, number of steps, or amount of assistance. The activity can then be progressed based on the person’s actual response rather than according to an arbitrary schedule. This makes the intervention more precise and reduces the risk of repeatedly overwhelming the person’s current capacity.

A personalized home management program may include:

• Graded movement or exercise
• Activity pacing
• Planned rest or recovery periods
• Position changes
• Joint-protection strategies
• Energy conservation
• Environmental modifications
• Relaxation or breathing practice
• Symptom and activity tracking
• A plan for responding to flare-ups
• Meaningful activity scheduling
• Strategies for returning to a task after interruption

The program should reflect the person’s routines and priorities. An older adult who wants to return to gardening may need a plan for tool placement, body position, task rotation, duration, and recovery. Someone struggling with meal preparation may benefit from a seated workspace, reorganized supplies, shorter work periods, and planned position changes. The home program becomes more effective when the person understands what each strategy is targeting and how it supports an occupation they value.

Occupational engagement is central to this approach because health and lifestyle are closely connected to involvement in meaningful daily activities. Research examining occupational engagement in adults with chronic pain supports the importance of integrating meaningful activity rather than treating pain only as an isolated symptom.  

A Simple Precision Rehabilitation Example

Consider two older adults who both report chronic low back pain rated as seven out of ten. The first person has stopped bending, lifting, and walking because they believe movement will cause further physical damage. The second person completes several hours of housework whenever symptoms are lower, then spends the next two days resting because of a severe flare. Their diagnoses and pain ratings are similar, but the functions maintaining their limitations are different.

The first person may benefit from education, graded exposure to movement, neuromuscular re-education, and confidence-building during meaningful tasks. The direct targets may include movement avoidance, guarding, or reduced confidence. The second person may need activity grading, pacing, task modification, and a more sustainable home routine. Their direct targets may include poor activity regulation, difficulty recognizing early warning signs, or limited use of symptom-management strategies.

Precision rehabilitation means looking beyond the diagnosis and pain score to identify what is actually interfering with function. The therapist then selects treatment ingredients that are reasonably expected to change that problem and monitors whether the change improves occupational performance. Chronic pain is the clinical condition, but it is not specific enough to serve as the only treatment target.

Main Takeaways

Occupational therapy for chronic pain is not defined by one modality, exercise, or technique. The practitioner identifies the physical, cognitive, behavioral, sensory, environmental, or routine-based factor interfering with daily function and selects a strategy that matches that problem. Kinesiology taping, heat and cold, neuromuscular re-education, self-regulation training, and home programming may all be useful, but they target different functions and should be selected for different reasons.

The most meaningful plan connects each strategy to an occupation the person values. A preparatory technique should help the person move into active practice. A relaxation strategy should be usable during real situations. A home management program should fit the person’s routines, abilities, environment, health status, and goals. Chronic pain management becomes more precise when the focus shifts from applying techniques to identifying what needs to change, why a particular strategy may change it, and whether that change helps the person live more fully.

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Helpful References

American Occupational Therapy Association. Pain Management. This clinical topic page provides an overview of occupational therapy’s role in comprehensive and integrative pain management.  

American Occupational Therapy Association. Role of Occupational Therapy in Comprehensive Integrative Pain Management. This resource describes OT’s function-centered contribution to pain self-management, health routines, ADLs, IADLs, and individualized multimodal care.  

American Occupational Therapy Association. Role of Occupational Therapy in Pain Management. This position statement is listed among AOTA’s official documents and supports occupational therapy’s recognized role in pain care.  

Lagueux, É., Dépelteau, A., & Masse, J. (2018). Occupational Therapy's Unique Contribution to Chronic Pain Management: A Scoping Review. Pain research & management, 2018, 5378451. https://doi.org/10.1155/2018/5378451

Leung, D. K. Y., Fong, A. P. C., Wong, F. H. C., Liu, T., Wong, G. H. Y., & Lum, T. Y. S. (2024). Nonpharmacological Interventions for Chronic Pain in Older Adults: A Systematic Review and Meta-Analysis. The Gerontologist, 64(6), gnae010. https://doi.org/10.1093/geront/gnae010  

Nielsen, S. S., Skou, S. T., Larsen, A. E., Bricca, A., Søndergaard, J., & Christensen, J. R. (2022). The Effect of Occupational Engagement on Lifestyle in Adults Living with Chronic Pain: A Systematic Review and Meta-analysis. Occupational therapy international, 2022, 7082159. https://doi.org/10.1155/2022/7082159

National Center for Complementary and Integrative Health. Chronic Pain and Complementary Health Approaches: Usefulness and Safety. This resource reviews the potential usefulness and safety considerations associated with several nonpharmacological chronic pain approaches.  

National Institute on Aging. Pain: You Can Get Help. This patient-friendly resource discusses chronic pain in older adults and the importance of reviewing treatment choices and safety with healthcare professionals.