Using Sensory Approaches to Treat Chronic Pain

This article explores the Model of Sensory Processing (Dunn, 1997) and its relevance in clinical practice for treating chronic pain.


Why Sensory Processing?

There is emerging research examining the relationship between chronic pain and sensory processing (Meredith et al. 2015; Clark et al. 2018). In my experience as an Occupational Therapist (OT), I have learned that rehabilitation professionals are beginning to explore the use of sensory treatment approaches when working with individuals living with chronic pain. Sensory integration therapy is typically used with individuals with Autism Spectrum Disorder or Sensory Processing Disorder, but has been found to be helpful with other populations as well. 

The Model of Sensory Processing

The Model of Sensory Processing (Dunn, 1997) is a theoretical framework that is used to understand how people process sensory information. In this theory, Dunn proposes there are four patterns of sensory processing, which are categorized based on neurological threshold and behavioral response. Individuals with low sensory thresholds may be quicker to respond to sensory stimuli. Individuals with high sensory neurological thresholds may require more sensory input to respond. 

People may respond to a stimulus either actively or passively. A passive self-regulation approach means the individual allows things to happen around them and then they respond. An active approach involves controlling the amount of sensory input they are receiving in the environment. The four quadrants of this theory place individuals in the following categories: sensation seeking (active response), low registration (passive response), sensation avoiding (active response), and sensory sensitivity (passive response). The Adult/Adolescent Sensory Profile (AASP; Brown and Dunn, 2002) is an assessment tool that can be used to discern one’s responses to sensory experiences. 

The following is a diagram outlining this model:

Sensory Processing Styles Impact Chronic Pain

There is still much that is unknown about sensory processing and chronic pain. In a study conducted by Engel-Yeger and Dunn (2011), they found that individuals who are low registration, sensory avoiding, and sensory sensitivity, were all positively linked with pain catastrophizing. Pain catastrophizing is negative cognitive and emotional responses to actual or anticipated pain (Darnall, 2015). Pain catastrophizing can lead to negative recovery outcomes and it is important to intervene and find ways to address this factor. Using sensory approaches can help individuals develop self-determined ways of regulating and therefore use an internal locus of control to adapt to pain. 

Researchers have explored the connection between certain sensory processing styles and chronic pain. In Meredith et al.’s (2015) study, findings supported the construct that high scores on sensation avoiding or sensory sensitivity may lead to worse pain outcomes in terms of catastrophizing and the use of maladaptive coping patterns. These findings may inform future research about the uses of sensory approaches in OT practice and chronic pain management.

Adapting Sensory Approaches to Treat Chronic Pain

How can sensory approaches be incorporated into chronic pain treatment? Sensory approaches can help those with chronic pain become more self-aware throughout the day. Clinicians can help individuals create a “sensory diet” as a toolbox to help individuals respond to pain. This can also help clients respond more effectively with anxiety and depression symptoms, which are often intertwined with chronic pain. In addition, sensory approaches such as Graded Motor Imagery can be used to help with re-mapping the sensorimotor cortex. 

A sensory diet can be made from a list of activities that may help decrease and/or prevent distress. Pain and distress are inextricably linked. Finding sensory approaches to retrain the brain to respond to stimuli in an adaptive way can be a proactive pain management approach. It is helpful to think of activities in categories based on the specific sensorimotor areas assessed using the AASP. The primary sensory systems are the tactile system, the vestibular system, and the proprioceptive system.

The Sensory Diet

The sensory diet is comprised of the following categories: movement, touch and temperature, auditory input, vision, olfaction, and gustation. Thinking of activities that are calming vs. alerting can ensure that the sensory diet meets the needs of the individual. Identify at least five sensory activities that can be used when experiencing emotional distress. This will promote more adaptive coping and decrease suffering. These strategies are similar to what would be used in learning distress tolerance or grounding approaches in mental health.

Examples of sensory activities could include: eating spicy foods, smelling scented lotions, looking at the sunset, listening to a water fountain, washing your hair, or playing an instrument. Try to think of activities that integrate multiple senses. Sensory diets can comprise activities scheduled at certain times of day, for example when pain is more prominent. Sensory input can also be offered by the environment e.g. being in a coffee-shop with background noises for comfort. Sensory input can be addressed using recreation/leisure as well as through interaction with others (Kranowitz & Aquilla, 2004). Our environments impact how we process pain. Think of a woman giving birth. If her partner is present, supportive, and coping well, she may have less anxiety and pain compared to if her partner fainted in the hospital room.

Final Note

Remember: pain is an unconscious, automatic process that is learned in the body. Our alarm bells may be sounding without the presence of danger, because that is what our body has been trained to do over time when one has chronic pain. A process known as “sensorimotor smudging” leads to the lines that represent different parts of the body in the brain becoming diffuse and blurred rather than localized, which can lead to changes in sensory processing. Log the sensory strategies that you use throughout the day and keep track of which activities are most helpful for you. This promotes the use of daily, regular check-ins and may provide a reminder to use active coping strategies to manage both mood symptoms and pain.

Please note: This article is made available for educational purposes only, not to provide personal medical advice.

References

  • Brown,C. E., & Dunn, W. (2002). Adolescent/Adult Sensory Profile: User’s manual. San Antonio, TX: Therapy Skill Builders.
  • Clark, J. R., Yeowell, G., & Goodwin, P. C. (2018). Trait anxiety and sensory processing profile characteristics in patients with non-specific chronic low back pain and central sensitisation-A pilot observational study. Journal of bodywork and movement therapies, 22(4), 909-916.
  • Darnall B. Targeting a saboteur of surgical outcomes: pain catastrophizing. Pract Pain Manage. 2015;15(4):37-38.
  • Dunn, W. (1997). The impact of sensory processing abilities on the daily lives of young children and their families: A conceptual model. Infants and young children, 9, 23-35.
  • Engel-Yeger, B., & Dunn, W. (2011). The relationship between sensory processing difficulties and anxiety level of healthy adults. British Journal of Occupational Therapy, 74(5), 210-216.
  • Kranowitz, C., & Aquilla, P. (2004). Awakening: A workshop for parents & professionals caring for children with sensory processing disorders. Indianapolis, IN: Sensory Resources.
  • Meredith, P. J., Rappel, G., Strong, J., & Bailey, K. J. (2015). Sensory sensitivity and strategies for coping with pain. American Journal of Occupational Therapy, 69(4), 6904240010p1-6904240010p10.

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