This is a blog post courtesy of Evan Zhou, MOT student (MOT 2025), who wrote this as part of a reflection piece (adapted by the OSOT Fieldwork Team).
This post highlights how much knowledge the MOT students often bring to placement, based on their prior experiences, as well as how much they learn during placement, which complements their classroom learning.
During a inclement weather day on my first placement (Level 1), I had the time to listen to a podcast titled “Tools to Reduce & Manage Pain” from the Huberman Lab Podcast and found it enthralling and transcendental. Below are my main takeaways and epiphanies.

Evan’s Pain Psychoeducation Philosophy:
- Providing tools and building emotional resilience are paramount for our clients when managing their pain.
- I am a big believer in cognitive reframing and emotional regulation.
- The main message that I want to teach my clients is that if we can increase one’s emotional well-being and provide ways to regulate the nervous system, perhaps one’s pain can be managed, and decreased.
- And over time, the client can build greater repetitions to build up their pain tolerance.
- My goal is not to cure their pain or fully alleviate it. But rather, to provide them the cognitive scaffolding to be able to contextualize their thought patterns and perceptions of pain in an accepting and non-judgemental way.
- This is the message that I would love my clients to work towards – “Here it is again, I recognize it, I honour it, it hurts like hell, but I know that it won’t be permanent and that it will go away. I know what I can do to manage it, and reduce some of the hurt, and make myself feel a little bit better again.” “It will pass.”
- Pain is a subjective and complicated experience and is pre-programmed into our brains to protect us, to keep us safe from injury or harm.
- However, its not only a physical experience, it also impacts us both at a sensory and emotional level too.
- After hearing Dr. Mackey’s experience, and witnessing this in my own clients I do believe that the emotionality piece gets lost in people with chronic pain syndrome (CPS) during their recovery.
- Based on client reports during sessions, I’ve noticed that clients with CPS often hyperfocus on their physical pain experienced within their bodies. There seems to be this assumption that if one can alleviate their physical pain, all their pain will recede thereby improving their QOL.
- This is 100% valid, and understandable but I do fear that this cognitive belief may potentially limits one’s ability to recover.
- In my opinion, one’s own physical pain may often be a manifestation of one’s emotional pain that they have bottled up and stored not allowing oneself to address it.
- Something that I’ve learned is that when OT’s provide psychoeducation regarding pain, we should explain it through a holistic lens, teaching our clients that pain is a combination of physical, emotional, psychological, and spiritual elements.
- One tool that my preceptors constantly use in their work is Pacing.
- Pacing is defined as breaking down an everyday activity into smaller, more manageable components.
- Its function is to help achieve a desired outcome while reducing the potential of a pain flareup. Pacing can help with finding that “just right fit” for a client in managing the activities that they need to do or want to do, while also being mindful of their fatigue and pain.
- Pacing can help clients balance between over-doing and under-doing, which is pivotal as the challenge with CPS is thatit waxes and wains. When you finally feel good it’s common for folks to try and do everything that on their to do list (things they weren’t able to do when they were in bed all day yesterday) so you do everything that you haven’t been able to do, but then you regret the next day.
- What happens is you go into this rollercoaster of no activity – activity- no activity. Which creates reinforcement of avoidance of activity X. And reinforces the notion of fear “that going to my job, doing my physio exercises, or going to the gym will cause me more pain. And I don’t want more pain so I’m not going to do this.”
- Unintentionally, clients who follow this line of thinking create a negative reinforcement model which disencentizes participating in meaningful activities that could provide physical, emotional, or psychological relief because they are scared that these things will make your pain worse.
- Therefore, folks experience occupational deprivation and reduce engagement in activities, which may negatively compound leading to greater atrophy, mood challenges, and ultimately greater disability. This totally makes sense and was a huge epiphany for me!
- So how do we to tackle this? Pacing – set small goals. If you can comfortably walk a block, add an extra 25m each day. If you are having a great day don’t do 50 blocks. You’re training for a marathon. Not a sprint.
- You are going to have good days and bad days. On your good days don’t overexceed it, or push yourself. Set a time on your watch, have a threshold time/distance and don’t exceed it.
- On the bad days, recognize that you have bad days. Everyone has bad days. Give yourself some grace and self-compassion and let yourself get the rest that your body and mind need. Then, the next day, restart to where you were previously and build from there..
- Pacing is defined as breaking down an everyday activity into smaller, more manageable components.
Interventions for Pain Medicine & Management from Dr. Mackey:
6 Broad Categories: The idea is to not necessarily solve their pain using one modality but to slowly chip away at their pain experience using various interventions and tools.
- Medications
- Nerve blockers, spinal cord stimulators, drug deliver pumps
- Psychological and behavioural therapies
- Physical and occupational therapy approaches to pain (ex. Pacing, diaphragmatic breathing, MSBR, MBCT, AROM)
- Complimentary/alternative medicines (ex. Chiropractor, Acupuncture, Trauma-informed Yoga, TCM, Qi-Gong, Tai Chi, Breathwork)
- Self-empowerment – reading stories, books, blog posts, evidence based podcasts, learning coping skills.
Feel free to share examples of topics you’ve learned about from your students, that have been enhanced while on placement…




