Chronic Pain

Overview

Chronic pain can be one of the most exhaustive and overwhelming side effects of injury, illness, or aging. It can be a persistent and pervasive pain that can vary in strength and impact. For some people, the pain can be so severe that they spend most of the time in bed and are unable to leave their house. For others, the pain may not be as intense, however the effect can still be severe and debilitating. Some people are unable to work or undertake 'normal' day to day activities. Many people with chronic pain can continue doing some activities with the aid of pain medication or other forms of pain management.

Chronic pain can include:

Headache;
Migraine;
Back pain;
Arthritis pain;
Neurogenic pain;
Psychogenic pain.

Effects of the condition

A person with chronic pain may experience the following:

Loss of concentration;
Loss of appetite;
Irritability;
Difficulty sitting for long periods;
Vision disturbances - blurring sensitivity to light, eye pain;
Psychological problems, depression, irritability, anxiety, panic attacks, personality changes, mood swings, self image;
Sleeplessness and insomnia;
Intense pain spasms;
The need to move around and stretch;
Numbness, tingling or burning sensations in the extremities;
Severe pain;
Sleepiness (side effect of medication).

Many of the 'symptoms' that people with chronic pain experience are a result of the medication. People will often put up with the pain for a period of time so that they can concentrate more effectively. People with chronic pain are often faced with the difficult decision of experiencing extreme pain, or being so affected by the side effects of the pain killers, that they are unable to effectively function.

The above effects can lead to:

Difficulty keeping to deadlines;
Lateness for appointments or inability to keep appointments;
Difficulty concentrating or participating in class discussions;
Inability to maintain a fulltime work or study workload;

Appropriate Adjustments in the Tertiary Education Environment

As each student will have different needs, it is important to negotiate these needs on an individual basis. The following is a list of adjustments that may assist the student:

General

Make book and reading lists available prior to the commencement of lectures (preferably at least two weeks prior to the commencement of the semester);
Provide students with chapter outlines or study guides. These should also be available at least two weeks prior to the commencement of semester;
Where possible, provide any written work in electronic format - either in an accessible format on the web, or on disk. This allows the student to reproduce the material in alternative formats (i.e., large print, alternative colour print and background, via screen readers);
If possible, meet with the student prior to, or early in the semester. Discuss the students needs and attempt to accommodate these needs in lectures and assessment criteria.

Lecture / class room adjustments

A student experiencing chronic pain may need to have an ergonomic chair and free standing desk placed either at the front of the class or at the back of the class;
The student may need to bring in a cushion and may at times need to stand and stretch, or even lay down during lecturers. Allow this and do not draw attention to the student. If the movement of the student is disturbing the class, talk to the student in private after class and negotiate arrangements. It may be less distracting if the student sits at the rear of the class or is seated at the end of a row;
Use a variety of teaching methods (eg, use overheads, videos, handouts, study sheets, group participation, Q&A);
Have print copies of overheads available for students prior to the commencement of lectures;
Repeat and rephrase important points;
Speak clearly and face the students whenever talking;
Always verbalise any points that are either written on the board or put up on overheads;
Use a microphone whenever the equipment is provided;
Tape lectures and place in the library so students are able to copy;
Use simple language and stay on topic;
Whenever new processes or procedures are introduced, or whenever directions are given, ensure that stages or sequences are made clear and are explained verbally as well as in written format;
Have regular breaks in long lectures - this will assist to prevent 'information overload' and allow the students to stretch;
Avoid putting the student on the spot by targeting them for questions or reading aloud in class - unless the student has indicated their willingness to participate (i.e. raised hand etc);
Be flexible in relation to 'participation' in tutorials. The student be feel fatigued and may avoid participating in discussions during tutorials;
Supply comprehensive lecture notes;
At the beginning of each lecture, outline the key points that will be raised in the lecture reiterate these and at the conclusion of the lecture;
Try and make sure there is good lighting in the lecture theatre/class room. If possible adjust blinds to ensure there is no glare on the board or where overheads are being projected;
Attempt to keep extraneous sound and visual stimuli to a minimum;

Assignments

Be flexible with deadlines and extensions;
Provide clear feed back to the student both verbally and in writing;
Consider negotiating an individual learning program for students with Chronic Pain. This can include:
- Flexible deadlines for assignments to take into account the effects of their disability and the requirements of other subjects;
- Alternative marking arrangements such as allowing the student to hand in a 'draft' for comment prior to submitting their final paper;
- Consider setting alternative assignments (of commensurate level) where a student can work on a few selected texts rather than having to read copious amounts of text.

Examinations

Allow extra time in formal exams, school based exams and class tests;
Allow the student to use a PC;
If the student requires natural or non fluorescent lighting, make sure there is an appropriate room available;
The student may need a private room;
The student may require a split exam;
Keep examination instructions clear and short. Use simple language. Avoid jargon unless it is crucial to the inherent requirements of the exam;
Allow time for rest breaks;
Allow the student to take in food, drink and medication if required;
The student may need to leave the room - allow this and if necessary have an invigilator accompany them.

* Remember: Alternative Adjustments, is about providing the opportunity for equality, not the attainment of a particular outcome. A student with a disability is still required to present work that is of a recognised standard. Providing flexibility in the process of learning does not mean that the subject standards are lowered.

Chronic Pain

Disability Support Centre

Chronic Pain

Overview

Effects of the condition

Appropriate Adjustments in the Tertiary Education Environment

General

Lecture / class room adjustments

Assignments

Examinations

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