Chronic Pain and Return to Work

1
Chronic Pain and Return to Work

• Larry Studt, MD
• April 29, 2008

2
Objectives

• Define Chronic Pain
• Discuss common causes of Chronic Pain
• Impact of Chronic Pain on the workforce
• What can we do?
• Healthcare providers
• Workplaces
• Patients
• Case examples

3
What is Chronic Pain?

• 6 months or more of pain (an unpleasant sense of
  discomfort)
• pain persisting beyond the expected normal
  healing time for an injury, for which traditional
  medical approaches have been unsuccessful

4
(No Transcript)
5
Chronic Pain statistics

• 1 out of 4-5 Americans suffer from Chronic Pain
• Recent study of 25 million people
• 41 had at least of one of four Chronic Pain
  conditions
• 21 back pain
• 18 arthritic pain
• 11 headaches
• 2 fibromyalgia

6
Common causes of Chronic Pain

• Low back pain
• Headache
• Cancer pain
• Arthritis
• Neurogenic pain
• Psychogenic pain

7
(No Transcript)
8
Chronic Pain impact on workforce

• 18 of employees report chronic pain on the job
• 19 of employees called in sick for 5 or more
  days in 2006 due to chronic pain
• 46 of employees with chronic pain felt their
  pain affected their ability to perform their job
• Estimates of 65-70 loss of productivity due to
  chronic pain

9
Chronic Pain impact on workforce

• Lost wages estimate at 1.1 billion in 2006

10
RTW percentages
11
Chronic Pain and Return to Work key issues

• Cause of impairment/pathology is real and
  compensable
• Self diagnoses can be elaborate
• Co-occurrence with other functional somatic
  syndromes
• Self-perpetuating cycle of disability
• Perception of things getting worse
• Catastrophic portrayal on employee
• Stigmatization of chronic pain and disability

12
What can we do?

• Healthcare providers
• Job performance, employee relations, and
  corporate human resource practices
• Depression and work
• Work-site inflexibility
• Disability cynicism
• Iatrogenic disability

13
Healthcare Providers

• Iatrogenic disability
• Avoid - When do you want to go back to work?
• Be aware of common side effects of medications
• Fatigue
• Reduced alertness
• Nausea
• Constipation

14
What can we do?

• Workplaces
• Define clear return to work roles and all levels
• Supervisors, managers, coworkers, etc.
• Identify return to work pathways
• Do no use disability system for poor performing
  employees
• Expect all employees to return to work through
  pathways

15
Case examples

• 37 year old male with ankle sprain
• Tripped on a beam
• 10 lost work days
• 67 restricted duty days
• PT, meds, transitional duty

• 39 year old male with left great toe fracture
• Severe toenail injuries
• Beam fell on foot
• 4 lost work days
• 35 restricted duty days
• No PT, few meds, transitional duty

16
Similarities

• Same company
• Injuries with 2 months of each other
• Same Medical Provider
• Same return to work model

17
Differences

• Ankle sprain patient
• Lower severity of injury
• Lack of motivation
• Dissatisfaction with job
• Uneasiness about restricted duty
• Other medical and psychiatric history

• Fracture patient
• Higher severity of injury
• Very motivated
• Loved job
• Did not want pain meds
• Wanted to return to work next day
• Language barrier

18
Case examples

• Both patients at risk for chronic pain
• Ankle sprain due to work issues
• Toe fracture due to severity of injury
• How will they fit into the Chronic Pain/RTW cycle?

19
(No Transcript)
20
(No Transcript)
21
Questions?
22
Bibliography

• Employees with Chronic Pain. Job Accommodation
  Network.
• H. Busch BA, S. Göransson MA, B. Melin PhD.
  Self-Efficacy Beliefs Predict Sustained
  Long-Term Sick Absenteeism in Individuals With
  Chronic Musculoskeletal Pain. Pain Practice 7
  (3) , 234240.
• Kenneth Mitchell, PhD. The Dance of the
  Invisible Impairments Chronic Pain Syndrome and
  the Disability Insurer. APS Bulletin Volume 10,
  Number 4, July/August 2000.

23
Bibliography

• Preventing Needless Work Disability by Helping
  People Stay Employed. A Report from the
  Stay-at-Work Return-to-Work Committee of the
  ACOEM. August 31, 2005.