• The Face to Face Disability Management Forum, held on May 25, 2011, at Toronto’s Fairmont Royal York Hotel, brought together more than 100 plan sponsors, group insurers, benefits consultants, pharmaceutical representatives and other stakeholders to discuss effective disability management strategies. Read Part 1 of our coverage.

Chronic pain is one of the most common causes of disability, and it can have serious implications for both employees and employers. For example, following are the results of a few American studies published in JAMA and the American Psychological Association’s Psychological Bulletin.

  • The prevalence of chronic pain in the general population has been estimated at about 30%.
  • One in eight workers loses five hours per week of productive time (excluding missed days) from pain.
  • Reduced productivity while at work, combined with lost workdays, equated to $61.2 billion in estimated lost productivity for the U.S. in 2001/02.

However, early intervention can prevent disability and contain costs. “[An interdisciplinary pain program] is about helping people feel better, get better, improve their function and get back to their lives,” said Catriona Buist, clinical director of Progressive Rehabilitation Associates in Portland, Oregon.

Unlike acute pain, which is a warning signal of impending or recent tissue damage, chronic pain has no protective role and is not a reliable indicator of tissue damage. By definition, chronic pain is long term (persisting more than three months) and, as such, it should be diagnostically and therapeutically approached as a chronic disease process.

A key part of the development of chronic pain is the fear-avoidance cycle, Buist explained. When individuals sustain an injury, they worry about the cause of the pain and future consequences. Fearful of making the injury worse, they avoid movement and activities, such as work and hobbies. This inactivity can quickly lead to deconditioning (decreased strength and flexibility and/or increased weight). Psychologically, individuals become fixated on the pain, which can increase feelings of anxiety, depression, learned helplessness or anger. Eventually, individuals may become stuck in “the sick role,” in which their whole life revolves around pain and helplessness.

Certain risk factors increase the likelihood that an individual will transition from acute pain to chronic pain and long-term disability. These include fear-avoidance, catastrophizing (focusing on negative outcomes), other physical or mental health comorbidities, lack of social support, job dissatisfaction, substance abuse and compensation status. Interestingly, physical factors, including the severity of the injury and the physical demands of the job, do not appear to contribute as much to the move to chronic disability.

Early intervention is critical to prevent the downward spiral. “It is much harder to deal with conditions once [patients] become engaged in the sick role,” said Buist, adding that the longer people are out of work, the less likely they are to return. Studies indicate that 50% of patients with more than three months of disability will not return to work at 12 months.

Ideally, employees should enter a comprehensive interdisciplinary program while still in the acute phase of their injury (within weeks or just a few months of the initial injury), said Buist. A variety of treatments—such as medical management, patient education, nutrition counselling, physiotherapy, biofeedback, occupational therapy and psychological counselling—may decrease pain, improve function and lessen disability. In such a program, the individual takes an active role as part of the treatment team.

The goal of treatment should be to restore function. “Too often, the focus is on decreasing the pain. That is a great outcome for chronic pain, [but] it doesn’t often happen,” said Buist. A more realistic outcome is to get people to a point at which their entire life does not revolve around pain, so they can return to work and other activities without fear of harming themselves.

“We know people are getting better when they get back to doing things they enjoy in spite of the pain, rather than waiting for the pain to disappear,” she explained.

The experts weigh in
A panel of experts tied together major themes from the morning’s presentations and answered questions from conference participants.

Michele Nowski, section manager for group disability and case management in Ontario and Atlantic Canada with Desjardins Financial Security, addressed the question of whether certain workplaces are more likely to have addiction problems. The National Council on Alcohol and Drug Dependency has identified certain types of organizational environments and roles that might put workers at a higher risk for addiction, she said. For example, workers in roles that have little supervision and a lot of mobility, such as travelling salespeople, may have higher addiction prevalence.

Higher rates of addiction have also been noted among workers who have had three or more jobs in the last five years compared with those who have had two or fewer jobs. Nowski qualified this finding by referring to Baker’s presentation. “For functional addicts, the workplace is the last vestige that they maintain as normal, so they would be in a job for longer periods.”

Noting that all of the conference’s speakers had touched on the need for early intervention, one participant asked how employers could be proactive, given concerns around privacy and confidentiality in the workplace. “When it comes to promoting health, you can do a huge amount of work at the level of generic interventions,” said Vallis. Baker agreed, adding that when employers address factors such as fairness and safety, they tell employees that they are important, which sets the stage for healthy discussion and change.

Elizabeth Garel is a freelance writer and editor specializing in healthcare. She is based in Toronto.

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Copyright © 2021 Transcontinental Media G.P. This article first appeared in Benefits Canada.

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