Throw everything you’ve got at chronic pain claims early on and you might just lessen future disability payouts, say the experts.

Maria Czarnota learned just how debilitating chronic pain can be when a cross-country skiing accident left her with a severely injured knee in 1994. On crutches and in distress, she found herself suddenly unable to take transit to work, move freely around the downtown office where she worked and effectively do her job as a technologist in a Toronto-based blood lab.

“The pain was excruciating,” she says, despite popping Tylenol 3s, doing leg strengthening exercises and wearing a brace from knee to ankle for four months. “It was constant.”

Luckily, Czarnota found herself in the rarest of workplaces—one that accommodated her temporary disability and assisted her in performing her duties. “The workplace gave me a volunteer who helped me with things I needed at my desk,” she says, “such as reagents and blood samples. I couldn’t do my job without her.”
The company also provided Czarnota with an ergonomic chair and took her off being on call at night for six months. “People understood… and they helped,” she says.

Czarnota’s story is a bright spot in an area of disability that is both poorly understood by employers and frequently undertreated by medical professionals. The ambiguity is not surprising. Chronic pain, defined by the Canadian Pain Society as lasting longer than one month, is a complex condition that affects a person on both a physical and psychological level. Caused predominantly by arthritic joint pain or back pain, it’s a condition that should be looked at as a disease state itself, rather than the outcome of a disease, according to Dr. Roman Jovey, program medical director, CPM Health Centres Inc., a Toronto-based outpatient chronic pain management company with offices across Canada.

“There are permanent changes in the nervous system that occur as a result of constant pain,” he says. “As far as we know, you can’t reverse those changes.”

Min Zhou, a pain researcher at the University of Toronto, agrees. “The brain handles injury just like that; it’s a permanent memory.”

One-third of Canadians affected
Unfortunately, the number of Canadians with chronic pain is growing, due to an aging society—and workforce. With more Baby Boomers getting older and opting to stay longer in the workplace, the prevalence of chronic diseases, and chronic pain, is on the rise.

“We expect just through these demographic changes, that we’re going to have more of this issue in the workplace,” says David Willows, vice-president of health and benefits at Aon Consulting in Toronto.

According to an SES Research (now Nanos Research) survey conducted in 2007 for the Canadian Pain Society, one in three or 33% of Canadians report they now live with moderate or severe chronic pain in their day-to-day lives. And many have seen their incomes slide due to chronic pain. The research company estimates that the average Canadian with chronic pain lost an estimated $12,558 in income per year.

“Chronic pain ranks high in the proverbial ‘pain in the neck’ category for primary treatment and care providers in Canada,” says Brenda De Jong, a senior organizational health consultant who works out of Hewitt Associates’ Vancouver office. “Typically people with chronic pain have a history of visits to multiple medical and paramedical professionals and extensive diagnostic testing—all resulting in time away from work as well as costs to the healthcare system.”

Lost productivity is further compounded by those employees who do show up for work, but due to their chronic pain aren’t working at full capacity.

“You’ve got people who are dragging themselves into work, who aren’t necessarily going off on disability, but who are in pain because of these kinds of conditions—what is the impact of them sitting there all day and suffering?” asks Willows. “Are they as productive as the person sitting next to them who feels terrific?”

“We might be headed down a slippery slope, if we don’t invest in health and
wellness upfront.” —David Willows

Aggressive therapy up front
One would think that employers would be doing everything in their power to curb chronic pain before it becomes a huge, long-term cost burden. But according to consultants, chronic pain is all too often tackled once it has become entrenched.

“I don’t think the employer community has been proactive in addressing this,” says Willows.
The trick to curbing the costs of claims and new drugs is to be aggressive at the onset of a claim—rather than waiting for the claimant to get worse, possibly ending up on more expensive, last-ditch medication and then on disability.
Jovey advocates an intensive multidisciplinary approach with a regimen of medication, physiotherapy and psychological counselling. “The ideal thing for people with chronic pain is a combo,” he says.

And that combination is a far cry from handing an employee with chronic pain some pain drugs with some physiotherapy thrown in. Chronic pain is now routinely treated with a range of alternative approaches such as exercise, physiotherapy, massage, acupuncture and naturopathy.

“This team approach, though costly up front, may result in cost savings by reducing the public health costs of frequent physician or emergency room visits, benefits costs including drug use, and in serious cases, disability,” says Hewitt’s De Jong.

Dr. Jovey also suggests a careful claims assessment can be helpful in curbing costs down the road. He says that at the very least employers review the condition of those employees with chronic pain 8-12 weeks after diagnosis, to determine whether more intensive therapy is required.

“You have a window of opportunity in the 8-12-week range where you can take some of those people and, with good multidisciplinary therapy, turn them around and get them working,” he says. “If you miss it, you’re just palliating people’s pain—you’re just trying to make them comfortable.”

Outsourcing to the experts
Many employers find that tracking short-term and long-term disability claims in-house becomes increasingly difficult due to the complexity and expense of chronic pain claims and are now looking at outsourcing to disability management providers and insurers.

Willows says that in the last two years he has seen a 15% rise in organizations outsourcing their short-term disability claims, a trend he predicts will continue going forward. “You hope that these early interventions into these situations will lead to more proactive case management,” he says.

More firms are undertaking health and wellness initiatives that may stave off chronic pain issues later on. These include introducing employee wellness portals, implementing healthy lifestyle programs such as weight management, diabetes monitoring and fitness initiatives such as credits towards gym memberships, says Willows.

“We might be headed down a slippery slope, if we don’t invest in health and wellness upfront,” he says. And, when it comes to chronic pain, he couldn’t agree more.

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© Copyright 2009 Rogers Publishing Ltd. This article first appeared in the October 2009 edition of WORKING WELL magazine.