Chronic pain is not only the most prevalent of ongoing workplace health concerns; it’s also the most expensive health care category in the United States. A study by the American Pain Society confirmed that
the annual cost of pain management across the country reaches $635 billion.
That figure translates to a similarly large proportion of workers compensation costs, imposing a significant financial burden on employers’ budgets. Moreover, the costs of chronic pain are persistent. As workers recover from injuries, the chronic pain that often lingers in the aftermath contributes to further expenditures on the part of the employer.
Managing persistent pain is a significant therapeutic challenge comparable to any other public health epidemic. It’s a multifaceted problem with many possible outcomes, and an effective approach to tackling it must be similarly versatile. Driven by biological and psychosocial factors as much as the direct health care variables, pain management treatment should explore all possible avenues toward shortening the recovery process and preventing instances of chronic pain.
Studies have identified several psychosocial characteristics that often accompany the functional consequences of chronic pain. These include perceptions of pain, attitudes and beliefs, psychological trauma or subconscious need, coping abilities, depression and anxiety, catastrophizing, sense of control or helplessness, fear and anxiety, social support, and sleep quality. Psychosocial characteristics can also place individuals at elevated or reduced risk for the transition from an acute to persistent pain state, or for the development of pain-related disability in the context of a persisting pain condition. For chronic pain caused by injury, these factors also compound the duration of the recovery process. Post-injury treatment of the psychosocial elements provides a boost to recovery and relief for the employer’s bottom line.
The Prevalence of Untreated Pain
When these psychosocial factors are present and left unaddressed, they can stall the efficacy of treatment and contribute to an organization’s disability claims, productivity losses, and employee absences. According to the American College of Pain Medicine, 100 million Americans suffer from chronic pain, with 4 in 10 workers reporting that pain interferes with their ability to do their job. On top of the financial costs, pain management implies significant losses in productivity and employee attendance.
100 million Americans suffer from chronic pain
Research has found that by addressing pain and related psychosocial issues early, it has a positive effect on the bottom line. Learn more about the prevalence of chronic pain and how it can be treated effectively with Addressing the Psychological and Secondary Effects of Pain, a DORN white paper on this topic.
Short-Term Factors of Pain
Perception of Pain
Our perception of pain varies over time and with circumstance and is regulated by emotion and at times by factors that seem unrelated to the stimulus. Chronic pain may continue without conscious awareness of its actual cause, with only the pain itself perceived consciously. In short, people become conditioned to experience pain. This contributes to longer recovery and decreased engagement from employees.
Attitudes and Beliefs
People are active processors of their experience, which is always reconciled by what they believe and how they interpret the situation. The influence of beliefs on pain is profound. In acute pain situations wherein pain directly arises from tissue damage, protecting the area of pain by refraining from activity may be adaptive.
However, beliefs about acute pain are often applied to chronic pain, and such beliefs are accompanied by activity avoidance and deactivation, which in turn significantly contribute to greater pain and disability. Modification of individuals’ negative thoughts about their pain seems to predict changes in pain, response to treatment, and disability. Moreover, it’s essential to tap into the core beliefs of employees when it comes to their investment in their own wellness. Belief inspires better engagement and better overall health, leading to better business outcomes.
Psychological Trauma
Pain can occur in reaction to various psychosocial stimuli, such as guilt or regret. In such cases, pain seemingly becomes the subconscious infliction of self-punishment. These fears may cause muscle contractions, contributing to low back pain or other chronic pain. An effective pain management strategy should include psychological options that can help workers deal with these mental and emotional factors during the post-injury recovery process, which should help limit new incidences of pain.
Coping Ability
Coping refers to an individual's personal strategies for dealing with challenging or traumatic circumstances. Coping strategies can be behavioral, like relaxation and pacing one’s activities, as well as cognitive, using distraction or positive thinking. Efforts may be active such as attempting to obtain information, problem-solving, guarding, asking for assistance, exercise and stretching, practicing coping self-statements and seeking social supports. A person’s coping strategies may also be passive, such as withdrawing from situations, feeling hopelessness, or becoming dependent on others.
The literature identifies several coping strategies that include guarding, resting, asking for assistance, relaxation, task persistence, exercising/stretching, coping self-statements, and seeking social support. These are effective methods of helping employees help themselves. By training employees in these strategies, it is possible to mitigate the ongoing prevalence of pain, as workers acquire the tools they need to manage their pain while continuing through the recovery process.
Catastrophizing
There is a large volume of evidence to suggest that catastrophic thinking about pain plays a significant role in the actual pain experience. Catastrophizing is a cognitive process where one assumes the worst possible outcomes, dwells on these, and interprets even minor problems as major calamities. These thoughts can harm perceptions, expectations, memories, and thereby experiences. As a further consequence, such individuals may develop passive coping styles, such as helplessness, that further exacerbate their condition.
Loss of Control and Helplessness
A sense of control represents an employee’s perceived ability to manage their pain or pain-related matters. How individuals conceptualize their ability to control pain and associated stress seems to be an influential determinant of how they cope with pain. An increased sense of control is correlated with greater functionality in individuals with chronic pain. Furthermore, improvement in control beliefs after treatment typically results in a reduction of pain and disability. A holistic approach to worker health should include awareness of the worker’s mental state—be aware if an employee expresses helplessness regarding their health and pain since this sensation is associated with greater pain and poorer physical and psychological adjustment in chronic pain.
Fear, Anxiety, and Depression
It’s very common for workers to experience fear related to how their work may affect their pain. Fear-related problems and anxiety are more prevalent in individuals with chronic pain than in the general public. The prevalence of any anxiety disorder among people with chronic pain may be twice as high as in the general population (35% vs. 18%); panic disorder and post-traumatic stress disorder are three times more common in individuals with chronic pain. Although fear and anxiety are often viewed as a single mood condition, they are likely to separate entities with distinctive physiological and emotional experiences. Anxiety is a future-oriented emotion; it is experienced as worry and nervousness related to some often-vague future issues, whereas fear is a present-oriented mood state about something specific that one wants to escape from or avoid.
Fear and anxiety reflect key components of the dysfunctional circle of pain maintenance. It has been shown that pain-related fear-avoidance is significantly associated with functional limitations and perceived disability in individuals with acute and chronic pain.
Rates of depression are higher in chronic pain populations than in the general population, and it is quite common in specialized pain clinic individuals for more than 50% of individuals evaluated to experience significant emotional distress. There is a wealth of evidence to suggest that depression, anxiety, and emotional distress contribute strongly to key long-term outcomes of persistent pain such as physical disability, work disability, healthcare costs, mortality, and suicide.
Social Support
Researchers and industry leaders have devoted significant attention to the role of social context at each step along the trajectory of chronic pain. Social support refers to the resources perceived as or actually being available from others in social networks. This support system can include family, friends, coworkers, and even the employer. For example, workers who engaged in physical exercise together with coworkers has been shown to help improve social climate and vitality among workers who experience chronic musculoskeletal pain. Conversely, support in the form of anxious behavior in response to communications of pain behaviors has been shown to be associated with increased pain and pain behaviors and maintenance of disability.
Sleep and Fatigue
A common obstacle in the pathway toward complete recovery, loss of sleep often impacts individuals who deal with chronic pain. Acute and chronic pain can disrupt sleep, resulting in difficulty falling asleep, staying asleep, and reducing the quality and duration of sleep. Studies indicate that sleep deprivation lowers the cognitive ability to cope with pain, and increases ratings of pain intensity, which in turn exacerbates poor sleep. Sleep disturbance can aggravate pain, inflammatory processes, increase emotional distress, and reduce overall well being. By targeting sleep as a foundational element of recovery, employers can mitigate these additional risks and ensure that the worker remains productive while they heal.
Conclusion
Chronic pain is a pervasive problem, one with a myriad of influences and an array of treatment options. While treating all of these factors at once can be daunting, an effective workplace healthcare strategy should approach the pain problem from all angles. This ongoing, continuous approach should remain focused on psychosocial factors not only in the immediate aftermath of an injury or pain event but throughout the recovery process. During these times, employers must endeavor, through versatile treatment programs and a multi-pronged approach to health, to engage with employees and encourage them to be active participants in their recovery process. This culture of wellness can nurture healthy, productive employees who remain invested in their performance at work. Treating and addressing the whole person through attention to improvements in Body, Behavior and the Environment simplifies the recovery process and even helps prevent injuries from occurring in the first place.el
