Accommodation and graduated return to work can keep workers productive
For more than 20 years, Lynn Cooper has been living with chronic pain, having injured her back at the office. Despite returning to work as soon as possible, her pain never went away and she developed migraines and other neuropathic pain and, eventually, had to stop working altogether.
“I followed every direction. I was the best patient, I think, that you could ever ask for,” said Cooper, who lives in Kitchener, Ont., and is now the president of the Canadian Pain Coalition. “Most people, including me, we want to be working. There’s nothing more frightening than to have to make the decision that you can no longer stay at work.”
Chronic pain is a growing concern for employers, with about 18 per cent of Canadians suffering from chronic pain, resulting in reduced productivity and increased disability costs, according to the results of two surveys.
Nanos Research surveyed more than 22,000 Canadians in 2007 and 2008 on behalf of Painexplained.ca, an advocacy group committed to raising awareness of the effects of untreated pain.
The survey found chronic pain prevalence increases with age, with about 23 per cent of men and 29 per cent of women aged 56 to 65 suffering from chronic pain. After age 65, the proportion stays the same for men but jumps to about 32 per cent for women.
A more detailed survey of 600 of the 1,703 respondents who reported moderate to severe chronic pain found nearly 60 per cent had lost their job, suffered loss of income or had reduced responsibilities as a result of their pain. Those still employed reported 28.5 lost work days per year because of their pain.
The survey found arthritic and joint pain is the most common cause of pain among moderate and severe chronic pain sufferers, followed by spine pain and pain related to a traumatic injury.
Chronic pain also affects a person’s mental health, with 27.9 per cent of the 600 moderate to severe chronic pain sufferers reporting a diagnosis of depression and 20.1 per cent reporting a diagnosis of an anxiety disorder.
“Pain is hurting Canada — on both an individual and societal level — and it is a national embarrassment that our medical system pays so little attention to a problem that is so common and costly,” said Roman Jovey, a medical doctor and steering committee member of Painexplained.ca.
The medical community focuses on finding a cure for the underlying disease causing the pain, at the expense of understanding and treating the pain itself, he said.
A 2009 study by the Canadian Pain Society found that while the total spending on research and development in the health field was $6.3 billion in 2007, only about $16.2 million of that (or 0.25 per cent) was spent on pain research.
At Toronto-based insurance company Sun Life Canada, chronic pain diagnoses make up about one per cent of long-term disability claims, said Annette Gibbs, vice-president of group life and disability claims.
Many of these claims involve fibromyalgia or employees recovering from car accidents, she said. Ten years ago, chronic fatigue was a major cause of chronic pain diagnoses but the prevalence has since levelled off, she said.
The company’s rehabilitation department works with employers and employees on long-term disability to help get workers healthy and back to work.
“We really are there to promote the strategy that work is healthy and that it’s good. Work is part of the health equation and, irrespective of what the presenting diagnosis is, we encourage people to live up to optimal function,” said Gibbs.
Flexible work schedules and telework can help these employees get back to work and stay on the job, she said. Employers also need to understand and accommodate for the fact there will be episodic flare-ups where these employees won’t be able to work, she added.
A graduated return-to-work policy is especially helpful for employees with chronic pain due to an injury, said Jovey. However, some employers won’t take a worker back until he is at the same level as before his injury.
While it’s understandable employers don’t want to put up with a partially functioning worker, it’s better for the employee to return to light duties and work his way up to full duties. Once a worker has been off the job for one year, the odds of him returning are less than one per cent, said Jovey.
Disability management programs can help employers identify employees who are at risk of short-term disability due to chronic pain and begin early intervention before the employee has to go on disability leave.
An external disability management team can identify employees with a high number of absences, said Pamela Connor, vice-president of health management operations at Shepell-fgi in Mississauga, Ont., an employee assistance program and disability management provider.
“We provide a case manager to speak with the employee and employer and go through what’s driving the absences and what are the best treatment solutions and what can be put in place to help reduce those days,” she said.
