Long term pain affects many people in today’s society. Approximately 10-20% of the working adult population reports persistent or recurring pain that limits their ability to work (Shaw et al. , 2012, p. 694). Pain that last more than three to six months following an injury or after the expected time frame of recovery, is seen as a chronic condition (Nilsen & Anderssen, 2013, p. 124). As a way of coping with this chronic pain, they develop many self-management techniques to get back to work and maintain employment.
In this study, different self-management techniques that help keep those with chronic pain at work, haracteristics of those people who stay at work despite chronic illness, and the resources available will be explored. With up to 20% of the adult population experiencing chronic pain of such an intensity and extent that it influences everyday life and work, the burden of chronic pain can be great. Not only does it cause suffers to miss work but also causes them to be less productive if they choose to continue to work.
Many workers with chronic pain report decreased work ability or work performance, which impairs their work productivity and may lead to long-term sickness absence or work disability (Vries, Reneman, Groothoff, Geertzen, Brouwer, 2012, p. 1). Despite this, many workers find ways to cope and maintain employment. These workers tend to have certain characteristics in common that help their return to and remaining at work successful. The first of these many characteristics is the physical realm. Many people with chronic pain reported that their level of physical activity greatly impacted the ability to return and remain at work.
Outdoor recreational physical activity was a central theme, with people reporting that fresh air out in nature had a positive effect not only on them physically but also entally. Being outdoors put people in a better mood, helped them get into better shape and boosted energy levels (Nilsen & Anderssen, 2013, p. 127). Those with chronic pain have come forward saying that they could deal with the pain better during certain activities and that finding a balance between rest and activity was essential. Some also reported that the activities involved with work can themselves be therapeutic as well (Vries et al. 2012, p. 7)
Physical characteristics are not the only thing that determine a successful return to and remaining at work. Many different sychological characteristics and strengths have been determined to increase the likelihood of a person remaining at work despite chronic pain. The first of these is pain acceptance. Acceptance of pain can be described as the level of daily activity despite the presence of pain and the degree to which pain is allowed in to experiences without efforts to avoid or control it (Vries, Reneman, Groothoff, Geertzen, Brouwer, 2012, p. 491-492).
It has been shown that those with a higher level of pain acceptance are able to return to work and are also more productive at work. When pain control becomes less important, he feeling to have control over life increases (Vries et al. , 2012, p. 497). Staying at work with pain may be regarded as a healthy coping behavior, which will help to maintain long-standing participation in work (Vries et al. , 2012, p. 7). One of the most talked about psychological strength is pain self-efficacy. This refers to the belief in one’s own capacity to execute behaviors necessary to produce a specific performance despite pain.
It also reflects how much effort a person will expend and how long they will persist in the face of obstacles and aversive experiences, which in this case is chronic pain Vries et al. , 2012, p. 7). Having self-efficacy could almost be seen as a prerequisite for staying at work because it promotes pain- coping strategies, organizing modifications at work and home, finding access to care as needed, and asking for support (Vries et al. , 2012, p. 497). Many people have resistance to behavioral changes or lack self-management skills needed to make the changes needed to return and remain at work.
The outer environmental characteristics also effect the ability to return and remain at work. Those who work more labor intensive jobs are less likely to return and remain at work. Workplace adjustments may need to be investigated prior to returning to work. A reduction of working hours seemed to be the most important for a person suffering from chronic pain. Although the work itself can be an issue, other factors such as emotional stress, relation with coworkers, and work satisfaction can also be influential.
Good communication with employers and coworkers is important for a successful return to work (Jakobsen & Lillefjell, 2013, p. 52). Most the resources available for those with chronic pain come into effect when the person is unable to remain or return to work. The first resource that may be available when leaving the work force is short and long term disability provided through the employer. These are insurance policies that are offered at a price to the employee and replaces a portion of the lost income when one becomes unemployed. This is otherwise view as “paycheck protection”.
Sadly, not all employers provide this coverage but this insurance can be brought through private insurance companies as well. The Consolidated Omnibus Budget Reconciliation Act (COBRA) is another resource those who lose their jobs can look into. Under this act, workers and heir families who lose their health benefits have the right to choose to continue group health benefits provided by their employer for a limited period of time under certain circumstances. The worker will have to pay the entire premium for the coverage during this time frame and is something that the worker would have to elect to continue.
This is a federal law, however, not all circumstances warrant this to become available and is not a guaranteed service provided. Family Medical Leave Act (FMLA) requires an employer to provide up to 12 weeks of unpaid, job protected leave to eligible workers for certain family nd/or medical reasons. Under this law, one can leave a job for reasons such as a serious health condition that makes the employee unable to perform the essential functions of the job, birth of a child, or care of spouse, child or parent who has a serious medical condition.
The currently held position of the worker will be held up to the 12 weeks, however, they receive no compensation during this time frame. This is a federally mandated law, however, in some states private employers have different guidelines that they follow. Social Security paid disability is another option for those with chronic pain. If you ave worked in the workforce long enough and have a medical condition that prevents you from working for at least 12 months or result in death, you are eligible for this benefit. Those who are eligible go through an application process that may take 3 to 5 months.
So although this is a great resource, there can be a gap in income from the time of leaving the work force to receiving benefits. This program is provided by the federal government. Americans with Disabilities Act (ADA) is another federally mandated law that prohibits the discrimination and guarantees that people with disabilities have the same pportunities as everyone else. To be covered by this act one must have a disability, defined as a physical or mental impairment that substantially limits one or more major life activities, a person who has a history of such impairments, or is perceived by others as having an impairment.
If the original incident that caused the chronic pain occurred while on the job, individuals can become eligible to take advantage of workers’ compensation. This is designed to provide certain benefits to workers who sustained injury while on the job, either by accident or occupational disease, who are ot willfully negligent at the time of the injury. By accepting workers’ compensation, the worker is entitled to medical benefits necessar as a result of the work-related injury, wages loss, and vocational rehabilitation following the injury. Those with chronic pain may also want to look at the many resources available online.
Many different organization, such as the American Chronic Pain Association (ACPA), Pain Connection and Partners Against Pain, offer medical resources, relevant literature, tips, and support group information to both suffers and caregivers. The ACPA even offers an app to track everyday ain and its characteristics. There are some preventative measures that can be taken to prevent removal of those with chronic pain from the work place. A primary prevention would be education on proper body mechanics, reduction of risk taking behaviors and physical activity to promote fitness prior to the pain starting.
Vocational rehabilitation and screening current employees for pain prior to it becoming chronic would be examples of secondary prevention. Tertiary prevention methods of self-management techniques and medication management would be ways to help reduce the pain once it becomes chronic. Education for those with chronic pain is greatly needed. With few resources available for those who return and remain at work, education must focus on teaching self-management techniques to assist those with chronic illness.
Self-management interventions apply psycho-educational techniques borrowed from cognitive-behavioral therapy to enhance coping skills and provide individualized plans for problem solving and dealing with temporary set-backs. These interventions have been shown to reduce the experience of pain, functional limitation, and distress commonly experience with chronic pain. Many people eport that if they managed their chronic pain correctly with self- management techniques, they would use less pain medications, have less doctor visits and felt that their physical activities would increase and improve (Kawi, 2013, p. 67).
Also teaching about and strengthening the characteristics that help people return and remain in the work force would be beneficial. Healthcare professionals have a responsibility to influence patient activation by supporting and educating patients in their self- management of pain (Kawi, 2013, p. 665). One self-management technique that can be taught is relaxation techniques. The goal of teaching this skill is to job satisfaction and reduce perceived work limitations by increasing relaxation and body awareness.
Pain, muscle tension, and anxiety are closely linked and helping an individual to reduce muscle tension and anxiety will reduce pain intensity (Gregory, 2014, p. 27). By making use of tools to reduce discomfort and altering job methods, one can increase the likelihood of returning and staying in the workforce. One relaxation technique that can be taught is diaphragmatic breathing. This technique can be used as a distraction to the pain and help the patient to relax. Also teaching guided imagery and progressive muscle relaxation (PMR) can help with relaxation.
PMR consists of systematically tensing and relaxing different groups of muscles, usually starting at the feet and working up the body (Gregory, 2014, p. 28). Discussing taking full advantage of micro-breaks and lunch breaks to relax and relieve tension is important in teaching relaxation techniques (Shaw et al. , 2012, p. 699). Another method that could be taught is cognitive restructuring with the goal to reduce emotional distress and perceived work limitations by countering negative automatic thoughts that are unrealistic or unsupported.
Identifying and replacing thoughts that pop up automatically about pain that contribute to the distress (Shaw et al. , 2012, p. 699). These dysfunctional thoughts may cause irritability, hostility and blame. By teaching the person to counter beliefs that work is harmful may help to improve performance on the job. Accepting the pain and the changes that may be required for functioning at work are pivotal to this technique. Keeping a positive attitude along with the ability to cope with emotional consequences of the injury also strengthen this technique (Johnston, Strong, Gargett, Jull, Ellis, 2013, p. 460-461).
There is yet another self-management technique that can be taught and that is problem solving. The goal of this teaching is to reduce perceived work limitations by expanding alternative methods to complete job takes and increase perceived control and mastery of pain. By teaching those with chronic pain to apply a systematic stepwise process to define, analyze and overcome functional difficulties with pain, one can determine more options for reducing discomfort (Shaw et al. , 2012, p. 699). The outcome of teaching this technique would be the development of the ability to problem-solve ‘how to do activities to minimize pain (Johnston et al. 013, p. 460).
Developing this skill could also help individuals learn how to prioritize activities in order to best cope with chronic pain. Lastly there is effective communication. Teaching selfmanagement techniques in this area will improve workplace support by reducing unnecessary pain behavior and by improving the effectiveness of communication intended to obtain assistance, access emotional support or request info or accommodation (Shaw et al. , 2012, p. 699). This includes not only communication with employer and coworkers but also with health care providers.
Since chronic pain may increase irritability, over-dependence on others and feelings of isolation, learning good communication can help avoid interpersonal conflicts through assertive communication and increase the ability to ask for help effectively when needed. It helps if the employee has an open mind, is cooperative and easy to talk too. Communication during sick leave is also important. Regular meetings during the sick-leave period helps the employer receive information regarding the employees condition as well as helps the employee feel missed and wanted back (Jakobsen & Lillefjell, 2014, p. ).
With the number of people in the work force faced with chronic illness, the need for resources and education is paramount. The majority of resources are dedicated to those who are forced to leave the workforce, leaving those who choose to go back to work at a greater risk. By teaching selfmanagement techniques to those with chronic illness and reinforcing characteristics that help cope with chronic pain, those with chronic illness can remain in the work force.