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- EXTRA EDITION
When he had complained about his back the day after moving a transmission, the service manager at the auto dealership sent him to the local hospital emergency room. When the X-rays didn't reveal a medical problem, the attending physician gave the mechanic Tylenol and prescription for [insert name of product] and directed him to take a few days off and to "go back to work on Monday if you feel OK." The mechanic reported what had happened at the emergency room to the service manager.
When Monday came, the worker was still bothered by lower back pain and called the physician who wrote a new prescription and indicated that the employee should take the week off. "Let's see how you're doing by the end of the week," said the doctor.
On Friday, the mechanic reported, "My back doesn't seem to be any better...." At that point, the physician prescribed a specific number of physical therapy sessions. Even so, the pain persisted, keeping the employee from returning to work.
The auto mechanic's experience with pain is repeated thousands of times each day.
While managing pain is a critical medical intervention when it comes to musculoskeletal injuries such as the auto mechanic's lower back problem, finding a way to deal with it successfully is often illusive. This is a particularly important issue since such conditions account for a high percentage of job-related injuries and a high proportion of workers' compensation costs.
Such cases can result in legal action, substantial settlements, loss of a job, and employers having to replace valuable workers.
It's important to point out that pain is both real and imagined, even though there are times when employers may feel that some employees are "faking it" or using pain to "milk the system."
The role of pain in work-related disabilities is attracting more attention. The reason is that pain control - "the biomedical promise of a cure for persistent pain and the elimination of pain-related disability" - has never been realized. This is the conclusion of a group of university, government, and private industry researchers. Their findings are summarized in an article, "Integrating Psychosocial and Behavioral Interventions to Achieve Optimal Rehabilitation Outcomes" in the Journal of Occupational Rehabilitation (December 2005).
They do not question the reality of pain, only how it is treated. Some of the findings can be particularly helpful in understanding the injured employee who is experiencing pain from a musculoskeletal injury. While the research deals only with injuries to the lower back, the psychosocial implications may have a broader application.
They point out that there are both internal and external psychosocial factors influencing how the injured worker reacts to pain. Some experts suggest that musculoskeletal disabilities are often 10 percent pain driven and 90 percent influenced by psychosocial issues. If this is accurate, injury management programs should acknowledge the role of these factors and take them into account.
It may be that, as the researchers suggest, "poor problem solving abilities, low expectancies about the probability of returning to work, and lack of confidence in the ability to perform work-related activities have been associated with prolonged work disability."
It appears that the fear of pain can become more disabling than the injury itself.
EXTERNAL INFLUENCERSAlong with internal factors, there are external psychosocial issues that can impact the injured individual. However, identifying the problem is only the first step toward finding a solution.
Here are some examples of how research in psychosocial factors point in some helpful directions.
One study found that "advice to stay active and information aimed at reducing fear can lead to significant reductions in sick days and higher rates of RTW."
In another study, employees off the job for an average of three months were given RTW skills training. One year later they had "significant less absenteeism" than those who did not receive the training.
Understanding the significance of psychosocial factors in musculoskeletal injuries is an important first step. The researchers indicate that the preliminary results of a training program for 300 physiotherapists and occupational therapists suggest, "front-line professionals can be taught to detect and intervene on psychosocial risk factors." This more effective approach can benefit the injured employee and provide cost savings for the employer.
Summarizing their work, the researchers conclude, "... superior RTW outcomes were achieved without demonstrating a greater magnitude of pain reduction." The message is clear: dealing with the psychosocial factors associated with musculoskeletal injury pain can have a positive influence on helping injured employees avoid disability and get back to an active lifestyle faster including returning to work.
Publication date: 08/21/2006