The impact of pain on work participation; Healthy Aging @ work?

Michiel Reneman

REHABILITATION MEDICINE / CENTER FOR REHABILITATION

Disclosure Statement of Financial Interest

I, Michiel Reneman, DO NOT have a financial interest/arrangement or affiliation with one or more organizations that could be perceived as a

real or apparent conflict of interest in the context of the subject of this presentation.

Focus of this contribution

Chronic non-specific musculoskeletal pain (CMP)Because: Largest subgroup of people with pain Most costly, because of work productivity loss

Outline

1. General introduction • Impact of pain on work and work on health and well-being

2. Measurement challenges3. Staying at work with pain

Impact of pain on work

CMP highly common among the general population~ 90% at least once in adult life

In many cases: rapid improvement / full recovery Recurrent

44-78% relapse of pain 26-37% relapse of work absence

Few: long term pain with significant limitations in ADL and work Chronic: > 3 months

Societal costs

Direct: costs related to medical care• Medical: medical, allied, complimentary, …• Nonmedical: transportation, meals, house renovations

Indirect: costs related to consequences of CLBP• Absenteeism and presenteeism• Disability• Replacement: overtime, recruitment, training• Household productivity: replacement by partner or outsider• Intangible costs: decreased QoL (often not included)

Direct and indirect costsVarious countries, various methodsUSA: LBP 6th costliest health condition, 3rd in associated disability… by any standards must be considered a substantial burden on

society

Direct and indirect costs in The Netherlands

€3.5B - €4.3B per year0.6% - 0.9% GNPDirect – indirect 12/88%…

Impact of work on health and well-being

Independent review: 'Is Work Good for Health and Well-being?‘

Commissioned by the UK Department for Work and Pensions

Examination of scientific evidence on the health benefits of work, focusing on adults of working age and the common health problems that account for two-thirds of sickness absence and long-term incapacity.

Impact of work on health and well-being

There is strong evidence showing that work is generally good for physical and mental health and well-being. Worklessness is associated with poorer physical and mental health and well being. Work can be therapeutic and can reverse the adverse health effects of unemployment. That is true for healthy people of working age, for many disabled people, for most people with common health problems and for social security beneficiaries. The provisors are that account must be taken of the nature and the quality of work and its social context; jobs must be safe and accommodating.

Overall, the beneficial effects of work outweigh the risks of work, and are greater than the harmful effects of long-term unemployment or prolonged sickness absence. Work is generally good for health and well-being.’

Waddell en Burton, 2006

Outline

1. General introduction • Impact of pain on work and work on health and well-being

2. Measurement challenges3. Staying at work with pain

CLBP: impact on work? Measurement challenges

Variability among studies in terminology and methodology

Extra complex• Mixed – absent AND present• Absent: temp AND

permanent• Part-time work• Self-employed

Pain research outcome measures: absenteism and presenteism

Absenteeism• Not / temporary / permanent • Modified hours / work / shifts • Measured from records: medical,

insurance, employer

Presenteeism• Present at work, but less

productive• Measurement?

Outline

1. General introduction • Impact of pain on work and work on health and well-being

2. Measurement challenges3. Staying at work with pain

• Results of a study among a large and underreported group of people with CMP: workers who stay at work despite CMP. What went right? Are they just ‘not absent’, or can they still be productive? How are these people or their work different from those with CMP who seek tertiary care? What lessens can we learn from these workers?

Relevance:– ‘Unknown’ in literature– New reference field– What can we and our patients learn from them?– Why do they SAW?– How can they SAW? What goes right?

Systematic review of scientific literatureN=120 workers with chronic pain, < 5% absenteeismControls: n=120 rehab patients / n=702 healthy workersIn-depth interviews with participants

Measurements: • Bio: functional capacity,

aerobic capacity, activities

• Psycho: cognitions, emotions, distress, coping, … etc

• Social: occupational physician, boss, partner

Study 1: Systematic review

• High level evidence for determinants for SAW is absent

• Existing knowledge is based on low level of evidence

Consistent (low level) evidence• low emotional distress SAW • low physical disability SAW • duration of pain

n.s.• catastrophizing

n.s.• self-esteem

n.s.• marital status

n.s.

Inconsistent evidence:• self-efficacy• age• gender• educational level• physical and mental health• pain intensity• depressive symptoms• coping

Study 2: Qualitative study

Motivators: why SAW with chronic pain?Success factors: how are they able to SAW?

Motivators:• work as life value• work as income• work as responsibility• work as therapy

Succes factors:• personality traits• adjustment latitude• coping with pain• use healthcare services• pain beliefs

Study 3: Contrast SAW and rehab patients

Group status was predicted best by: • pain intensity, duration of pain, pain acceptance,

perceived workload, mental health, and psychological distress

No difference: • Self-reported physical activity level, active coping

and work satisfaction

Study 4: Work ability and work performance (0-10)

Pain Self-Efficacy consistently explained high WA and WP!

Study 5: Activity level and pattern

• Level: 30% higher in SAW• Pattern: PM higher in SAW

Study 6: Functional capacity and deconditioning?

• Capacity: SL < CMP < Healthy• CMP is associated with relevant deconditioning for

work• SL more often relevantly deconditioned than SAW

Study 7:Social determinants of SAW

Partner, boss, colleagues, occupational physicianExpected Fall 2012

Final results expected November 2012• Thesis

The results of this study can be used to develop interventions to promote SAW.

The knowledge gathered in this study provides a new reference for clinicians working in rehabilitation, occupational, and insurance medicine.

The impact of pain on work participation; Healthy Aging @ work?

Summary / take home

1. Work is generally good for health and well-being2. Sustained work participation with chronic pain is often possible

and desirable.3. On average, chronic pain is associated with lower WA and WP4. Higher WA and WP is associated with higher pain self-efficacy.5. Many determinants of sustained work participation with chronic

pain are still unknown6. Work participation should be a outcome measure for pain

management.

Thank you

m.f.reneman@cvr.umcg.nl

REHABILITATION MEDICINE / CENTER FOR REHABILITATION