IMPACT ON RECOVERY AND RETURN TO WORK THE INJURED WORKER’S FAMILY AND SIGNIFICANT OTHERS

RELEVANCE OF A BIOPSYCHOSOCIAL MODEL IN WORK INJURY

RELEVANCE OF A BIOPSYCHOSOCIAL MODEL The majority of injured workers return to work Estimates of 5 to 15 % remain off work three months or longer and chronic pain becomes a major factor in predicting RTW Back injuries continue to be the single most common work- related injury. Low back pain alone was calculated to cost approximately 26.8 to 56 billion in medical care, compensation payments, and time lost from work 90% of these costs are incurred by the 5 to15% who become chronically ill or develop a pain-related problem and fail to return to work. Pain costs U.S. employers about $80 billion a year in sick days and lost productivity

COST OF WORK INJURIES AND ILLNESS In 2012 a UC Davis researcher estimated the national annual price tag of occupational injuries and illnesses at $250 billion. This figure is $31 billion more than the direct and indirect costs of all cancer, $76 billion more than diabetes, and $187 billion more than strokes. The study suggests that the U.S. should place greater emphasis on reducing work-related injury and illnesses, especially since the costs have risen by more than $33 billion (inflation adjusted) since a 1992 analysis, the author said. Occupation and Safety: Jan, 2012

CHRONIC PAIN AND DISABILITY Dr. Gary Franklin, medical director for the Department of Labor and Industries in Washington state, which administers the state-run workers compensation insurance fund, said experiencing chronic pain is equivalent to becoming disabled. From his experience, “everyone who remains in the system (after five months) is disabled,” he said. “If you are not putting most of your effort into preventing an injury from developing into chronic pain and therefore long-term disability, “you've lost the ballgame.” Business Insurance: 2015

CHRONIC PAIN Chronic pain is defined as ongoing and lasting 3 to 6 months post injury or longer The amount of tissue damage is not always correlated with the experience of pain Pain is a subjective, multi-dimensional construct that involves sensory, affective, cognitive, autonomic and behavioral components Individual variation in pain experience contributed to psychological, social, contextual, and biological factors Bottom Line: The pain experience is affected by psychosocial variables which contribute to delayed recovery, functional impairment and disability

Psychosocial Factors/ Psychiatric Comorbidity Acute Pain Sub- acute Pain 2-4 mos. Chronic Pain 3-6 mos. INFLUENCE OF PSYCHOSOCIAL FACTORS Influence/Ris k

FACTORS PREDICTIVE OF MEDICAL TREATMENT OUTCOME AND RETURN TO WORK

VARIABILITY IN SPINE SURGERY OUTCOMES 300,000 to 400,000 spine surgeries performed each year Success rates vary: (reduction in pain, medication use, function) Laminectomy/discectomy – 80 to 90% Spinal fusion – 70 to 80% Procedures for “failed back surgery syndrome” – 50-60% Satisfactory pain relief is achieved from 16% to 95% in lumbar spine fusions

FOCUSED RESEARCH EFFORTS Inconsistency in spine surgery results and the demand for evidence-based treatment led researchers to examine factors that affect spine surgery outcomes Primary goal is to determine which patients are most likely to achieve pain relief and improvement in functional abilities as a result of spine surgery

FINDINGS Clinical results of spine surgery are often mediated by several factors in addition to physical illness, including a patient’s emotional status, social environment, lifestyle, and incentive for improvement Growing body of research over last two decades demonstrates that psychosocial factors contribute to the variability in spine surgery outcome

PREDICTORS OF SURGICAL OUTCOME Chronicity Previous spine surgeries Nonorganic signs Nonspine medical utilization Smoking Obesity Pending legal actions Reinforcement of disability by family members Marital dissatisfaction Job dissatisfaction Physical or sexual abuse Pre-injury psychological problems Current psychological problems Coping

PREDICTORS OF DISABILITY Job Satisfaction Length of Time Off Work Relationship with Supervisor Relationship with Co-Workers Work History Perception of Fault Litigation Coping Psychological Dysfunction Compensability Level of Social Support

FACTORS AFFECTING PAIN EXPERIENCE Expectations Beliefs Prior History and Learning Experiences Coping repertoire and self-management skills Self-Efficacy Depression Anxiety Fear Reinforcement Systems, i.e. family, significant others

INJURED WORKER’S FAMILY AND SIGNIFICANT OTHERS

IMPACT ON FAMILY Joblessness and chronic disability are associated with poverty, depression, suicidal behavior, family breakdown Injury or illness put a strain on relationships in a number of ways, through emotional stress, financial pressure and isolation Family and friends are deeply impacted, and this eventually may lead to problems within these relationships The injury or illness may result in a breakup or result in temporary or permanent loss of intimacy An injured worker may suffer significant financial loss as a result of their injuries. These costs may include loss wages as well as medical costs, costs of transportation, and losses related to lifestyle changes injured workers and their families have to make

MARITAL DISTRESS Marital dissatisfaction and problems within a marriage are common among patients with chronic pain Dissatisfied spouses have expectations of outcome that are more negative and tend to attribute the patient’s pain to psychological rather than physical problems Contribute to less favorable treatment outcomes

FINANCIAL CONSEQUENCES 48% of U.S. families do not save any of their annual income Over 50% do not have a private pension plan One-third do not have retirement savings 68% of Americans would find it very difficult or somewhat difficult to meet their current financial obligations if their next paycheck were delayed for one week 65% of working Americans say they could not cover normal living expenses even for a year if their employment income was lost; 38% could not pay their bills for more than 3 months 69% of workers in the private sector have no private long-term disability insurance Council on Disability: 2012

SUPPORT BLOGS My husband was injured at work. He has been to the doctor and is now in physical therapy and nothing is easing the pain. His doctor says that the MRI and CT don't show anything wrong however the therapist could not believe that he has such poor range of motion but yet they can't find anything wrong. He had lower back surgery several years ago for a ruptured disc and states that the pain he is feeling now is the same. His leg becomes numb and he's been tripping. He's in constant pain and feels like nobody is listening to him and doesn't know where to turn. I was tempted to take him to the emergency room just to see if they could give him something to ease the pain. He wants to work, he wants to play with his children and is tired of telling them "No, I can't". He has requested a second opinion and his back Dr. gets angry. One month he was told it was arthritis, the last visit he had he was told it was degenerative disk. Does anyone have any suggestions as to what rights he has? He doesn't want to go against the system but it's not doing anything for him. He's miserable and there's nothing I can do to help.

SUPPORT BLOGS My husband suffers from chronic pain due to DDD, failed back surgery and nerve damage. He is having a lot of trouble and more pain than usual. I am getting frustrated because I don't know how to help. He is in a downward spiral and I believe his doctor doesn't believe him. He is becoming very depressed and I no longer recognize the person he is after 17 years together. I was hoping to find anyone who suffers with chronic pain and their advice on what their spouse does that helps or maybe how family members help their loved ones.

INCREASING POSITIVE OUTCOMES

EVIDENCE-BASED TREATMENT Most efficacious approach to the treatment of chronic pain conditions is an interdisciplinary team approach in which healthcare providers share a common philosophy and general treatment goals

CHRONIC PAIN MANAGEMENT Temporal Model ACUTE PAIN CHRONIC PAIN PATIENT’S ROLE PSYCHOSOCIAL FACTORS Healthcare Practitioner Role

HEALTHCARE TREATMENT GOALS Increase activity level Facilitate return to work or productive lifestyle Help improve quality of life Provide education to patient and family Decrease dependency on healthcare system

HEALTHCARE TREATMENT GOALS Decrease the incidence of severe, incapacitating pain Emphasize assumption of self-care Teach self-management skills Emphasize use of multiple interventions to manage pain, e.g., exercise, behavioral and cognitive interventions, etc. Address issues of depression and anxiety

PROACTIVE EMPLOYER OBJECTIVES FOR DISABILITY PREVENTION Prevent occurrence of accidents and disability Intervene early for disability risk factors Coordinate services for cost-effective restoration and return to work Recognize signs and symptoms of worker impairment Develop early interventions and preventive responses to potential work disruptions Monitor injured/disabled workers responsively

REDUCING LOST WORK TIME Prevention (i.e., safe work environment, training, etc.) The relative absence of complicating preexisting psycho-social factors, such as drug abuse, alcoholism, job dissatisfaction, personality disorder (employer policies, effective supervision, pre-employment screening, UDS, EAP, etc.) Early intervention - Appropriate assessment and treatment Attention to co-morbid anxiety and depression, and other psychosocial issues Employer accommodates reasonable recommended work restrictions

TOWARD POSITIVE OUTCOMES

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