An insight into chronic pain
09/10/2023
In the UK, chronic pain affects just under 28 million adults (a third to half of the total population). This may be due to injury, long term condition or degenerative illness.
Pain is a subjective and highly personal experience. Direct measurement of pain is impossible, rather we must rely on individuals’ self-report, and to some extent their behaviour, to provide a glimpse into their experience.' (R.B. Fillington PhD)
In 2019, The World Health Organization (WHO) updated the International Classification of Diseases (ICD-11) to include primary and secondary chronic pain.
Chronic Primary pain is defined as pain that persists for longer than three months and is associated with significant emotional distress or functional disability and cannot be explained by another chronic condition.
Examples of chronic primary pain conditions include fibromyalgia, complex regional pain syndrome, chronic migraine, irritable bowel syndrome and non-specific low-back pain.
Chronic secondary pain is defined as pain that may initially be regarded as a symptom of other diseases being the underlying cause. In many cases, the chronic pain may continue beyond successful treatment of the first cause; in such cases, the pain diagnosis will remain, even after the diagnosis of the underlying disease is no longer relevant.
Examples of chronic secondary pain are chronic pain related to cancer, surgery, injury, internal disease, disease in the muscles, bones or joints, headaches, or nerve damage.
The three most common types of chronic pain are back pain (53%), headache (48%) and joint pain (46%).
Psychological Factors
- Pain Perception can vary dramatically among individuals, for example, a broken bone could be highly distressing for one individual while for another they hardly register the break as painful.
- Concentrating on the pain may increase pain intensity, while distractions may decrease the pain intensity.
- How an individual thinks about their pain may influence it; Beliefs that the pain may be caused by an underlying serious condition, that it would be made worse with certain activities and having an unrealistic expectation of recovery or deterioration may affect pain intensity and occurrence.
- Negative mood, such as transient anxiety and depression may be associated with greater intensity of pain.
- Prior experience of pain may also have an influence on intensity and occurrence.
Biological Factors
- An individuals' associated symptoms such as inflammation may influence their experience of pain.
- General health may also play a part, if the individual has other conditions, these may affect the overall intensity and occurrence of pain.
- Brain function can influence pain: sleep disturbance, medication use.
Social Factors
- Language and cultural barriers: miscommunication and lack of cultural knowledge may increase pain intensity.
- Work/Disability/Low job satisfaction: poor support in the workplace and low job satisfaction may influence the pain experienced.
- Economic: Financial worries may intensify pain.
- Environmental: Personal issues, social relationships both in and outside of the workplace, work conditions, life stresses may all influence pain intensity
Individual experience
Chronic pain is an individual experience, with many factors which can influence the way in which an individual can function day to day.
Some individuals will just get on with it, not allowing the pain to take over their lives and will hide their experience of pain from those around them. They can cope with their pain and continue as normal.
There are those who suffer in silence, not wanting to be a burden on their family or their work colleagues. They may not feel supported, or fear that they may lose their job and worry about the implications of this on themselves, their family and their lives in general. Often these individuals will not seek out medical support.
Others may be consumed by their pain, bringing it to the forefront of their lives and enabling it to define their whole being.
Research shows that those individuals who are listened to, confirmed and supported with their chronic pain are more likely to have a positive outcome and can maintain a healthy personal and social life as well as feeling they are a valued member of the work force.
Managing pain in the workplace can be a challenge for both the employee and employer, but it is not impossible.
Chronic pain is invisible and can fluctuate causing frustration. It can lead to stress, sleep disturbance, fatigue, mood changes and weight gain or loss. It can affect personal and work relationships. Unless acknowledged and managed, it can become disabling.
Early intervention is more likely to achieve a positive outcome and could avoid the pain becoming chronic. But, if it does, what can be done to manage this?
Communication is key to understanding, managing, and supporting an employee with chronic pain to return to or remain in the workplace as a productive member of the workforce.
Kindness, compassion, and empathy are fundamental for workplace discussions:
- What is stopping the employee from returning to the workplace or fulfilling their role to maximum ability?
- Are there any changes/adaptations/equipment that would help?
- Does the employee feel supported?
Aiding the employee to be able to effectively return to or maintain their role does not have to be difficult, it could be as simple as appointing a work buddy to support with heavier tasks, putting stock onto higher shelves, moving a desk to minimise the need for mobility or authorising additional breaks from work activities.
Reducing hours, working from home, flexible working hours or facilitating lighter duties could also be considered.
The list of changes which could be made is not limited. Open discussion, highlighting issues and mutual agreement of actions together with regular reviews can provide a positive outcome.
The employee could be directed to:
- Occupational Health Department
- GP
- Pharmacist
- Support Groups for chronic pain
Ultimately, facilitating a fully supported return to work/maintaining work is likely to have a positive effect for the employee experiencing chronic pain, achieving reduced absenteeism and boosting productivity.
References
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Chronic pain in the workplace: A diary study of pain interference at work and worker strain. Fragoso Z.L., McGonagle A.K. Stress Health. 2018; 34:416–424. doi: 10.1002/smi.2801
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Cognitive and emotional control of pain and its disruption in chronic pain. Bushnell et al. Nature Reviews Neuroscience. (2015).
Cultural Influences on Pain Perception and Management. Elaine T. Miller, PhD, RN, CRRN, FAAN, FAHA Dania M. Abu-Alhaija, BSN, RNDOI: https://doi.org/10.1016/j.pmn.2019.04.006
Factors of importance for return to work, experienced by patients with chronic pain that have completed a multimodal rehabilitation program – a focus group study, Disability and Rehabilitation, Frida Svanholm, Gunilla Margareta Liedberg, Monika Löfgren & Mathilda Björk (2022)44:5, 736-744, DOI: 10.1080/09638288.2020.1780479
Individual differences in pain: understanding the mosaic that makes pain personal. Fillingim, Roger B. PAIN 158(): p S11-S18, April 2017. | DOI: 10.1097/j.pain.0000000000000775
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Suffering out of sight but not out of mind - interpreting experiences of sick leave due to chronic pain in a community setting: a qualitative study. Lundin Å, Ekman I, Wallström S, Andréll P, Lundberg M.BMJ Open. 2023 Apr 11;13(4): e066617. doi: 10.1136/bmjopen-2022-066617.PMID: 37041054
