THE INJURED WORKER’S FAMILY
AND SIGNIFICANT OTHERS
IMPACT ON RECOVERY AND RETURN TO WORK
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 workrelated 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
INFLUENCE OF
PSYCHOSOCIAL
FACTORS
Influence/Risk
Acute
Pain
Subacute
Pain
2-4 mos.
Chronic Pain
3-6 mos.
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
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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
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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
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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
HEALTHCARE TREATMENT GOALS
•Decrease dependency on healthcare system
•Increase activity level
•Facilitate return to work or productive lifestyle
•Help improve quality of life
•Provide education to patient and family
HEALTHCARE TREATMENT GOALS
•Decrease the incidence of severe,
incapacitating pain
•Address issues of depression and anxiety
•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.
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
Thank You