PROMPT RETURN TO WORK

It is important to return the injured worker back to the workplace promptly to maximize his or her coping skills and functional capacity to return to a normal activity level. The prompt return to work will reduce the incidence of chronic pain syndrome behaviors, minimize impairment and promote the healthful adjustment to or modification of the worker’s lifestyle, to reach the best possible outcomes both vocationally and psychosocially.

Returning an injured worker back to the workplace either to his or her original position or to an alternative position within appropriate restrictions is the ultimate goal of occupational medicine and worker rehabilitation. This may be particularly challenging with an individual suffering from chronic pain. Chronic pain patients are defined as individuals out of work with pain lasting more than 6 months. While representing a small percentage, 3 to 10 %, of all work injuries, these individuals account for an estimated 80 to 90 percent of the total dollar spent in the worker’s compensation system (1). This dollar amount includes both direct and indirect costs. Direct costs include medical, and legal fees. While indirect costs include administrative and training costs, indemnity as well as lost efficiency.

Pain by definition is a subjective personal experience of discomfort known only to the individual. Because of its subjective nature, quantifying this experience is highly problematic. There are no diagnostic tests that actually measure pain. Thus an individual’s expression of pain is ultimately a manifestation of a complex nociception stimuli and the brain’s processing of that stimuli. In addition, particularly in the case of chronic pain, psychosocial factors can significantly affect the interpretation or motivation of these signals and the manifestation of pain behaviors.

There is a distinction between chronic pain and chronic pain syndrome. Chronic pain is the brain’s interpretation of nociceptive stimuli from the body. Chronic pain syndrome is the individual’s behavioral response to pain. This behavioral response is affected not only by the pain stimuli received by the brain from the body, but also by the individual’s emotional state, personality factors and social factors. Chronic pain syndrome includes all changes that an individual experiences when chronic pain enters his or her life. These changes can include: loss of activity tolerance, physical deconditioning, alterations in mood and behavior, changes in interpersonal relationships and loss of social and recreational pursuits. In addition, there may be vocational adjustments, such as loss of a job, diminished productivity, impaired work motivation or the change of a job or profession. Factors that may increase the risk for chronicity and disability can include: previous work injury, total work lost over last 12 months, poor physical fitness, self-rated poor health, heavy smoking, psychological distress and depressive symptoms, low job satisfaction and personal problems. It is important to minimize the development of these chronic pain syndrome behaviors and assist the chronic pain worker adjust to or modify his or her lifestyle to reach the best possible outcomes both vocationally and psychosocially. The prompt return to work of an injured worker is an important part of this adjustment.

In order to minimize individual impairment, it is essential to address return to work concerns immediately with an injured worker. Impairment following an injury may include: diminished functional capacity, reduced strength, limited range of motion, loss in activity tolerance or the use of assistive devices. Impairments can mean restrictions at the workplace. In order to minimize impairment and maximize the successful vocational and psychosocial outcomes, prompt return to work should be a primary goal. To ensure a prompt but safe return to work, appropriate job restrictions should be made. These job restrictions can be temporary or permanent. The restrictions should be based on what the employee can not do, they should be specific and should match the essential or primary job functions.

Returning an injured worker back to the workplace either to his or her original position or to an alternative position within appropriate restrictions is the ultimate goal of occupational medicine and worker rehabilitation. In some cases accommodations may be used to assist the worker in this transition. Other tools to achieve this goal, particularly, where there is no accommodation opportunity, additional medical intervention including pain management, physical reconditioning, or work hardening may be employed to better obtain this goal.

The prompt return to work of an injured worker will also facilitate good coping skills and promote the healthful adjustment to or modification of the worker’s lifestyle. The changes that enter the individual’s life following an injury can affect interpersonal relationships, financial status, recreational or leisure activities, vocational situation and can even cause mood and behavior disturbances. Depression is probably the most commonly encountered emotional disturbance experienced by injured individuals. It is usually part of the worker’s response to loss that they may have incurred in his or her personal life. Other emotional disturbances can include: irritability, anger and resentment, fear or anxiety or changes in his or her personality. These emotional disturbances affect the well being of the individual. The prompt returning of the worker, back to the workplace will promote the healthful adjustment to or modification of a new lifestyle and minimize emotional or personality disturbances thus promoting general well-being.
The prompt return to work will reduce the incidence of chronic pain syndrome behaviors, minimize impairment and promote the healthful adjustment to or modification of the worker’s lifestyle, to reach the best possible outcomes both vocationally and psychosocially. It is important to return the injured worker back to the workplace promptly to maximize his or her coping skills and functional capacity to return to a normal activity level.


References:

1. Monsein M, Clift R: Pain and Returning to Work (chap 29), The Comprehensive Guide to Work Injury Management, Aspen Publish. 1995.

2. ErgoRehab, Inc programs/con ed courses: www.ergorehabinc.com


Nicole Matoushek MPH, PT, CEES, CSHE
www.ergorehabinc.com


ErgoRehab, Inc.

More information about ErgoRehab, Inc. courses

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