Barriers to rehabilitation and return to work for unemployed chronic pain patients: A qualitative study

Abstract

This paper explores the perceived barriers to return to work presented by unemployed patients with chronic musculoskeletal pain. The findings are based on one to one in depth semi-structured interviews conducted with patients from four sites in the UK. Interview data were recorded from 38 patients (15 male, 23 female) aged between 29 and 62 years the sample included patients who had participated in a vocational rehabilitation scheme, those who had refused to participate and a nai ve group. Patients were in receipt of long-term social welfare benefits (incapacity benefits) and recruited via local Job Centres. The mean duration of work absence was over 5 years. The data was transcribed and analysed by means of thematic analysis. Several themes were identified as barriers to return to work from the data including pain related issues, uncertainty (both financial and physical), the healthcare system, interaction with benefits providers, perceptions of employers and personal limitations. The uncertainty and the pain condition itself were the overarching barriers from which other obstacles stemmed. This is the first qualitative study of long term unemployed benefit recipients with chronic pain. Others authors have reported psychosocial factors as barriers to work among disabled populations however, this qualitative study has identified barriers specific to unemployed chronic pain patients. The themes identified will help with the planning and development of future initiatives for returning chronic pain patients to employment.

A synthesis of qualitative research exploring the barriers to staying in work with chronic musculoskeletal pain

“…A conceptual analysis of these 77 papers is reported in full elsewhere [18]. Of these 77 papers, 19 (reporting 15 qualitative studies) included concepts related to experience at work [14, 15,[27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43].…”

Patients' experiences of living with persistent back pain

“…It can also make it difficult to plan activities, both on a short-term and a long-term basis (Corbett, Foster, & Ong 2007;Patel, Greasley, & Watson 2007). Patients may thus be forced to give up work and valued leisure activities (Corbett, Foster, & Ong 2007;Osborn & Smith 1998;Patel, Greasley, & Watson 2007). The loss of activities and social roles which previously contributed to the patient's sense of self worth, is likely to add to emotional distress (Harding, Parsons, Rahman, & Underwood 2005;Vroman, Warner, & Chamberlain 2009).…”

“…This can make it difficult to know what to do for the best, leading to a sense of helplessness and being at the mercy of what the pain 'decides' to do next (ibid). It can also make it difficult to plan activities, both on a short-term and a long-term basis (Corbett, Foster, & Ong 2007;Patel, Greasley, & Watson 2007). Patients may thus be forced to give up work and valued leisure activities (Corbett, Foster, & Ong 2007;Osborn & Smith 1998;Patel, Greasley, & Watson 2007).…”

“…This may include being clear and honest about abilities and limitations, and sharing experiences with other people (ibid). Finally, the provision of pain management strategies can help to restore the patient's sense of control and ability to plan ahead (Holloway, Sofaer-Bennett, & Walker 2006;Patel, Greasley, & Watson 2007;.…”

Return to work following disabling occupational injury – facilitators of employment continuation

“…Thus far, research in this vein has tended to focus on barriers to (2)(3)(4)(5)(6) and/or facilitators of (7-10) a return to the workplace. Although this is an important milestone in the return-to-work process, it is only a step toward the achievement of a safe and sustainable employment outcome.…”