Obstacles to returning to work with chronic pain: in-depth interviews with people who are off work due to chronic pain and employers

Abstract

Background: The global burden of chronic pain is growing with implications for both an ageing workforce and employers. Many obstacles are faced by people with chronic pain in finding employment and returning to work after a period of absence. Few studies have explored obstacles to return-to-work (RTW) from workers' and employers' perspectives. Here we explore views of both people in pain and employers about challenges to returning to work of people who are off work with chronic pain. Methods: We did individual semi-structured interviews with people who were off work (unemployed or off sick) with chronic pain recruited from National Health Service (NHS) pain services and employment services, and employers from small, medium, and large public or private sector organisations. We analysed data using the Framework method. Results: We interviewed 15 people off work with chronic pain and 10 employers. Obstacles to RTW for people with chronic pain spanned psychological, pain related, financial and economic, educational, and work-related domains. Employers were concerned about potential attitudinal obstacles, absence, ability of people with chronic pain to fulfil the job requirements, and the implications for workplace relationships. Views on disclosure of the pain condition were conflicting with more than half employers wanting early full disclosure and two-thirds of people with chronic pain declaring they would not disclose for fear of not getting a job or losing a job. Both employers and people with chronic pain thought that lack of confidence was an important obstacle. Changes to the job or work conditions (e.g. making reasonable adjustments, phased return, working from home or redeployment) were seen by both groups as facilitators. People with chronic pain wanted help in preparing to RTW, education for managers about pain and supportive working relationships. Conclusions: People with chronic pain and employers may think differently in terms of perceptions of obstacles to RTW. Views appeared disparate in relation to disclosure of pain and when this needs to occur. They appeared to have more in common regarding opinions about how to facilitate successful RTW. Increased understanding of both perspectives may be used to inform the development of improved RTW interventions.

The Pain at Work Toolkit for Employees with Chronic or Persistent Pain: A Collaborative-Participatory Study

“…Paradoxically, employers completing our survey advocated for early disclosure, but the workplace culture and management behaviours often prohibited this. This aligns with prior research in which people with chronic pain were hesitant to disclose for fear of negative outcomes, yet employers indicate a preference for early disclosure [ 81 ].…”

Predictors of return to work among women with long-term neck/shoulder and/or back pain: A 1-year prospective study

“…Most of the previous studies on predictors of RTW among individuals with MSP have been conducted on workers in general, or only on male workers, and have focused on acute and sub-acute pain or non-specific low back pain [19][20][21][22][23][24]28]. A previous systematic review [33] aimed at summarizing prognostic factors related to RTW among people with long-term neck/ shoulder or back pain suggested that perceived health, recovery beliefs and work ability may be predictive of RTW.…”

“…Earlier research has also shown that individuals’ belief in their ability to work in the future is a predictor of RTW [ 24 , 25 ], and that increased work ability per se is an important predictor for RTW among women with pain in the neck/shoulder and/or back [ 26 ]. Furthermore, social support from work and outside work influences recovery from long-term MSP [ 27 ], which may have a significant role in RTW [ 28 ]. Several studies have reported that social support outside work, such as close relationships and supportive social environment, is associated with reduced MSP.…”

Development and feasibility of an intervention featuring individual supported work placements to aid return to work for unemployed people living with chronic pain

“…Prior underpinning work included a systematic review of supported employment interventions [14], a metaethnography on the perceptions of obstacles to RTW of people with chronic pain and employers [15], and indepth interviews with people off work due to chronic pain, and separately with employers, to capture additional detail about perceptions of obstacles to RTW not covered by our reviews [16]. Using University of Warwick's University/User Teaching and Research Action Partnership (UNTRAP) group (who have public patient involvement (PPI) training), we also consulted people living with chronic pain, who were unemployed, about their views on both the underpinning work and the feasibility study from point of design to completion.…”

“…Some of those not placed indicated that they came into the study with high expectations and felt let down. However, some noted still being pleased at having joined the study as they had found the work preparation session helpful and valued the opportunity to meet people in a similar situation (quotes 15,16).…”