Pain, work, and the workplace: a topical review

Correlation Between Pain Intensity and Trunk Sway in Seated Posture Among Office Workers with Chronic Spinal Pain: A Pilot Field-Based Study

This pilot study examines the relationship between pain intensity and trunk sitting postural control in 10 office workers with chronic spinal pain, using field-based real-time inertial sensors. Pain intensity was assessed with the Numeric Pain Rating Scale (NPRS) before and after work across three non-consecutive workdays, while postural control was evaluated through estimated center of pressure (COP) displacements. Linear and nonlinear metrics, including sway range, velocity, the Hurst exponent, and sample entropy, were derived from the estimated COP time series. Pearson correlation coefficients (r) and corresponding p-values were used to analyze the relationship between pain intensity and postural control. Significant correlations, though limited to specific metrics, were found (r = -0.860 to 0.855; p < 0.05), suggesting that higher pain intensity may be correlated with reduced postural variability. These findings provide preliminary insights into the potential link between pain intensity and postural control. Understanding trunk posture dynamics could inform the development of targeted ergonomic interventions to reduce musculoskeletal stress and improve sitting comfort in office environments.

Mental and Physical Well-Being of Partners of People Living with Chronic Pain: A Narrative Review

This narrative review aims to explore the mental and physical well-being of partners of individuals living with chronic pain. Chronic pain not only affects those who suffer from it, but also significantly impacts the lives of their partners; however, the impacts on partners are not well recognised, despite extensive evidence indicating that their quality of life can be equally affected. This review synthesises current literature to identify the psychological and physical challenges faced by these partners, including increased stress, anxiety, depression, and the potential for developing chronic health conditions themselves. A search of Medline for "chronic pain" and "partner/spouse" from January 1990 to the present was performed, and relevant articles were selected for review. The main findings were that while partners often experience a range of negative physical and psychosocial impacts on their quality of life, dyadic coping strategies can mitigate these effects. This review underscores the importance of future research to develop targeted interventions that address the unique needs of this population, promoting better health outcomes and fostering resilience in the face of chronic pain.

Well-being After Finalization of a Workers' Compensation Claim: A Cross-Sectional Survey

OBJECTIVE

Injured workers can be disadvantaged after a workers' compensation claims ends. This study investigated the association of a range of variables with well-being in injured workers who had finalized a workers' compensation claim >3 months prior.

METHODS

On-line, cross-sectional survey (n = 129, 55.81% female). Well-being was measured using the Psychological Wellbeing 18-item (PWB) and the Personal Wellbeing Score (PWS).

RESULTS

Multivariable quantile regression analysis controlling for education level demonstrated associations between the PWB and levels of psychological distress (-1.53; 95% CI, -2.11 to -0.94; P < 0.001) and resilience (6.51; 95% CI, 2.65 to 10.37; P = 0.001), and between the PWS and levels of psychological distress (-0.04; 95% CI, -0.51 to -0.29; P < 0.001) and resilience (1.2; 95% CI 0.47 to 1.93), P = 0.001.

CONCLUSIONS

Contemporaneous variables of resilience and psychological distress were stronger correlates with well-being than historic claim-related variables.

Social Determinants and Consequences of Pain: Toward Multilevel, Intersectional, and Life Course Perspectives

Despite wide endorsement of a biopsychosocial framework for pain, social aspects of pain remain rarely addressed in the context of pain prevention and management. In this review, we aim to 1) examine the broad scope of social determinants and consequences of pain and their interactions across multiple levels of organization, and 2) provide a framework synthesizing existing concepts and potential areas for future work on social aspects of pain, drawing upon socioecological, intersectional, and life course approaches. Integrating interdisciplinary theory and evidence, we outline pathways through which multilevel social factors and pain may affect each other over time. We also provide a brief summary of intrapersonal aspects of pain, which are thought to operate at the interface between individuals and the social context. Progressing from micro- to macrolevel factors, we illustrate how social determinants of pain can directly or indirectly contribute to pain experiences, expression, risk, prognosis, and impact across populations. We consider 1) at the interpersonal level, the roles of social comparison, social relatedness, social support, social exclusion, empathy, and interpersonal conflict; 2) at the group or community level, the roles of intimacy groups, task groups, social categories, and loose associations; and 3) at the societal level, the roles of political, economic, and cultural systems, as well as their policies and practices. We present examples of multilevel consequences of pain across these levels and discuss opportunities to reduce the burden and inequities of pain by expanding multilevel social approaches in pain research and practice. PERSPECTIVE: Despite wide endorsement of a biopsychosocial framework for pain, social aspects of pain are often unclearly defined, hindering their use in pain prevention, management, and research. We summarize the scope of social aspects of pain and provide a framework synthesizing existing concepts and potential areas for future work.

Phenotypic characteristics of patients with chronic widespread pain and fibromyalgia: a cross-sectional cluster analysis

OBJECTIVE

This study aimed to explore whether phenotypic characteristics of patients with chronic widespread pain (CWP) and fibromyalgia (FM) can be aggregated into definable clusters that may help to tailor treatments.

METHOD

Baseline variables (sex, age, education, marital/employment status, pain duration, prior CWP/FM diagnosis, concomitant rheumatic disease, analgesics, tender point count, and disease variables derived from standardized questionnaires) collected from 1099 patients (93.4% females, mean age 44.6 years) with a confirmed CWP or FM diagnosis were evaluated by hierarchical cluster analysis. The number of clusters was based on coefficients in the agglomeration schedule, supported by dendrograms and silhouette plots. Simple and multiple regression analyses using all variables as independent predictors were used to assess the likelihood of cluster assignment, reported as odds ratios (ORs) with 95% confidence intervals (CIs).

RESULTS

Only one cluster emerged (Cluster 1: 455 patients). Participants in this cluster were characterized as working (OR 66.67, 95% CI 7.14 to 500.00), with a medium-term/higher education (OR 16.80, 95% CI 1.94 to 145.41), married/cohabiting (OR 14.29, 95% CI 1.26 to 166.67), and using mild analgesics (OR 25.64, 95% CI 0.58 to > 999.99). The odds of being an individual in Cluster 1 were lower when having a worse score on the PDQ (score ≥ 18) (OR < 0.001, 95% CI < 0.001 to 0.02).

CONCLUSION

We identified one cluster, where participants were characterized by a potentially favourable clinical profile. More studies are needed to evaluate whether these characteristics could be used to guide the management of patients with CWP and FM.

Best Practices in Documenting and Coding High-Value Care in Workers' Compensation Encounters-ACOEM Guidance Statement

ABSTRACT

Workers' compensation outpatient care requires attention to causation, functional assessment, work disability prevention, and return-to-work planning, elements not usually addressed in other types of outpatient encounters. Because these elements of care deviate from the usual pattern of ambulatory services, providers of workers' compensation care have faced challenges in billing and auditing practices resulting in underpayment when providing high-value care based on evidence-based guidelines. Recent changes in Centers for Medicare & Medicaid Services rules on documentation requirements for coding outpatient evaluation and management encounters offer an opportunity for occupational health clinicians to be paid appropriately for care that follows occupational medicine practice guidelines. There remains a need to define the elements of documentation that should be expected in delivering high-value workers' compensation care. This article provides guidance for documenting high-value workers' compensation care.

Long-term health conditions and UK labour market outcomes during the COVID-19 pandemic

BACKGROUND

Long-term health conditions can affect labour market outcomes. COVID-19 may have increased labour market inequalities, e.g. due to restricted opportunities for clinically vulnerable people. Evaluating COVID-19's impact could help target support.

AIM

To quantify the effect of several long-term conditions on UK labour market outcomes during the COVID-19 pandemic and compare them to pre-pandemic outcomes.

METHODS

The Understanding Society COVID-19 survey collected responses from around 20,000 UK residents in nine waves from April 2020-September 2021. Participants employed in January/February 2020 with a variety of long-term conditions were matched with people without the condition but with similar baseline characteristics. Models estimated probability of employment, hours worked and earnings. We compared these results with results from a two-year pre-pandemic period. We also modelled probability of furlough and home-working frequency during COVID-19.

RESULTS

Most conditions (asthma, arthritis, emotional/nervous/psychiatric problems, vascular/pulmonary/liver conditions, epilepsy) were associated with reduced employment probability and/or hours worked during COVID-19, but not pre-pandemic. Furlough was more likely for people with pulmonary conditions. People with arthritis and cancer were slower to return to in-person working. Few effects were seen for earnings.

CONCLUSION

COVID-19 had a disproportionate impact on people with long-term conditions' labour market outcomes.

Worldwide cohort studies to support healthy ageing research: data availabilities and gaps

BACKGROUND

Population ageing is a transforming demographic force. To support evidence-based efforts for promoting healthy ageing, a summary of data availabilities and gaps to study ageing is needed.

METHOD

Through a multifaceted search strategy, we identified relevant cohort studies worldwide to studying ageing and provided a summary of available pertinent measurements. Following the World Health Organization's definition of healthy ageing, we extracted information on intrinsic capacity domains and sociodemographic, social, and environmental factors.

RESULTS

We identified 287 cohort studies. South America, the Middle East, and Africa had a limited number of cohort studies to study ageing compared to Europe, Oceania, Asia, and North America. Data availabilities of different measures varied substantially by location and study aim. Using the information collected, we developed a web-based Healthy Ageing Toolkit to facilitate healthy ageing research.

CONCLUSIONS

The comprehensive summary of data availability enables timely evidence to contribute to the United Nations Decades of Healthy Ageing goals of promoting healthy ageing for all. Highlighted gaps guide strategies for increased data collection in regions with limited cohort studies. Comprehensive data, encompassing intrinsic capacity and various sociodemographic, social, and environmental factors, is crucial for advancing our understanding of healthy ageing and its underlying pathways.

The combined effects of coping and pain interference on army readiness

Introduction

Chronic pain and associated interference with daily activities are common in the military and impact Force readiness. Chronic pain affects one-third of service members and is a leading cause of medical non-readiness (MNR) in the military. Research suggests that underlying psychological mechanisms related to trait coping styles and pain interference (PI) affect functional outcomes, but little research exists examining this relationship within an Army population. The purpose of this study was to examine the combined effects of PI and coping on U.S. Army soldier readiness by using annual well-being data from the Global Assessment Tool (GAT) and medical non-readiness (MNR) based on duty restriction records.

Methods

The sample comprised 866,379 soldiers who completed the GAT between 2014 and 2017 with no duty restrictions at the time of baseline GAT completion; subjects were observed through 2018 for duty restrictions. Parametric survival regression models with a Weibull distribution predicted demographic-adjusted hazards of MNR by dichotomized PI (no PI/PI) and beneficial/non-beneficial use of GAT coping components (good coping, bad coping, catastrophizing-flexibility, and catastrophizing-hopelessness). Incident MNR was evaluated for all duty restrictions, and stratified by selected body systems (upper extremity, lower extremity, psychiatric).

Results

Among soldiers with PI, hazards were higher in those reporting non-beneficial coping styles (bad coping, hopelessness) and lower in those reporting beneficial coping styles (good coping, flexibility). Across all coping styles, PI/coping interactions were particularly strong for catastrophizing-hopelessness and when examining MNR from psychiatric conditions.

Discussion

These findings suggest some synergistic associations between pain and coping that may impact pain-related occupational disability. Coping skills may be an effective interventional target for chronic pain reduction/prevention within military programs, such as the Master Resilience Training Course offered to soldiers in the Army. Further research should assess whether early coping style interventions can reduce pain-related outcomes.

How does arthritis affect employment? Longitudinal evidence on 18,000 British adults with arthritis compared to matched controls

INTRODUCTION

One in ten working age people in the UK live with arthritis or a similar condition affecting their joints. This impacts their quality of life, including through their work. But little is known about how arthritis affects labour market outcomes and the types of people most likely to be affected.

METHODS

Data from three population-representative household panel surveys (BHPS, ELSA, UKHLS) collected in 2001-2019 was harmonised. Propensity score matching was used to match 18,014 UK adults aged 18-80 who have arthritis with comparable adults without arthritis. The relationship between arthritis and employment, and earnings and work hours conditional on employment, were assessed using multilevel regression modelling. Heterogeneity in these relationships were assessed by age, gender, degree-level education status, NS-SEC job classification and employer type.

RESULTS

On average, arthritis was associated with a 3 percentage point reduction in the probability of employment. The effect size varied over people's life course and was larger amongst females, people without a degree, and those in routine or intermediate occupations (when compared to those in professional occupations) or working for small private companies (when compared to large private companies and non-private employers). Our models predict, for instance, that arthritis is associated with an 11 percentage point reduction in the probability of employment among 50-year-old women without a degree. This contrasts with a 5 percentage point reduction among 50-year-old men without a degree. If employed, men with a degree earned less if they had arthritis, whereas others (including women with a degree and men without a degree) had similar earnings regardless of their arthritis status. Those in professional occupations with arthritis also earnt less, especially if they were women aged over 40, with indications that this was driven by reduced work hours.

CONCLUSION

Policy interventions to support people with arthritis who wish to remain in work might be designed with people in routine work in mind, and targeted at those working in smaller private firms. More research on the cost-effectiveness of those interventions is needed.