Chronic or persistent pain is just that – lasts or recurs for more than 3 to 6 months and likely to be with you for the rest of your life. It is a common but serious condition that can impact on a person’s well-being and have negative psychological, social, and economic effects. Given its widespread prevalence in US workforce, it causes a big financial impact for employers due to lost productivity and reduced workforce participation. Chronic pain is the number one cause of adult disability in the United States, and musculoskeletal pain—especially joint and back pain—is the most common single type of chronic pain.

IMPACT OF COVID-19 ON CHRONIC PAIN

COVID-19 has resulted in the most rapid transformation of the workplace. Working from home has become the new normal.

Before COVID-19 era, full-time employed Americans spend more than 2,000 hours a year working. This number has likely gone higher in 2020. With so much time spent on the job, in a totally different work environment, with much fear and uncertainty surrounding the pandemic – work life as we know it has changed. American workers are experiencing common types of pain, such as lower back pain, shoulder pain, neck pain, and facial pain. Majority of them are skipping routine medical care for pain management, due to obvious reasons. Left untreated, these acute musculoskeletal problems will turn into chronic pain.

There’s no blueprint for what we’re facing and benefit leaders need to change strategies to keep up.

PREVALENCE OF CHRONIC PAIN IN THE US

Chronic pain is already a national epidemic. Pain-related conditions affect 116 million adults in the United States.

Approximately 4 in 10 Americans say pain interferes with their mood, activities, sleep, ability to do work or enjoyment of life.

The combined incremental costs of care and lost productivity from pain cost the U.S. economy an estimated $560–$635 billion annually, equating to a cost of $2,000 per U.S. resident.

These costs make chronic pain more expensive than the annual costs of heart disease ($309 billion), cancer ($243 billion), and diabetes ($188 billion).

WHY IS CHRONIC PAIN DIFFICULT TO DECIPHER?

Many primary care providers (PCPs) are comfortable treating acute pain due to its short course and usually identifiable cause, however they are much less comfortable treating chronic pain due to the myriad of complexities. Sometimes, it is not possible for physicians to pin point the cause of chronic pain and it can be frustrating not to have a diagnosis. Chronic pain is complex because it involves the nerves and nervous systems, including the central nervous system made up of the brain and spinal cord. It can continue even after the injury or illness that caused it has healed or gone away. Pain signals remain active in the nervous system for weeks, months, or years. Some people suffer chronic pain even when there is no past injury or apparent body damage.

Therefore, tests such as x-rays and MRI scans that look at the state of tissue are often negative or inconclusive and therefore are not often needed.

That makes pain very subjective. Only patients can adequately describe what it is like and the effects that it has on their life.

Unfortunately, most medical students lack adequate training in pain management, usually receiving only a few hours’ worth in their entire education, which is a key barrier to effective pain treatment and management.

HOW DOES CHRONIC PAIN IMPACT PRODUCTIVITY IN THE WORKPLACE?

Chronic pain is complex condition and the symptoms vary in duration, intensity and are highly individualized. However, individuals with chronic pain often share many of the same frustrations and difficulties. Those suffering from chronic pain in the workplace are less engaged at work, have poorer health capital, and can be prone to a greater feeling of unfairness. Nearly half of employees living with chronic pain (46%) say their pain affected their ability to perform their job.

Somatic experiences of pain and pain interference with daily activities at work often leads to psychological distress and strain in workers. Employees living with chronic back and joint pain have a higher risk of developing depression. Research suggests that anywhere from 30 to 50% of people with chronic pain also struggle with depression or anxiety.

Absenteeism, or employees missing work, is a common side effect of chronic pain. Employees also suffer through presenteeism – being physically present at work but unable to perform at full capacity.

HOW EMPLOYERS CAN SUPPORT EMPLOYEES LIVING WITH CHRONIC PAIN?

Organizations that create practical solutions for employee health at work are typically leaders in terms of employee satisfaction and overall productivity. As pain management becomes an ever-larger share of health costs, leading employers are paying more attention to the incidence and prevalence of pain in the workplace, the direct and indirect costs of pain, and the mitigating programs and interventions made available to employees. 

To start, it is important for employers to design work environments that help employees avoid injuries and manage pain. A supportive workplace can help employees manage their chronic back and joint pain and improve their wellbeing.

Two, providing good advice and support at an early stage is critical. Employers can assist in helping to identify and support the implementation of strategies to assist employees experiencing chronic musculoskeletal pain. This includes promoting regular breaks, offering flexible work hours, recommending rest and exercises, and creating an open culture that raises awareness about pain.

Third, employers should offer chronic pain management programs which are comprehensive and multi-modal with mental health support.

Four, employers should change benefit plan designs to facilitate access to high-value treatments (that treat pain effectively and offer non-opioid alternatives) and providers. Access is still a significant barrier for many individuals and employers’ efforts to design and communicate easy access to treatment for pain is a critical part of making sure employees get better.

CHRONIC BACK AND JOINT PAIN MANAGEMENT PROGRAM

The chronic joint and back pain management programs should be comprehensive and encompass a wide variety of methods to manage discomfort, improve function, and boost overall health and wellbeing. These programs should include treatment for co-occurring disorders, such as depression, anxiety, or addiction when necessary.

The programs must require the patient to take an active role in his or her own treatment. While some of these programs may be carried out in an outpatient basis, digitally-delivered programs are most conducive for access and adherence.

Here are some key features for digitally-delivered chronic pain management programs.

Physical Therapy

Guided and paced physical activity has the capacity to retrain the brain and therefore chronic pain. For workers dealing with a chronically aching back or general soreness, stiffness and pain, movement is the best course of action. That’s where physical therapy comes in.

PT strengthens muscles and joints and helps patients learn to move and perform daily activities in ways that don’t aggravate old injuries or put them at risk of new ones. Physical therapists also treat inflammation and address the movement dysfunction that’s at the core of much chronic back and joint pain.

Typical treatment involves gradual exercise, building up overall activity and relaxation techniques, to manage pain and improve function.

Behavioral Health Support

Behavioral health support helps people cope with the thoughts, feelings and behaviors that accompany chronic pain.

It promotes adaptive coping by increasing self-efficacy in the management of pain, reduce avoidant behaviors, reduce negative or unhelpful beliefs about their pain, reduce negative mood symptoms to shift the perspective from pain to improved functioning, and to increase general quality of life despite having chronic pain.

By shifting patients thinking away from the pain and change their focus to more positive aspects of their life, they can change the way their body responds to the anticipated pain and stress.

Pain Education

There’s promising research that member education may relieve pain symptoms or improve physical functioning. An effective way of resolving chronic pain in the workplace is by educating members on “self-care” strategies. Self-management of persistent pain is beneficial in the long term by lowering the risk of depression, reducing pain levels, and enhancing physical activity in chronic back and joint pain patients.

By empowering people to advocate for better pain control and prevention measures, pain education reduces unnecessary hospital admissions, dependence on strong pain drugs, as well as time and money spent on pain care.

INTEGRATE AND EVALUATE MSK ‘POINT’ SOLUTIONS

Leading-edge employers, in an effort to mitigate the impact of pain and its related syndromes, have begun to engage more directly with employees to ensure that they understand pain, its causes, and how to manage it appropriately. Many of them have started to embrace alternative therapies to manage pain, such as massage, acupuncture, yoga, and chiropractic care. What is less clear, however, is how to best design, coordinate, and measure the impact of these interventions.

Great opportunity for improvement exists in simply connecting disparate and fragmented MSK programs that detect pain-related symptoms and problems but do not necessarily effectively coordinate or manage care. These include Tele-PT, second opinions, exercise-focused digital programs, EAP etc.

Using an evidence-based and continuous quality improvement process and
outcomes management approach to integrate vendors could construct a more comprehensive understanding of action paths and programs worth considering.

BUILD FOR FLEXIBILITY AND DIVERSITY

When considering programs and treatments to manage pain, employers should address the accessibility issue to ensure that all of their employees including those who are at different locations and those who are mobile or work from home, are able to access the programs. Ideally, these programs are offered to both employees and their family members. For non-digital programs, employers should have policies that support employees utilizing these services such as paid break times, during all shifts.

BENEFIT PLAN DESIGN CHANGES

In most health plans, there is a mismatch between the widespread prevalence of chronic back and joint pain and the available benefits for treatment options. Many people with chronic conditions remain underinsured, spending greater than 10% of their incomes on medical care, excluding premiums. In addition, access to specialist care and services such as physical therapy are often subjected to limitations.

For organizations with high MSK spend attributed to chronic pain, at the minimum, generous coverage is needed for comprehensive, interdisciplinary modalities of treatment like physical therapy, stress management, rehabilitation, alternative therapies and medications that are known to be effective and safer than usual care. For cost-sharing, benefit leaders should explore new and innovative models such as value-based benefit designs (VBID), where member co-pays would be reduced or eliminated for best-practice pain treatment. VBID have proven successful in encouraging healthy behaviors and reducing health care costs.

Another strategy is to align incentives with patient outcomes rather than the current fee-for-service reimbursement that rewards volume over quality. When outcomes are rewarded, clinicians are more likely to use therapies seen to be effective.

SUMMARY

Pain creates an enormous burden for both employees and employers, and despite the potential for improved management of pain, systematic programmatic approaches are lacking.

Sprite Health provides an evidence-based digital care program for chronic back and joint pain. This 12-weeks program blends exercise therapy, behavioral support and education. The combination of a dedicated care team (physical therapist, behavioral coach and care concierge) with robust self-management technology tools help your people with goal setting, and guide them every step of the way with support, adjustments, education, motivation and positive reinforcement.