Psychological Barriers to a Successful Return to Work: Chronic Pain

Chronic pain, characterized by persistent pain for longer than 3 months despite treatment and/or medication, is the most common reason for Long Term Disability (LTD) claims. Prevalent conditions for chronic pain include back and neck pain, arthritis, and fibromyalgia. The goal is to manage or improve, chronic pain symptoms to prepare the insured for a return-to-work (RTW). There can also be psychological barriers that may be impacting the insured’s ability to reintegrate into their role or modified role successfully.

NYRC connected with one of our experts in the field, Dr. John Lee, Ph.D., C.Psych., for a Question & Answer to discuss psychological barriers in pain syndromes and how employers and LTD insurance providers can navigate the topic of mental health in chronic pain cases, in general.

What psychological barriers prevent an employee with chronic pain from a successful return-to-work?

“There are several psychological barriers that can impede an employee’s RTW:

• Fear of Pain – Individuals with chronic pain may fear exacerbating their pain and believing that their pain will result in significant harm. This leads to avoidance behaviors, perpetuating the pain cycle. 
• Depression and Anxiety – Mood disorders can reduce motivation and energy levels, making it extremely challenging for an individual to engage in work-related activities.
• Catastrophic Thinking – Patients may catastrophize their pain and its meaning, believing it is much worse than it is, leading to avoidance of work and activities crucial for rehabilitation.
• Social and Systemic Issues – An absence of support from colleagues or supervisors can lead to feelings of isolation and hinder a successful return. In other cases, a toxic or harassing environment can also lead to significant disincentives to return to work and reduce patient’s motivation to adhere to a treatment plan.”

How can an employee be screened for psychological barriers during an Independent Medical Evaluation (IME)?

“During an IME, several methods can be employed to screen for psychological barriers, including:

• Psychological Interviews – Conduct structured interviews to carefully assess the employee's mental state, coping strategies, and concerns related to returning to work. The interview should get at potential barriers to successful recovery in particular, as well as individual thinking styles that may hinder rehabilitation.
• Questionnaires and Assessment Tools – Administer standardized assessments like the Tampa Scale for Kinesiophobia or the Pain Catastrophizing Scale to evaluate catastrophic thinking and fear avoidance beliefs/behaviours.
• Observational Assessment – Observe the patient for signs of pain behaviour, avoidance behaviour, emotional distress, and readiness for change. 
• Review of Medical Records: Examine past psychological assessments and treatment history to gain insight into pre-existing conditions as well as post-injury challenges.”

Why is psychological screening important for employees off work due to chronic pain?

“Proper psychological screening is crucial for employees with chronic pain because it helps to identify the underlying psychological factors that can significantly impact their ability to return to work successfully,” says Dr. Lee. “Chronic pain is associated with a multitude of emotional complaints such as depression, anxiety and stress, which research shows can further worsen pain and hinder rehabilitation efforts. Moreover, there are certain ways of thinking and interpreting information that patients have that, if properly identified, can help clinicians address root causes of barriers to recovery.  Overall, proper screening allows clinicians to assess the employee's mental health, coping mechanisms, cognitive styles and readiness to return to work, helping to tailor their rehabilitation plan accordingly.”

How does the identification of a psychological barrier assist the employer and employee with a successful return to work?

“Identifying psychological barriers is crucial for developing a targeted and effective treatment plan. It allows for tailored interventions, improved communication, advance planning for accommodation, and monitoring progress through objective testing.”

What is the most common psychological barrier in these cases and how is it handled?

“The most common psychological barrier in employees with chronic pain often relates to their anxiety about exacerbating pain at work and causing harm, letting supervisors/co-workers down and being a burden, as well as fear of loss of employment. These fears can be addressed through proper education regarding hurt vs. harm, cognitive behavioural therapy techniques, as well as clear communication with stakeholders to ensure a successful return to work.”

Conclusion

Providing assessment and support for insured persons who are ready to return-to-work improves outcomes and contributes to a successful return. An employee’s return and reintegration into society improves mental health, wellbeing, and overall quality of life.

NYRC’s roster contains qualified mental health professionals who are equipped with the knowledge and expertise to provide guidance on your LTD files and assist with an insured’s successful return-to-work.

If you are interested in learning more about navigating mental health and return-to-work files, please click the link below to request information on a Lunch & Learn for your team with Dr. John Lee, Ph.D., C.Psych., or another one of NYRC’s mental health experts.