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By MATTHEW BRODSKY, senior editor/Web editor of Risk & Insurance®

When you're talking chronic pain, presenteeism is better than absenteeism. Getting someone to come to work and perform to their best of their abilities, even if those abilities are diminished, might be the best outcome you can hope for as an employer, according to a pain expert who gave an online presentation on the topic on Tuesday.

And by chronic pain, we're talking here everything from migraines to back pain, abdominal pain to fibromyalgia--any pain that is persistent, not entirely explained by a physical illness or injury, and generally frustrating for everyone involved.

Two RTW keys are the type of treatment given to employees and the speed with which they are brought back to work.

"We have found that a gradual return-to-work plan is best," Sletten told his virtual audience.

And once employees do come back to work, adaptation and moderation are the words. Even if a worker cannot return to their previous duties because of their pain, keeping the person at work in some modified capability is helpful.

As for the providers most likely to make a RTW strategy a success, Sletten said, the literature is clear that pain rehab programs and clinics--versus traditional pain interventions like pills, needles and invasive procedures--deliver the best outcomes. (Of course, Sletten works for one such clinic.)

The goals of such intensive, multiweek, multidisciplinary interventions are to reduce disability and to reduce the person's "expressions of suffering." One key aspect of a pain rehab program is the discontinuation of opioid use. Another is an assessment done by therapists to set reasonable recovery goals for each individual. It's also a matter of controlling patients' expectations and helping them understand that the treatment is but the beginning point of learning to cope with their pain. In this way, the rehab program can become a bridging step between being out of work and going into a work-hardening program or even simply back to their job.

Of course, not every employer has a Mayo Pain Clinic around the corner. They might feel stuck with the usual local physicians, whose idea of treatment is another prescription.

"Unfortunately, there is an intractable bunch who believe in better living through chemistry and injections," Sletten said.

The solution here, he suggested, is searching through online resources, to see if a pain clinic is closer than you think. The American Pain Society and the International Association for the Study of Pain have helpful online resources too, Sletten added.

If a pain clinic is not close by, then your plan could be to put together a treatment team, consisting of a provider with a physical-medicine background and a psychologist or psychiatrist--a team to treat all of the emotional, behavioral and physical factors in the patient's chronic pain.

One additional thing for employers to do when chronic-pain sufferers return to work is to confront the "enablers" in the office.

"One of the most difficult things we deal with," said Sletten.

These are folks who dote on their colleague, always ask them if they're feeling better and maybe even cover for them with work, all of which serves to remind the employee of their chronic pain. Sletten advised that employers address the enablers directly and tell them they are doing more harm than good.

Sletten's Web lecture was part of the DMEC Virtual Education Forum, put on by the Disability Management Employer Coalition in conjunction with insurer Unum.

March 11, 2010

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