Chronic Pain at Work

Pain is defined as an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage. 
Chronic pain is defined as pain experienced on most days (or every day) for three months or more. High-impact chronic pain is pain that limits a person’s life or work activities most days for three months or more.  Health Canada states that almost eight million Canadians live with chronic pain. These individuals experience a range of physical, emotional, and social challenges. 

Common symptoms experienced when living with chronic pain include:

• Issues with mobility or function, such as agility, dexterity, flexibility, strength, and grip
• Stiffness, especially in the morning or when stationary for periods of time
• Fatigue
• Concentration
• Reduced physical and mental stamina

Chronic pain can result from a known cause, such as rheumatic diseases or degenerative conditions (such as osteoarthritis or osteoporosis), cancer, post-surgical events, multiple sclerosis, or Acquired Immune Deficiency Syndrome (AIDS). Chronic pain syndromes may include fibromyalgia, sciatica, persistent headaches, or irritable bowel syndrome. Many conditions may cause chronic pain - not all are listed here. 

However, a precise cause is not always known. Chronic pain can occur without an obvious injury or disease, after an injury has healed, or after a condition has been treated.  Similarly, the amount of pain a person experiences is not always equal to the amount of damage or harm to their body. For example, someone can experience pain without tissue damage or can have tissue damage without pain. 

Nerves in our body carry messages to the brain. The brain interprets these messages, including whether there is a feeling of pain.  

Chronic pain can cause changes to the brain and nervous system. For some, the pain may reduce over time. For others, the cause of the pain may not be reduced. For others, these changes cause the brain to send signals of pain even when there is no harm or damage. 

The impact of chronic pain can range from mild discomfort to unbearable pain. Descriptions of the pain can include persistent, nagging, and wearing. The severity can vary and is often unpredictable. Some conditions have “flare-ups,” meaning there is a period when symptoms are experienced more intensely than the normal day-to-day pain. Similarly, some individuals will have both good and bad days. 

The pain can make movement and sleep difficult. It can also contribute to frustration, anxiety or depression. People with a chronic condition often worry about the future, such as worrying about causing more pain to themselves or about their ability to work.  

In a work setting, some workers may try to continue to work while experiencing pain, while others may continue to work because they are afraid of losing their jobs or feel they cannot report the conditions they believe are contributing to their pain.  Often, these situations lead to increased stress and may worsen their condition. 

Pain can also be related to social barriers. Since pain is “invisible”, other people may not understand the pain or may not believe the pain is real. Individuals who experience pain can often feel isolated.

Overall, chronic pain can impact:

• Physical health
• Mental and emotional health
• Finances and job security
• Social interactions
• Sense of self and spirituality
• Ability to take part in everyday activities

Always consult with your healthcare provider about the care that is right for you. Treatments and therapies will vary and may include:

• Medications
• Psychological interventions
• Physical and rehabilitation interventions
• Medical devices 
• Pain treatment procedures, such as stimulation or nerve blocks
• Therapeutic activities, such as acupuncture, massage, etc. 
• Self-management techniques, such as meditation, support groups, and dietary practices, etc. 

The most important action a workplace can take is to prevent or reduce injuries from occurring and to address situations that may make the pain worse. Discuss options with the worker to determine what can be done to manage their pain, such as from conditions like rheumatoid arthritis, osteoarthritis, fibromyalgia, cancer, multiple sclerosis, stomach ulcers, gallbladder disease, irritable bowel syndrome, migraine disorder, traumatic brain injuries, etc. There are many causes of chronic pain, and not all are listed here. 

Another approach is to assess if the work itself is causing pain. Conduct a hazard identification and risk assessment and focus on areas where the pain may occur, such as when work-related musculoskeletal disorders are an issue.  Use the hierarchy of controls to address tasks that involve awkward postures, prolonged static postures (both sitting and standing), repetitive movements, manual lifting, vibration, working in the cold, under stress, psychosocial factors, etc. 

Early intervention often helps reduce the impact of the injury and may prevent more serious injuries. Encourage workers to report early symptoms. Workplaces should act on what has been reported, such as adjusting the work environment to reduce the causes of the pain. Encourage workers to seek treatment and recover. Employers should inquire if they see workers completing tasks in a different manner, switching positions, leaning forward, shifting weight more frequently from foot to foot, or not being able to turn their head or body to look at a person who is speaking. These actions may indicate a worker is trying to work around pain. 

Employers should establish a “return to work” or “stay at work” program as part of their duty to accommodate individuals. Being able to work is good for the individual’s physical and mental health.  An accommodation is a modification to rules, policies, practices, or tasks to ensure that a person can fully participate in the workplace without discrimination.  Human rights legislation specifies that employers have a “duty to accommodate” a worker’s needs in relation to a disability (either mental or physical) up to the point of undue hardship. Each situation is unique, and any accommodation (and hardship) would be evaluated on a case-by-case basis.  Remember that workers’ health information is considered confidential unless they give the employer permission to tell others.

• Establish policies and procedures that support workers who are living with chronic pain.  
• Encourage communication in a psychologically safe work environment.
• Listen with compassion to workers when they opt to discuss their situation. 
• Create awareness about chronic pain. 

Make sure human resources, managers, and supervisors are aware of these policies and procedures and can apply them appropriately. Monitor and follow up to ensure that accommodations are in place and appropriate.  Allow time for the plan to become effective. Make adjustments to the accommodation plan as needed. 

For more information on return to work programs, please see the following OSH Answers documents:

• Return to Work – Accommodation
• Return to Work – Program Overview
• Return to Work – Job Demands Analysis
• Return to Work – Functional Abilities Evaluation
• Mental Health – Return to Work 
• Psychological Health and Safety Program – Assessing Psychological Hazards

If pain occurs:

• Encourage early identification – provide support and implement procedures that allow workers to report conditions that are developing or continuing
• Reduce the physical demands of work, including heavy lifting, carrying, repetitive work, forceful movements, static postures, fast-paced work, vibration, etc. 
• Adjust work demands, including reducing stress, as stress has been shown to aggravate symptoms
• Be flexible – plans should be tailored to the individual and their situation. Understand that for many individuals, symptoms will vary (there will be “good days and bad days”)
• Follow ergonomic principles – for example, if working at a desk:
  • adjust workstations to make the layout suit individuals
  • use a different style of computer mouse, keyboard, voice recognition system, or wireless headsets
  • use cushions to relieve pressure when sitting
  • use an adjustable chair and desk
  • allow the individual to be able to sit or stand as needed 
• Change how tasks are done – use lift assist devices, move items using carts, change knob handles to lever handles, add handles to packages that have to be lifted, etc. 
• Provide alternatives – consider task rotation, working from home
• Adjust work hours – allow reduced hours, flexible start and finish times, taking breaks, and a gradual return to work
• Provide support – for example,
  • allow the individual the ability to pace their work or take breaks
  • provide a location to meditate, stretch, or lie down to rest
  • offer private spaces to administer required medications
  • offer access to counselling, fitness programs, or memberships
• Design the workplace to accommodate persons living with disabilities. Consider how the individual may need access to facilities such as toilets, meetings held on different floors or in different buildings, dedicated parking near the entrance, etc. 
• Provide education and training on how to work safely, and on understanding chronic pain and how it affects individuals.  Help colleagues understand the impact of chronic pain 
• Encourage care – provide time to attend appointments, participate in fitness or exercise programs, etc. 

• Understand that pain can vary, and the individual may have good days and bad days
• Know that they may need to do tasks differently, such as use their non-dominant hand, sit or stand when others do not, stretch more frequently or lean on counters or chairs
• Accept that some movements may be necessary to reduce pain (such as switching positions, leaning forward, or shifting weight more frequently from foot to foot) or may be difficult (such as not being able to turn their head or body to look at a person who is speaking)
• Help workers living with chronic illness feel connected by including them in work and social events (virtual or in-person)