From the Guidelines
Return to work is generally recommended even when pain is the only finding without objective pathology, as prolonged absence from work can lead to deconditioning, psychological distress, and reduced likelihood of ever returning to employment. A gradual return to work approach is most effective, starting with modified duties or reduced hours that progressively increase as tolerance improves. This approach should be individualized based on the person's specific job demands, pain intensity, and functional limitations. Communication between the healthcare provider, employer, and patient is essential to establish appropriate accommodations. Some key points to consider when implementing a return-to-work plan include:
- Individualized approach based on job demands, pain intensity, and functional limitations
- Gradual increase in work hours and duties as tolerance improves
- Regular reassessment of progress and adjustments to the plan as needed
- Provision of pain neuroscience education to help patients understand that pain doesn't always indicate tissue damage and that movement is generally safe and beneficial
- Consideration of the potential benefits of work itself, including structure, social support, and improved self-efficacy, as supported by evidence from studies such as 1 and 1. Key aspects of the return-to-work plan should focus on achieving functional goals, decreasing pain severity, improving quality of life, and identifying and addressing any treatment-related adverse events or behaviors, as outlined in 1.
From the Research
Evidence for Return to Work with Chronic Pain
- There is evidence to suggest that cognitive behavioral therapy (CBT) can be effective in managing chronic pain and improving outcomes such as mobility, quality of life, and disability 2, 3.
- A study found that patients with chronic musculoskeletal pain who received CBT as part of an interdisciplinary pain management program showed improved depression and anxiety outcomes, and were more likely to be working at 3-year follow-up 2.
- CBT has been shown to be a useful alternative to opioid therapy for chronic pain management, with lower risks of addiction and overdose 3.
- The pathophysiology of pain is complex and involves both physiological and pathological components, including nociception, inflammation, and central sensitization 4.
- While there is no direct evidence to support return to work when pain is the only finding and there is no objective evidence of pathology, CBT and other interdisciplinary approaches may be beneficial in managing chronic pain and improving functional outcomes 5, 6.