This month’s newsletter focuses on the topic of pain. At first glance this may not seem of particular relevance within the workplace but in fact an understanding of the nature of pain and its potential effect on an employee can be very useful to an employer.
Pain is something that hurts! This may appear simplistic but it is the truth. Pain is an individual response. For example not all people with the same condition hurt with the same intensity and amount.
Therefore in order to understand pain we need to understand that pain is unique to the individual.
From a clinical perspective pain is divided under three broad headings. These definitions are from the website of The British Pain Society (www.britishpainsociety.org)
- Acute Pain: This tends to be of sudden onset in response to a specific injury or illness. Acute pain is of a limited duration – less than 12 weeks.
- Chronic Pain: Chronic pain is a continuous and long-term pain of more than 12 weeks duration. It can also be the pain experienced after the time that healing would have been expected to have occurred after trauma or surgery.
- Neuropathic pain: Is pain initiated or caused by a primary lesion or dysfunction in the peripheral or central nervous system. For example pain following shingles, or an amputation, or spinal cord trauma. Pain that occurs in diabetics or in patients with multiple sclerosis, can also be neuropathic.
However there can be pain when there is no evidence of a specific underlying medical condition that would lead to such pain. Dr Michael Luckmann consultant in anaesthetics and pain management at St Mary’s Hospital, Newport, Isle of Wight writes of the work of pain clinics:
“As for Chronic Pain – long-term pain patients are usually referred to our team in the Hospital once investigations into causes have been completed and there is either some cause identified that cannot be cured or improved or there is no clear cause but all serious treatable ones have been excluded. Attempts should have been undertaken in Primary Care to help, and if these are unsuccessful patients are currently referred to Pain Clinics in Hospitals.
So we – a team of medical specialists, specialist physiotherapists, psychologists and nurses working closely together – assess and treat ongoing pain as a problem in itself. In almost all cases, it is not only the pain itself but the longer term consequences that trouble patients: restrictions in mobility, being unable to work, restrictions in social life, impact on mood with frustration, depression, anger, life threats etc. We try if possible to relieve pain itself – often temporarily or intermittently – and improve long term coping and life quality, dealing with the above problems associated with pain.
The treatment and management options in general include specific tailored combinations of medicines, local treatments such as TENS, targeted injections or other procedures, acupuncture, individual or group based physical and psychological treatments, all with the objective to relieve, support and strengthen self management as much as possible. Our programmes on the Island include Return-To-Activity, Functional Restoration and Pain Management Programmes. Other pain clinics will have similar but slightly different options, with tertiary centres offering more tailored programmes and treatments for specific patient groups such as children/adolescents, CRPS patients, Fibromyalgia patients etc.
We never question whether pain is real – if patients suffer we offer help. We realise, that long term pain almost always is far more complex than a local source e.g. injury, inflammation, arthritis, but has a highly relevant central nervous system component which we usually label simplistically as “central sensitisation”, and has very important behavioural and belief aspects: responses to pain – how one deals with it – and beliefs about pain – what’s causing it and why it persists – determine quality of life far more than the underlying diagnosis, and we address problems in behaviour, beliefs and response accordingly to improve lives with pain.”
To summarise therefore pain is subjective to the individual and its management can be very complex.
When we look at pain in the context of the workplace our experience suggests that there are 3 main distinct areas that are of direct concern to employers and employees alike.
- Employee states that their job role is causing them pain. This appears to be solely a work problem with completely reduced symptoms away from the workplace.
- Colleagues and manager report that an employee appears to be “struggling” with their role and appears to be in pain. Employee does not raise an issue and their work attendance is acceptable.
- Employee says that they are in too much pain to attend work. They have unacceptable levels of attendance and performance issues while at work.
1. Employee states work is causing pain:
From an employer’s perspective this needs a two-fold approach.
There needs to be a focus on the job role and the individual.
A Risk Assessment needs to be carried out that reviews the following:
• What part of the job role is causing the employee pain?
• Are they doing it correctly?
• Are other employees also experiencing problems?
• If so how many?
• Are there any other factors such as the potential for “short cuts” if targets have to be met or they can go home after the job’s finished?
• Is the role repetitive with no job rotation?
• If there appears to be a pattern of problems with a number of individuals this will require further action which could include ergonomic assessments/re-training or other options.
A specific Risk Assessment should be undertaken for the individual in order to ascertain any of the above issues.
The individual should then be restricted from the task.
A referral should be made to Occupational Health.
If as a result of the above the situation is found to be specific to the individual and any workplace adjustments advised by occupational health do not appear to be effective, then the individual will either need to be redeployed or be considered under Capability measures.
If there appears to be a problem for other staff members alternative working methods or processes will need to considered.
2. Employee appears to be in pain but does not raise it as an issue:
There is one question for the employer here: Are there any performance issues?
If the answer is no then the Line Manager MAY wish to have a brief chat just to check if the employee needs any support. However otherwise accept that the employee is an adult and should have their dignity respected by being allowed to deal with their own pain.
If the answer is yes: Can you define the performance issues? Are they slower or is the quality of their work poorer? If so discuss with the employee and if appropriate refer to occupational health to see if there are any possible adjustments to the role.
3. Employee says that they are in too much pain to attend work. They have unacceptable levels of attendance and performance issues while at work
The employer must take the employee’s word at face value. If they are in too much pain to work they will need to be considered under capability. The employer needs to decide regarding the timescales for this.
In this case the reason for referral to Occupational Health is to ask whether the pain is likely to be time limited and if so for how long? If Occupational Health are unable to give a timescale for an expected return OR the individual is not able to return within the occupational health timescale It is important to remember that past sickness absence is the best predictor of future sickness absence. For example if an individual has been in too much pain to work but prior to their sick pay running out say they are ready to come back to work the question should be “What has changed?”
Occupational Health may also advise on possible workplace adjustments. However if these cannot be accommodated OR the employee is still in too much pain to work once again capability needs to be considered.
Our experience is that employers can believe that the medical “experts” can determine whether or not the pain is real. We cannot, nor is it relevant.
If an individual self-declares that they are in too much pain to work and Occupational Health advises that they cannot give a timescale for this to change, then the employer needs to consider Capability and possible dismissal on medical grounds.
The OHC team are happy to answer any questions you may have regarding this topic. Please contact us via firstname.lastname@example.org
Call us today and take the first step to a safer work environment.