Chronic pain does not require unemployment.
We all do better if
we stay involved.
Injuries and time off work go hand in hand.
There is nothing more automatic than getting off your feet with a sprained ankle. And if you break your leg, you will take at least a couple of days off work. And if you sprained your low back yesterday, you are not going to do any heavy lifting today. We wouldn’t think of treating a broken arm without a cast. We know we can’t really use the arm until the cast comes off.
And so it is automatic to think that with chronic pain, we should at least cut back on our work, and probably quit altogether. And if you think this way, you are not alone. The soaring numbers of people on disability, a higher percentage than at any time in the past, are sure evidence that many people AND physicians think this way.
They are wrong:
Unemployment is not good for you,
or your pain.
There is strong evidence, based on multiple large medical studies, showing that unemployment is harmful to your health. Even people with musculoskeletal problems, such as chronic neck and low back pain do worse with unemployment. Comparing people who go back to work, (or continue working) to people who quit working (with the same health challenges) shows the true cost of unemployment. These comparisons show that those who quit working:
have a higher mortality rate
develop poorer general health and lower quality of life
have more long-standing illness
experience poorer mental health and have greater psychological distress and psychological/psychiatric morbidity
have higher medical consumption and hospital admission rates
experience more musculoskeletal pain
Continuing to Work or Returning to Work is good for you.
There is a strong evidence base showing that work is generally good for physical and mental health and well-being. The benefits of returning to work, or continuing to work are:
activity-based rehabilitation and early return to work (or remaining at work) are therapeutic and beneficial for health and well-being for most workers with musculoskeletal conditions
work can reverse the adverse health effects of unemployment. (this has been demonstrated for healthy people of working age, for many disabled people, for most people with common health problems and for social security beneficiaries)
Work is therapeutic.
The best place to
rehab a work injury
is on the job.
Most people with musculoskeletal problems do work.
There is a high prevalence of musculoskeletal conditions, yet most people with musculoskeletal conditions (including many with objective disease) can and do work, even when symptomatic. Many patients with severe musculoskeletal diseases such as rheumatoid arthritis remain at work and experience health benefits from working. Thus, musculoskeletal conditions do not automatically preclude physical work.
Full time parenting is a real job.
Some full time parents stay home to raise children and this is a real job. They get the same benefits from active participation in child rearing as employees that return to work.
Adults need to be involved in the activities that are normal for their age. This means going to school or raising children or working for most adults, or participation in active hobbies for adults of retirement age.
Even people on
can find volunteer positions that
are compatible with their
Participation is the Goal
The GOAL for our patients:
Be actively involved in raising children,
Or attending school,
Or working or volunteering at least 20 hours per week,
Or participating in active hobbies for people of retirement age.
Light duty or different job duties may be required.
Musculoskeletal symptoms (whatever their cause) may certainly make it harder to cope with physical demands at work, but that does not necessarily imply a causal relationship or indicate that work is causing (further) harm. Some people will need a different job description. Some people that have been working on their feet all day may need a desk job. Some desk workers may need to be able to get up and move around. Some workers may need to go back to work part time at first. Cooperation between the employer and the health care provider to make reasonable accommodations is important. Returning to work should be the goal and is generally in the best interest of the worker and employer.
Working, or returning to work is associated with:
better mental health,
less use of medical resources,
and overall increased satisfaction with life.
Work is good for people, and the best place to rehab work injuries is at work. Unemployment has a deleterious influence on general health, and unemployed people have worse mental health, more aches and pains, and generally lower quality of life. Although time off work may have a role for acute injuries, it is not beneficial for chronic pain.
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