At Paradigm Outcomes, our specialists know that pain is a complex and subjective experience. This is due to the influence an injured worker’s psychological, social and cultural background has on his or her pain perception. This condition is impacted by the pain’s intensity, as well as its meaning to the injured person; what a person believes affects his recovery. Clearly, pain symptoms and the path toward recovery exist within a broad context of an individual’s life and perceived place in society.

There is a relationship between how a person understands his or her pain condition now and in the future, and how well recovery occurs. How pain impacts the injured worker’s life in the present, how it might impact him or her in the coming months, and how much control he or she has over the pain are all questions providers and claims managers should consider when preparing care plans for long-term health and pain management.

Coping With Pain

As people experience major trauma or chronic pain they are immediately less active, and the subsequent physical deconditioning can exacerbate pain problems. Unless that person recovers quickly, he or she must learn to cope with a “new normal.” The pain experience can result in a fear of activity and the rigors of rehabilitation, and can also cause hyper vigilance—a selective attention to bodily symptoms and a preoccupation with the physical experience of pain. These traits can become a roadblock to successful healing.

Anxiety and fear can physically exacerbate pain through autonomic processes that activate pain sensors and create a physical response to a perceived physical threat to the body. In other words, fear of pain can be more disabling than pain itself (Waddell 1993), and those who are able to successfully develop coping mechanisms for such fear avoidance are more likely to experience successful pain management outcomes.

The Biopsychosocial Model for Managing Chronic Pain

Ongoing, or chronic, pain is not a specific disease and not solely a physical response, but rather a reciprocal and constantly changing interaction of variables—biological, psychological and sociocultural— that shape a person’s pain response. After an injury, the development of chronic pain is a process that includes the sensation itself, the perception of pain, and an appraisal of the pain’s meaning and the responses of others.

Lifestyle, interpersonal relationships, stability of home and community, and relationships with the healthcare team are key factors in whether a person can successfully support him or herself through pain management. Positive life goals beyond pain management can drive patient success over time. But, keeping focused on broader life goals during a time of adversity is difficult for some.

Addressing Injured Worker Challenges

Targeted tactics can help mitigate the three main areas of concern for an injured worker with chronic pain. First, some patients become entrenched in care that is not getting them better. When a lack of medical sophistication or knowledge results in blind trust and poor medical choices, try education, seek a credible second opinion or engage case management services (like those provided by Paradigm Outcomes) to raise the likelihood of success. Second, when an individual’s temperament or coping style becomes counter adaptive—when the desire for a “quick fix” gets in the way or a dislike of exercise makes rehab difficult—cognitive behavioral techniques and coaching can make the difference.

Long-standing individual personality traits are the third most common challenge. His or her coping ability, perceived gain from having an injury, or a sense of entitlement or anger management problems can all impact long-term pain management. In these instances, more in depth psychological screening and cognitive behavioral techniques can be powerful tools for improvement.

Psychological Testing

Formal psychological testing should be considered with injured workers who present with complex psychological distress that leads to more intractable functional deficits, excessive pain behaviors, or substance overuse or abuse.

Tools such as the Beck Depression and Anxiety Test, the Illness Behavior Questionnaire, the Sickness Impact Profile, the West-Haven Yale Multi-Dimensional Pain Inventory, and MMPI and Millon testing can provide valuable insight into an individual’s condition and coping strengths and weaknesses, as well as identify obstacles to benefitting fully from potentially helpful invasive procedures or interventions.

Functional Restoration

Restoring function is the best outcome for chronic pain cases. All interventions should have some positive benefit to physical and social functioning. Therapeutic exercise, cognitive behavioral therapy and psychotherapeutic modalities can help address the individual’s entire wellbeing. Experienced medical case management can further assist by clarifying diagnoses, establishing good lines of communication between the injured worker, provider and carrier, and identifying the best options for treatment. A strong team leader is needed to help chart and navigate a successful return to meaningful function.

Other recommended components of a multidisciplinary pain program include:

• Help the injured worker assume responsibility for managing his or her own pain

• Foster self-management and self-efficacy

• Promote exercise, body-mechanics education, lifestyle changes, pacing, and coping strategies

• Support weight loss, smoking cessation, and opiate detoxification

• Evaluate and promote a readiness to change

An injured worker who can learn to minimize his or her disability conviction and fear avoidance, and become more self-efficient is well on their way toward recovering from chronic pain. For more information about helping chronic pain patients get off narcotics, take an active role in their health, restore function and get back to work, visit the Resources section of www.paradigmcorp.com. Paradigm Outcomes is always ready to assist with complex medical needs.