More than 100 million people-- as many as a third of the U.S. population--are dealing with chronic pain at any one time, medical researchers estimate. Often defined as any pain lasting more than 12 weeks, chronic pain may be the result of an injury like a sprain, an illness such as multiple sclerosis or a condition such as spinal stenosis. It may lead to other health problems such as sleep disturbance, fatigue and mood changes. It may cause people to limit their movement, which may in turn reduce flexibility, strength and stamina. In the most severe cases, this downward spiral leads to depression, despair and general disability. There’s a societal cost as well, estimated to be more than $600 billion a year in medical treatments and lost productivity.
Yet many of those who experience chronic pain continue to work either because they need the income, to retain insurance coverage or because they enjoy what they do and don’t want to give it up. Physicians and policy makers almost universally agree that the 1990s trend of treating such pain with long-term use of opioid medications has had disastrous consequences. In 2017, the number of overdose deaths involving opioids was six times higher than in 1999, according to the Centers for Disease Control and Prevention (CDC).
The CDC and the National Institutes of Health now believe that helping people self-manage their chronic pain is a far more promising approach. In pain self-management programs, individuals are taught to solve problems, manage pacing of activities, improve their decision-making and take other actions such as practicing meditation to manage pain.
Individuals who participate in these programs have significantly increased their ability to cope with pain. They improve their ability to be active, healthy, and involved members of their communities.CDC
The Center for Rehabilitation Outcomes Research (CROR) at the Shirley Ryan AbilityLab will be adding to the research on chronic pain with a grant from the National Institute on Disability, Independent Living and Rehabilitation Research (NIDILRR) examining the barriers holding back people with chronic pain from finding jobs or staying employed. CROR researchers are now recruiting participants for a study looking at whether cognitive behavioral therapy (CBT) delivered at work can reduce the interference of chronic low back pain for people with a variety of conditions or disabilities. “Cognitive behavioral therapy has already been validated in the treatment of chronic pain, but we want to fine tune the intervention for people with pain at work,” said Dawn Ehde, Ph.D., principal investigator on the study.
In fact, the Shirley Ryan AbilityLab was a national leader in creating an outpatient pain management program for people dealing with chronic pain. “Here at the Pain Management Center, we recognize that pain is multifaceted,” says Maya Yuen, PT, OCS, Manager of the hospital’s Pain Management Center in Chicago. “It’s not only the injury that occurred at the site. It can evolve into something systemic. You might go from localized pain to generalized pain.” The Pain Clinic helps patients understand how persistent pain works, which can reduce the anxiety and self doubt that often comes with it. It’s a comprehensive approach that may include working on movement with a physical therapist, looking at workplace modifications with an occupational therapist and talking about fear avoidance with a pain psychologist.
Fear can be a powerful factor that stops people from returning to work or even attempting to participate in activities they used to enjoy. “People can be debilitated by fear even if they currently aren’t feeling pain,” Yuen says. “Someone might say, ‘I haven’t sat down for five minutes in the past five years because I know what will happen.’ Other people have been able to integrate themselves back into work life and taught themselves to reframe their pain. They have their pacing and mindfulness strategies that help them get through their day. That’s the magic that happens at a place like this.”
Jennifer Barthel has been working as a vocational rehabilitation counselor for more than two decades. She helps people at the Shirley Ryan AbilityLab’s pain clinic, many of them on leave from their jobs because of a work-related injury, start thinking about going back to work—either in their previous job or a new position that might be better suited to their current abilities. During an intensive four-week program, participants are taught pain management skills.
My role is to help them start thinking of themselves as workers again. We talk about how chronic pain puts you in the mindset of thinking about what you can’t do—from getting up in the morning, to brushing their hair to going outside to have fun. They often aren’t functioning in their home life. Their relationships may be falling apart.Jennifer Barthel
By the end of the program, 90% of participants are released to work. “We’re not saying just go back to work,” Barthel notes. “That only happens after you receive the services you need. But if we can get you back to work, you regain your sense of yourself. You have a routine and a schedule. You’re interacting with people, which provides socialization. You take control of your finances again. Now that the pain doesn’t have as much control over you, you’re the one saying ‘I’m getting up. I can do this.’”
Jenni Grover, a Chicago area writer who has fibromyalgia, a disorder characterized by widespread musculoskeletal pain, has been treated for chronic pain since 2000. Working with a pain psychologist, she has learned to decrease her anxiety with daily meditation, breathing exercises, journaling and exercise, and that has helped reduce her pain. But in late 2018, she experienced a flare-up, and her medical team recommended she participate in the Shirley Ryan AbilityLab’s pain-management program.
Even though Grover knew many of the techniques that other participants were just learning, she worked on integrating that knowledge with her daily life. One day, the group went grocery shopping accompanied by an occupational therapist who noted that Grover was extending her arms to push a cart, creating strain on her elbows. The next day, the group cooked a meal with the groceries they had purchased and was coached on the best way to lift heavy bowls. “For me that’s a big part of why their approach works,” Grover says. “They’re looking at you as a whole person, not a symptom to be fixed.”