How can taking a lifespan approach give us new ways to think about the problem of pain and work?

Posted by Ann Caluori | Wed, 27/01/2021 - 14:09

Guest blog by Dr Elaine Wainwright, Bath Spa University and Professor Christopher Eccleston, University of Bath.

It is important to take a lifespan approach if we want to better support people being meaningfully occupied when they live with ongoing pain. We need to understand more about how early developmental disruption associated with pain can be repaired as we grow and age in the working world. How is working, studying, or being occupied with pain, shaped by being very young, by being a millennial, or by being at work post-retirement age, in addition to being an adolescent and an adult of working non-pensionable age, the two groups most often studied? Why should such considerations matter?

Famously, Waddell and Burton (2006) found that work which is physically and psychologically safe, is good for our health and wellbeing (1). Yet persistent pain has a major impact on working life. Defined as pain that lasts or recurs for more than three months (2),  it can disrupt sensory, cognitive and social domains in addition to reducing physical functioning (3). Persistent pain is a global health problem associated with mental illness, poor quality of life and job loss (e.g. see 4). Many of us live with chronic pain: a meta-analysis estimated a prevalence rate of 35-51.3 % for the UK (5).

Healthcare costs associated with persistent pain are high and have been estimated at £12.3 billion annually (6). It has also been estimated that 48-88% of the total cost of chronic pain is attributable to indirect costs due to reduced productivity, sick leave and disability. Musculoskeletal (MSK) problems are the second most common reason for sickness absence e.g. they accounted for just under 50% of the total days lost to sickness, at 27.8 million days, in 2018 ONS data analyses (7).  For those who manage to work with chronic pain, 50% report that pain interferes with what they are trying to achieve (8).

There is value in thinking about the impact of pain on work from a lifespan development perspective. From this viewpoint, we might think about the effects of pain on meaningful occupation as we age and grow, so we would include paid work, but also other types of activities such as learning, caring and volunteering. We know that pain is a major part of childhood for many (9). We know that pain-free life expectancy is reduced by earlier pain experience (10) and that many young people who experience pain will unfortunately go on to become adults still living with pain. Pain can interfere with so many of the things that we busy ourselves with, giving our lives purpose and meaning. Pain disrupts schooling, paid work for people of traditional working age, occupational activities with indirect benefits, and meaningful engagement for those in later life production. If we think about the impact of pain on occupation from a lifespan development perspective, the following questions become important and useful:

  • How can we best repair developmental disruption associated with pain for preschoolers and schoolers experiencing painful conditions, as they age and enter working life?
  • How can we best offer specialist, tailored vocational support to young people in pain for the school to work transition, which takes account of their condition, its impact, and the challenges of our current employment structures?
  • How can we translate what we know about ‘good work for health’ into use for complex modern labour markets, in which people may transition in and out of full and part-time work, self-employment, unemployment, precarious and portfolio careers?
  • How can we best offer triangulated ergonomic, psychological and vocational support to those in later life production to maximise environmental and individual factors for ongoing occupational success?
  • How can we promote intergenerational knowledge and communication about a good working life lived with pain, to narrow gaps between generations about pain beliefs and behaviours?

There are other important questions about pain and occupation from a lifespan development approach that we discussed and evidenced in detail in a recent book (11). From children and young people to those in the middle of life and beyond, we can take a life-course approach to occupation and work when people are in pain. There is so much excellent occupational health practice to be extremely proud of (12). This, combined with a better understanding of how and why people in pain seek to be occupied across the lifespan, could maximise production of the kinds of meaningful activity which are good for health and wellbeing and reduce the negative impacts of living with ongoing pain.

Elaine Wainwright is Reader in Occupational Health Psychology, Bath Spa University, and Honorary Research Fellow, Centre for Pain Research, University of Bath, UK. Christopher Eccleston is Professor of Medical Psychology and Director, Centre for Pain Research, University of Bath, UK.

References

  1. Waddell, G. & Burton, K. (2006). Is Work Good for Your Health and Well-being? London: The Stationary Office.
  2. Raja, S. N., Carr, D. B., Cohen, M., Finnerup, N. B., Flor, H., Gibson, S., ... & Vader, K. (2020). The revised International Association for the Study of Pain definition of pain: concepts, challenges, and compromises. Pain, 161(9), 1976-1982.
  3. Williams, A. C. D. C., & Craig, K. D. (2016). Updating the definition of pain. Pain, 157(11), 2420-2423.
  4. Eccleston, C., Wells, C. and Morlion, B. (Eds) (2017) European Pain Management. Oxford, OUP.
  5. Fayaz, A., Croft, P., Landford, R.M, et al (2016). Prevalence of chronic pain in the UK. BMJ Open; 6: e010364.
  6. Bridges S. Chapter 9. Chronic pain. In : Health Survey for England - 2011, Health, social care and lifestyles, Volume 1. The Health and Social Care Information Centre, 2012.
  7. ONS. Sickness Data in the UK Labour Market, 2018. [last accessed 26.01.2021]
  8. Breivik, H., Eisenberg, E., & O’Brien, T. (2013). The individual and societal burden of chronic pain in Europe: the case for strategic prioritisation and action to improve knowledge and availability of appropriate care. BMC public health, 13(1), 1229.
  9. King, S., Chambers, C. T., Huguet, A., MacNevin, R. C., McGrath, P. J., Parker, L., & MacDonald, A. J. (2011). The epidemiology of chronic pain in children and adolescents revisited: a systematic review. Pain, 152(12), 2729-2738. doi: 10.1016/j.pain.2011.07.016
  10. Zimmer, Z., & Rubin, S. (2016). Life expectancy with and without pain in the US elderly population. Journals of Gerontology Series A: Biomedical Sciences and Medical Sciences, 71(9), 1171-1176.
  11. Wainwright, E. and Eccleston, C. (Eds) (2019) Pain and Work: A Lifespan Development Approach. Oxford, OUP.
  12. Daniels, K. et al (2019) The value of occupational health to workplace wellbeing. Society of Occupational Medicine and Cohort.