Some chronic pain may be easy to treat
Pain costs workers time and money
The office manager who is certain she has carpal tunnel syndrome, and the grocery store checkout clerk who is convinced he has a pinched nerve might be correct; but it may be more likely that they are suffering musculoskeletal pain that is both easier to treat and less likely to be chronic, given correct diagnosis and treatment.
"The first thing to do is to try to help patient understand source of his or her pain, what’s causing it," says David Hubbard, MD, medical director for Rosemont, IL-based CorSolutions, consultants on disease management of chronic illnesses. Once they know where their pain is coming from, they are better prepared to work on the cause. Sometimes, he says, what they learn can surprise them.
While patients with chronic pain often believe their pain is nerve- or joint-related, such as a pinched nerve or carpal tunnel syndrome, it is far more apt to be muscular pain, says Hubbard. "Over 85% of pain conditions are of muscular origin, with nerve and joint pain and headache accounting for most of the remainder," he reports. "Not understanding the source of the pain can lead to costly and inappropriate treatment, including surgery."
Muscles major sources of pain
Muscle pain is the most common form of chronic pain, and can result from overexertion, repetitive use, or continuous stress on the muscle. Often mistaken for a pinched nerve, muscle pain is easily dealt with by sometimes minor adjustments to motion and position, Hubbard says. "Five percent of the time, it’s a pinched nerve; and for those 5%, surgery is required," he says. "But the other people, the single largest category, what they need is a combination of slow stretches, to work on what is probably a pinching component aggravated by muscle tension."
One of the most common workplace muscle injuries is repetitive strain injury, or cumulative trauma, which can be mistaken for carpal tunnel syndrome because pain is felt in the wrists and hands. Hubbard says the pain is actually coming from the forearm and shoulder, and often is caused by keyboarding in an awkward position.
Other sources of chronic pain include:
• Nerve compression. Typically, nerve compression is due to inflammation and edema in surrounding tendons and ligaments caused by overactivity. Disc herniation and carpal tunnel syndrome are typical examples of nerve compression.
• Nerve damage. Peripheral nerve damage is caused by either diabetes or trauma; nerve damage, Hubbard says, is the only source of chronic pain that is incurable. Medications can help manage the pain, but neither surgery nor physical therapy will cure it. Root damage is typically caused by prolonged root compression from a disc protrusion or damage during decompression surgery.
• Joint/tendon conditions. These conditions generally involve some degree of inflammation of synovia, tendon insertions, or ligament attachments. Inflammation can arise from trauma or over time from repetitive, awkward motions.
• Migraines. Migraines are severe episodes of throbbing head pain, light sensitivity, nausea, and vomiting that last from an hour to several days.
• Complex regional pain syndrome (CRPS). The hallmark of CRPS is when a light touch on an extremity, most commonly the hand, is perceived as painful. Typically, the patient’s distress and disability are dramatically out of proportion to the objective findings.
• Fibromyalgia. The predominant symptom in fibromyalgia is widespread aching pain, involving much of the body, especially the neck, back, and proximal extremities. Associated symptoms are fatigue, sleep disturbance, lack of energy, and depressed mood.
Tension and stress add to pain
Awkward working positions — either from keyboards positioned incorrectly, workstations not ergonomically arranged, or other often easily remedied condition — contribute to chronic muscle pain. But stress if often found to be prolonging and exacerbating the pain, says Hubbard. "Almost always, in addition to the awkwardness, is a tension component," he says. "So I tell them to look for source of their tension.
"It can be a pulling between the shoulder blades when they are angry, or feeling they’re being treated unfairly at work. You can teach people to notice that situation and take action — take a break, get out of the situation, do something proactive."
Sometimes, the stress might not be obvious. Hubbard says he worked with an employee who believed she was headed for surgery for carpal tunnel syndrome, when she realized there was a pattern to the occurrences of her pain. Her desk was located next to the office copy machine, and when co-workers used the copier, they put their paperwork on the corner of her desk.
"She’d see people putting their stuff on her desk, and she could feel the tension; and two hours later, she’d start having pain," he says. "So we recognized that this minor pattern was causing the tension and aggravating her pain, so she rearranged the top of her desk so people couldn’t put their stuff there. That hugely eliminated the problem."
While some of the things that cause chronic pain are minor, more than 60 million Americans have conditions such as heart disease, hypertension, cancer, arthritis, diabetes, and mental illnesses that can be both life- and work-threatening.
According to Partnership for Solutions, a national policy research program funded by the Robert Wood Johnson Foundation and based at Johns Hopkins University, more than 125 million Americans live with at least one chronic health condition. By 2020, that figure is expected to grow to 157 million, fueled by the aging of the baby boomers and medical advances that are increasing life spans.
The Glenview, IL-based American Pain Society (APS) also attributes the increase, in part, to poor diagnosis and care of pain-related conditions, and cost shifting from group health plans. Chronic pain is the second leading cause of medically related work absenteeism, resulting in more than 50 million lost workdays each year, according to the APS, and it is the leading cause of disability in the working-age population.
In its 2004 survey of 800 people who suffer from chronic pain, the APS found that 51% of survey participants who are employed said their pain adversely affects their productivity at work, and 41% said it affects their ability to put in a full day’s work. One in six (16%) said their chronic pain has adversely affected their opportunities to advance in their careers, and 45% said it has had a negative effect on personal relationships with spouses/partners, children, grandchildren, and friends.
According to the Joint Commission on Accreditation of Healthcare Organizations, pain costs the United States an estimated $100 billion each year and causes more than 50 million lost workdays per year.
For more information, contact:
- David Hubbard, MD, Medical Director, CorSolutions. Phone: (858) 668-3380. E-mail: [email protected].
- American Pain Society, 4700 W. Lake Ave., Glenview, IL 60025. Phone: (847) 375-4715. Web site: www.ampainsoc.org.
- Joint Commission on Accreditation of Healthcare Organizations, One Renaissance Blvd., Oakbrook Terrace, IL 60181. Phone: (630) 792-5000. Monograph, "Pain: Current Understanding of Assessment, Management, and Treatments," is available on-line at www.jcaho.org.]
The office manager who is certain she has carpal tunnel syndrome, and the grocery store checkout clerk who is convinced he has a pinched nerve might be correct; but it may be more likely that they are suffering musculoskeletal pain that is both easier to treat and less likely to be chronic, given correct diagnosis and treatment.
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