Identifying and Treating Psychosocial Barriers to an Injured Worker’s Recovery

Ever wonder why some injured workers return to work relatively quickly while others with similar injuries take longer or maybe never return to work? Ever wonder why some employees seem to cope with pain so much better than others with the same diagnosis? Many other factors play into a patient’s pain and disability besides the underlying medical diagnosis, commonly known as “psychosocial,” which refers to a patient’s psychological and social issues that affect their recovery from the physical or biological injury.

“Some injured workers may develop psychological problems as a result of their injury, but others might have been experiencing these issues from day one,” said Mitch Neuhaus, Senior Vice President – Claims at Safety National. “These factors require special attention from the onset of the claim until the very end. Focusing solely on treating the physical injury and ignoring the other aspects of an injured worker’s life can be short-sighted and detrimental to recovery.”

Identifying High-Risk Factors

Questionnaires are a popular tool for identifying issues that might affect an injured employee’s recovery time from a work injury. Assessments, like the Vermont Disability Prediction, Back Disability and Absenteeism Screening Questionnaires, are used to identify employees at high risk for responding poorly to the common medical treatment regimen. Not only can these questionnaires be used in the early stages of a claim, but they can also be used later in the process to address psychosocial factors as soon as possible before the recovery is sent off course. Some of the areas that these questionnaires measure are:

• Pain attitudes, beliefs and perceptions
• Perception of work
• Catastrophizing, feeling helpless around an injury
• Behavioral response to pain
• Activities of daily living (ADLs)

These questionnaires attempt to identify the probability that injured employees might develop problems during recovery. Contributing factors to recovery can include:

• History of drug or alcohol abuse
• Work dissatisfaction
• Family, legal or financial problems
• Low expectations of recovery
• Disabled spouse or young children at home
• Low wage earner
• History of depression or moodiness

Low- and moderate-risk individuals can usually be managed with proper education, but high-risk candidates might require additional resources to prevent them from becoming long-term chronic pain or disability patients.

Applying the Right Resources

Offering the first comprehensive guidelines that address psychosocial risk factors, the Washington State Department of Labor and Industries guide on psychosocial determinants influencing recovery (PDIR) details several approaches that treating providers can utilize. While more complex cases should be referred to specialists for further analysis, some options that can accelerate recovery include:

• Pain coping techniques
• Relaxation training, like breathing techniques, meditation, visualization, muscle tension and movement techniques
• Physical activity and logging
• Sleep habit management

With very few adverse effects and well-documented proof of its effectiveness, cognitive behavioral therapy (CBT) has become the most common treatment for behavioral health conditions. Not only can it be used to treat chronic pain, but it is recommended for post-traumatic stress disorder (PTSD), depression and substance abuse disorders. CBT has become overwhelmingly popular with the rise of telehealth, allowing most injured workers to access care from the comfort of their homes.

Acceptance and commitment therapy (ACT) is an alternative form of CBT that focuses on accepting pain experiences. Rather than fighting an issue, it trains individuals to expand their understanding to work through a difficult situation. This treatment can be applied to injured workers facing work stress, substance use disorders, anxiety and psychotic symptoms.

Treatments will vary depending on the conditions the injured worker is encountering, but you might be well served to investigate these options further to avoid some of those claims that veer off track or to assist some that have already veered off and need to get back on track.