The Causes, Comorbidities and Consequences of Chronic Pain in Construction Workers: Part I
Editor’s Note: This is a two-part article. Part I addresses the causes and consequences of chronic pain in the construction industry. Part II addresses the risks of opioids and alternatives to opioids in the treatment of chronic pain in construction workers.
The construction industry is characterized by a high frequency and severity of musculoskeletal injuries, including sprains and strains of joints and connective tissues. Many construction workers work through the pain and delay healing and sometime compound recovery and worsen the initial injury. In fact, such injuries are prone to reaggravation without proper rest and treatment, thereby further delaying recovery time and jeopardizing healing.
Musculoskeletal injuries are associated with contributing to the prevalence of chronic pain among construction and industrial trades workers. Many studies point to the devastating personal, organizational and societal impacts of chronic pain. Among the major adverse consequences of chronic pain include the following:
- sleep deprivation;
- anxiety and depression;
- restricted work activities;
- tardiness and absenteeism;
- decreased quality of life;
- loss of concentration and presenteeism;
- substance misuse disorders;
- decreased productivity;
- increased risk of suicide; and
- increased use and costs of medical care.
Meet the Panel
In this two-part article, a panel of uniquely qualified professionals in three interrelated disciplines involved in addressing the effects of chronic pain share insights on the risks and comorbidities associated with chronic pain.
Penney Cowan is the Founder and Chief Executive Officer of the American Chronic Pain Association (Rocklin, CA).
Dr. Marcos Iglesias is Vice President and Chief Medical Director at Travelers (Hartford, CT).
Dr. Talal Khan is Medical Director of Outpatient Services at Pine Rest Christian Mental Health Services (Grand Rapids, MI) .
Ms. Cowan and Dr. Khan are featured in Part I of this article. Dr. Iglesias and Dr. Khan are featured in Part II of the article.
Causes, Consequences and Treatment of Chronic Pain
Spoor: What is the prevalence of chronic pain in the United States?
Dr. Khan: Different studies worldwide report chronic pain prevalence of between 15-40%. Common consensus is 20 % of U.S. Adults, that is, 1 in 5 Americans live with daily chronic pain. And about 8-10 % live with high impact chronic pain.
Beyer: In construction, there is the prevalence of “tough guy/gal” culture. Are workers in the construction trades less reluctant to seek help and support for the management of chronic pain?
Cowan: Yes, but it’s more than just wanting to appear tough. Because their livelihood depends on their ability to work, people are inclined to ignore the first symptoms in the hope that it will just go away. The problem is our bodies do tell us when we need to seek help; that’s what pain is meant to do. No one is invincible. We are all human and things happen. It’s important to realize that having pain does not mean that you are weak. It means that you need to take care of the problem so that you can live your life as you choose. Do not let it get so bad that the damage may create other issues.
Spoor: What is the connection of chronic pain and sleep deprivation?
Khan: This is a complicated relationship, almost like a vicious cycle. It is obvious that the person struggling with pain would find it difficult to sleep, but these sleep problems continue even after the pain is controlled. People with poor sleep also perceive more pain than the average person and quite often pain does not improve till the sleep structure is normalized.
A body dealing with chronic pain is constantly at battle and the stress response neurochemicals are always firing, leading to anxiety and overstimulation of the nervous system which causes difficulty in falling asleep and poor-quality sleep and eventually depression.
Spoor: How do sleep deprivation and chronic pain link to depression?
Khan: Sleep has demonstrated close links to depression, anxiety, bipolar disorder and other conditions. Sleep disturbance is one of the diagnostic symptoms for depression. The bi-directional relationship of sleep and depression is well established, one worsens the other.
Chronic physical pain can cause psychological pain. Imagine just having a pebble in your shoe that you are not allowed to remove. The agony of having to deal with it and constantly having to work around it can become emotionally exhausting. The combination of sustained anxiety, discomfort, frustration, and a sense of helplessness eventually leads to depressive symptoms. Living with limitations, lower level of functioning, reduced activities and lack of restful sleep causes an overall poor quality, depressing experience of life.
Beyer: Ultimately, has chronic pain been studied as an indicator for suicide risk?
Khan: Yes, several studies have shown that people with chronic pain are at an elevated risk of suicidal thoughts and behaviors. People struggling with pain report higher scores on depression and hopelessness scales. This relationship is strongest with psychological trauma or emotional pain. Psychological pain increases with chronicity of physical pain and in the context of depression and hopelessness, suicide may be seen as an attempt to escape from what is experienced as unbearable suffering. The focus of chronic pain treatment should not be to be “pain free” or have “zero pain” but to take the steps needed to have quality of life and function with a “manageable level of pain.”
Spoor: What progress is being made in helping those struggling with chronic pain management? Are you hopeful for the future?
Cowan: I am hopeful for the future of pain management. These days there is much more focus on the needs of the person with pain, on the individualized treatment, and on designing programs that will increase their function and quality of life. The one thing that we must realize is that there may always be some level of pain, but we can live a full life despite pain. We can learn to live with our pain if we have the right direction, care, and support.
Beyer: With your personal journey with chronic pain, what advice do you have for others struggling with chronic pain?
Cowan: The first thing you need to realize is that your pain is real, and you have the right to have it treated and with respect. If you are having a difficult time with your health care provider, you can always get a second opinion. We need to have our pain validated; if it is not, we become very defensive and it can get in the way of effective treatment.
Focus on abilities, not disabilities. Do not allow the pain to become your identity. Stay focused on all the things that you can still do, the abilities you have. Too often people get lost in their pain and what it has taken away and give up. Listen to your body and pace: Pain is not always at the same intensity each day. Some days we have less pain and try to do more. Then we may push too hard and not listen to our bodies telling us it is time to stop. If you pace your activities on a good day, you may actually have another good day tomorrow.
You are part of the treatment team. You must realize that you cannot be a passive patient but need to be an active participant in your care. Talk with your provider about what your responsibilities in the treatment are and how you can incorporate self-management strategies as part of the overall plan.