Mental health comorbidities affect workers' recovery from back pain: report

How can employers help employees with back pain get back to work faster?

Mental health comorbidities affect workers' recovery from back pain: report

Comorbidities are fairly common in worker’s compensation cases involving lower back pain, and can have a significant impact on workers’ recovery, according to a report from the Workers Compensation Research Institute (WCRI).

The most common comorbidities are:

  • hypertension (28%)
  • arthritis (21%)
  • sleep dysfunction (17%)
  • depression (16%)
  • anxiety or panic disorders (16%)

“Identifying these comorbidities and understanding their impact on recovery may help workers’ compensation stakeholders better understand which low back pain cases are more likely to have poorer outcomes and potentially adapt treatments for workers with high-risk comorbidities,” said Ramona Tanabe, president and CEO of WCRI.

“Up until this study, there was little information regarding the prevalence of comorbidities among workers with injuries, because comorbidities are typically under-identified in workers’ compensation claims data.”

The human spine plays a major role in the functioning of the body, and many Canadians are suffering from an unhealthy spine, according to a previous report. And even if one has no injury, spinal pain alone can be detrimental to workers’ performance, Dr. Ayla Azad, CEO of the Canadian Chiropractic Association (CCA), said in a previous interview with HRD Canada.

Mental health and lower back pain

However, mental health comorbidities have a more significant impact on hampering workers’ recovery than physical health comorbidities, found the survey of about 68,850 workers in different countries, including Canada.

A larger functional status (FS) score change between the intake and discharge of workers represents a greater improvement in function. 

However, the FS score change among workers with mental health comorbidities was only 13.7 points, compared with 14.8 points among those with physical health comorbidities. The change is 13.1 points for those that have both.

“The presence of multiple mental health conditions (anxiety or panic disorders, depression and sleep dysfunction) was associated with smaller FS score changes than the presence of multiple physical health comorbidities (such as arthritis, diabetes and hypertension),” read part of the report titled Comorbidities and Recovery after Physical Therapy for Low Back Pain.

“This suggests that better engagement and assessment and treatment of associated mental health comorbid conditions could improve outcomes of physical therapy and other treatments for low back pain in workers’ compensation systems.”

According to Fern Health, the comorbidity between mental health issues and back pain can impact employees in a few different ways:

  • Workplace stress specifically makes chronic musculoskeletal pain worse.
  • Chronic pain can lead to depression, and vice versa.
  • Anxiety and depression make pain feel worse.

Developments in occupational health

Vennela Thumula, co-author of the report from WCRI, told HRD Canada that there is some development in the realm of occupational health addressing the aspect of mental health as associated with back pain.

“If you look at our occupational disease guidelines, more recently, they are shifting to a more biopsychosocial approach to treatment, especially for low back pain. Instead of treating it as a medical condition, the recommendations from medical treatment guidelines are to also address the psychosocial aspect of it, which includes mental health comorbidities.”

This is happening even in cases when the mental health part is not elevated to a sickness level, she said.

“Even when they are not elevated to being called comorbidities but they have psychological risk factors, then they are associated.”

Seven in 10 workers (70%) who were injured on the job in Ontario still experience pain 18 months after the incident, according to a previous report from the Institute for Work and Health (IWH).

Early treatment key for back pain

To help avoid the troubles that lower back pain and comorbidities can cause workers, early identification of comorbidities is necessary, said Thumula.

“The recommendation in these medical treatment guidelines, in general, is when a person gets injured on the job, early after the injury – within 21 days of the injury – use one of the many screening tools that are available to identify whether they have those [other] risk factors, because [the] majority of them are considered to be modifiable risk factors. 

“If early assessments and interventions [are done], the targeted interventions are provided to address them, it results in faster return to work.”

Entitlement to ongoing workers’ compensation benefits should not have been cut off without a broader consideration of whether a workplace accident aggravated a worker’s chronic back pain rather than a specific degenerative condition, the British Columbia Supreme Court previously ruled.

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