Pain management consultation: What employers need to know

With musculoskeletal (MSK) problems accounting for two fifths (40%) of all sickness absence before the pandemic, and predictions of an increase in MSK related insurance claims due to inadequate home working arrangements, eating more and exercising less over the last few months, it seems timely that NICE is suggesting a renewed focus on pain management.

The National Institute of Clinical Excellence (NICE) is currently consulting on chronic pain management. Its draft clinical guideline, the consultation period for which ends on 14 September 2020, suggests there is too much focus on medication in the assessment and management of chronic pain in the over 16s. Instead, it emphasises the importance of listening to the individual and gathering information about the emotional and functional impact of pain, including work, before ‘prescribing’ a treatment or intervention.

This comes at a time when more than half of employees reported new aches and pains during lockdown, especially in the neck (58%), shoulder (56%) and back (55%), according to a survey by the Institute for Employment Studies.

Practitioner views

Generali UK Employee Benefits spoke to its practitioner partners to find out whether there are any considerations for employers on the back of the NICE guideline, with regards to the design and implementation of wellbeing strategy.

First and foremost, take an informed and balanced view, says Beverly Knops, Executive Manager and Specialist Occupational Therapist at Vitality360. “Don’t just read the headlines and make assumptions about current therapies or treatments an employee may be accessing.

“Read the full document to gain a greater understanding but note this is still only in draft form. If appropriate, ask employees what they think about the documents and really listen to their response. Individuals who are currently taking medication may be very anxious about how their GP will interpret the guideline.”

Knops says that overall it “reflects a positive move away from people potentially taking medications over long periods with limited benefits and possible harm”.

She adds that the most useful part of the document is that which focuses on assessment and matching treatments or interventions to need. “This section helps readers understand how complex pain is and how much pain impacts on people’s lives. This might include effects on lifestyle and day-to-day activities, including work and sleep disturbance, physical and psychological wellbeing, social interactions and relationships.”

Health & safety implications

Meanwhile, Dr Julie Denning, Managing Director, Working To Wellbeing, also welcomes the guideline, saying that it “validates what we are seeing in clinical practice.

“Many of our patients are taking multiple medications which appear to have limited impact on their pain levels and often have side effects which can be debilitating in themselves. Pain management programme content and impact are hugely variable, often not psychologically focussed and without a health behaviour change agenda.

“They also have long waiting lists to access them, thus perpetuating pain cycles and increasing deconditioning. We often hear patients wanting their pain medication increased because it is no longer working and this is prescribed for them. Furthermore, we often see patients who are prescribed one medication for pain and then another to counteract the side effects of that medication, often resulting in them taking a cocktail of medication.”

Dr Denning adds that all of this has ramifications from a work perspective in terms of health and safety, job performance and risk: “For example, reasonable adjustments may have to be made regarding operating machinery. And productivity can be affected if patients are unable to concentrate because their head is foggy from the medication they take.”

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How can employer’s help?

Employer best practice with regards to work-related pain conditions is no different to overall workplace wellbeing best practice, in that it should start with employee-insight gathering. Dr Denning suggests the following:

  • Understand your employees’ needs.Use Wellbeing Action Plans to do this and work out a shared plan of action to enable employees to self-manage their pain at work. Remember that mental health and physical health are closely connected and both need to be addressed as part of the plan.
  • Provide evidence-based wellbeing screening and support programmes to provide early intervention support to prevent work-related long-term pain conditions from developing and to identify problems currently and provide tailored, behaviour change related solutions. Health coaching will be at the heart of such programmes.
  • Provide clinician led exercise programmes as part of wellbeing strategy, e.g. yoga classes, access to gyms etc.
  • Offer second medical opinion services as part of wellbeing strategy. Expert services, such as those offered by Teladoc Health’s Best Doctors, are often included with group income protection products. So, it’s worth examining the early intervention services to which you might already have access. With regards to pain, second medical opinion services offer an additional resource should employees want an expert view on a condition or a prescribed course of treatment and / or are suffering anxiety about any changes in treatment.