The experiences and expectations of return-to-work input in people with chronic pain: are we progressing?

Introduction Work is good for you, but chronic pain can have a negative impact on a person’s life including their ability to work. However there are significant economic costs associated with worklessness and therefore it has been advocated that returning people to work, or retaining those that are still in work, should be a major outcome of healthcare. This has traditionally not been the case and evidence questions the ability of healthcare clinicians to provide appropriate return-to-work (RTW) input to and support. Prior to presenting to pain clinics, patients may typically have accessed various aspects of healthcare over a significant period of time, but little is known about the previous RTW input this population may have received and, as such, whether they expect such input as part of their pain management. The purpose of this study is to explore the experiences and expectations of RTW input in people, of working age, who have chronic pain. Methods A qualitative approach using thematic analysis was used. Individual semi-structured interviews were conducted with a purposive sample of 5 participants of adult working age, recruited from a hospital-based pain clinic. The participants were at various stages of their engagement and management with the service from recently assessed to having completed a pain management programme. The sample included those not employed and employed including one currently on sick leave, but about to return. Interviews were transcribed and coded, then analysed for themes. Results Three emergent main themes, with relative sub-themes, were identified: ‘Influence of health condition’ with ‘diagnosis and ‘knowledge and understanding’ sub-themes; ‘Drivers of RTW input' with ‘health professionals’ and ‘the participant’ sub-themes; ‘Services and processes’ with a ‘Link between health, JobCentres and employer’ sub-theme. Generally participants reported little or no appropriate RTW input from their GP or previous contact with physiotherapy. They did not also expect to receive RTW input from the pain clinic, although all subsequently did receive some form of RTW input, which may have been due to their previous negative experience. Conclusions The participants in this study report experiencing little or no RTW input from health professionals. Any attempt to access RTW input and actually engage in returning to work was initiated and driven by the individual. Possibly as a result of these experiences, the participants were therefore not expecting to receive RTW input through the pain clinic. This is despite the research evidence and associated recent policy/legislation changes advocating that RTW input should be a priority. Further research to explore the reasons why RTW input does not still appear to be a priority for health professionals, especially GPs, would be useful