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Simple tool helps prevent chronic pain and long-term disability

Helen Signy

GPs can help almost one in four workers who suffer a workplace injury avoid chronic pain, long-term disability and get back to work faster with a simple intervention within the first week after injury, a study suggests. 

The Work Injury Screening and Early intervention (WISE) study is examining the impact of a 10-question survey for GPs and health workers1 to use with patients who have suffered from soft tissue workplace injuries. The tool identifies patients for whom early psychosocial intervention could result in an improved outcome.

“GPs don’t always think of the psychosocial aspects of pain management in the first instance, but these risk factors have been shown to be key predictors of delayed recovery,” says lead author Professor Michael Nicholas of the Pain Management Research Institute at Royal North Shore Hospital in Sydney.

The psychosocial risk factors identified include:

  • High pain ratings;
  • Anxiety and depression;
  • Impaired sleep;
  • Expectations of delayed recovery; and
  • Beliefs that rest and avoidance of certain activities are necessary until the pain eases.

If severe enough, these problems can become serious obstacles for return to work. Yet study participants who were treated by a clinical psychologist working in collaboration with a GP and the patient’s workplace were able to return to work sooner.

“Identifying people at risk within a week of their injury and getting them to see a psychologist straight away would be more effective, cheaper, and would mean they would get back to work sooner, compared to a wait and see approach,” Professor Nicholas says.

Patients who were identified as being at risk and then participated in the treatment arm of the controlled trial spent significantly less time off work than similar high-risk cases in the control (treatment as usual) arm (on average, 29 days versus 53 days), and their claim costs were significantly less after 18 months (on average, $16,000 versus $20,000 – 22% less).

The study involved 17 hospitals in NSW and found 24% of screened workers to be at high-risk of long-term disability.

The NSW Ministry of Health is now rolling out a plan to implement the routine use of the protocol used in the study for all injured public health workers. It means that in future, these injured workers will get much quicker access to a comprehensive, biopsychosocial assessment of their injuries and earlier help in dealing with a range of complex issues often initiated by these injuries.

“These results were achieved with no new treatments, just much earlier screening for psychosocial risk status (the major predictor of outcomes) and much faster response times to injured workers than normally happens,” Professor Nicholas says.

“It also emphasised the benefit of good communication between the workplace, treatment providers and the insurer. For GPs, the results should mean a much more efficient and less complicated approach to dealing with injured workers.”

Professor Nicholas says the questionnaire takes two to three minutes to complete and could be handled by a practice nurse.

He cautions that identifying those at risk is only part of the intervention and the next step is to provide relevant help for the injured workers identified. In many cases, especially if there is no readily accessible clinical psychologist, the GP could deal with several of the psychosocial issues identified, but they may require additional training to gain confidence in doing this.

The Pain Management Research Institute is offering a webinar for GPs on ‘Putting Cognitive Behavioural Therapy Skills into Practice’. Click here for more details.

This content was independently produced by Cirrus Media with a sponsorship from Pfizer Australia.

 1 The 10-item Orebro Musculoskeletal Pain Screening Questionnaire (Linton et al., Spine, 2011).

GPs can help almost one in four workers who suffer a workplace injury avoid chronic pain,...

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