A Case Study Andrea James AFOEM June 2018 Work related shoulder injury 45 yo male operator at a cement manufacturing and distribution plant Work related right shoulder injury after forcibly turning a valve ID: 1043467
Download Presentation The PPT/PDF document "Chronic pain and return to work" is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
1. Chronic pain and return to workA Case StudyAndrea James AFOEM June 2018
2. Work related shoulder injury45 y.o male operator at a cement manufacturing and distribution plantWork related right shoulder injury after forcibly turning a valveDiagnosis: bursitis and impingementW/Claim accepted promptly, company self insured, RTW coordinator appointedTreating GP certified worker as fit for modified duties, full time hours, day shift onlyPatient reported high levels of constant pain, lots of time off work 6/12 conservative treatment including two steroid injections, physiotherapy, NSAIDs, occasional opioids No improvement and referred to a surgeon.Surgery at 8/12 after injuryYellow flags – pain avoidant behaviours, prior Hx of slow recovery due to chronic pain after a muscular back strain, worker’s beliefs about work/exercise aggravating conditionRed Flags – nilBlue Flags – relationship with LM not great, disgruntled about recent changes at the worksite
3. Return to work post surgery4/12 post operatively certified as fit to return to a graded RTW (12 hours/week) light duties in a control room gatehouse Over next 6/12 chronic pain and sleep disturbanceGP treating pain with increasing doses of oxycontin and endoneNo increase in work capacityOP appointed by employer. OP liaison with GP - led to referral to a pain management specialistYellow flags – ongoing pain avoidance behaviours, worker resistant to increasing hours, ?due to new family responsibilities, length of commute to and from work, symptoms of depression becoming apparent Red Flags – nil However, should chronic pain and opioid use be regarded as a red flag?Blue Flags – colleague attitudes to worker’s incapacity and length of time for recovery
4. Pain Management ProgramTreatment: multi disciplinary approach - tailored for this patient - pain specialist, physiotherapist and psychologist, Medications at various times: Fentanyl patches, tapentadol SR (Palexia) oxycodone/naloxone (Targin), gabapentin, endone for break through pain, celoxicib, duloxetine (Cymbalta)OP engagement with worker to address occupational factors and psychosocial factors, liaison with all partiesPain specialist addressed medications/pain educationPsychologist and physio addressed pain behaviors/responses to pain/sleepGP involvement maintained (mainly COCs)Yellow flags –pain avoidance behaviours addressed by psychologist, worker resistant to increasing hours, other psychosocial factors addressed by OP in conjunction with managerRed Flags – nil Blue Flags – addressed by manager and RTW coordinator
5. Return To Work Over the next 6/12 gradual increase in work capacity commencing with a graded increase in hours and then additional dutiesRTW full duties Key issues: Early identification of chronic painPain control - medications, addressing pain behaviors and responses to painCoworker and LM responses to a worker with chronic painMental health comorbidity and pain impact on sleepInsidious development of psychosocial factorsAvailability of suitable meaningful duties