What impacts a back pain patient's ability to continue working? The answer seems easy: the extent of disability caused by the pain. However, research comparing those who continue working with chronic back pain and those who do not suggest that there are a number of factors beyond pain level that may influence the decision.

Back pain is a frustrating condition; with a cause never identified for a vast majority of cases, it is notoriously difficult to treat. Getting out of bed can be hard enough with chronic pain; getting through a work day may seem impossible. A recent study uncoated a number of factors unrelated to an amount of pain that may come into play when determining whether or not to continue working.

The researchers conducted interviews with back pain patients, some of which continued to work or returned to work and others who discontinued work; they also interviewed significant others. There were 3 main factors on which the working and out-of-work groups differed significantly.

1. Nature of the Work

Not surprising, researchers found that patients with more flexible jobs – those that allowed for a combination of moving and resting and those that were lenient with workers concerning time off for treatments – were able to continue working, while patients with lower-level jobs who hadn 't cultured personal relationships with their direct supervisors were less likely to continue working.

But these were not the only distinctions between the groups concerning the nature of work. Patients who continued to work exhibited a better understanding of their rights in the workplace. Significant others of patients in the working group were also generally knowledgeable about employee rights.

2. Perceived Consequences of Back Pain

A number of studies have focused on the impact of a patients' beliefs about their conditions. This study compared how people who stopped working received their activity limitations in relation to pain with how working patients perceive them. People who ceased working tended to emphasize what they were now unable to do, whereas those who continued to work emphasized what they were still able to do.

Importantly, it was found that significant others of the out-of-work group tend to enableactivity rather than encourage activity. The fears that they reflected concern their loved ones were not always reasonable; one significant other said she never leaves her partner alone because she is afraid he will be hit by a car when crossing the street, since he can only cross slow. The activities that both patients and significant others in the out-of-work group reported being unable to do were not always what could have considered “essential” daily activities, either. This suggests that, when both patient and significant other catastrophize the condition, the individual with back pain will be less likely to continue normal activity in the face of pain.

3. Patient Identity

Significant others of working patients touted the strength and heroism of their partners, saying that they refused to let pain define them. Significant others of the out-of-work group were generally on the defensive, discussing them and their significant others as victims who have no control over the situation, and who were unfairly stigmatized for their conditions. Each significant other of a working participant confirmed the reality of this stigma, unprompted by the interviewer, with a disparaging remark towards people who deserve working due to pain.

A detailed report on the study can be found at http://www.biomedcentral.com/1471-2474/14/48 .

What insights can we glean from the above? First, this study attests to the potential psychosocial factor influencing employment status. It is possible that a significant other before to catastrophize may influence the patient's perception of his or her condition. Gaining a realistic sense of activity limitation and highlighting what you can do as opposed to what you can not important both for the patient and those close to him or her. Education into back pain and cognitive behavioral therapy may be beneficial to treatment.

Second, know your rights. Patients and their significant others who could articulate rights and expectations concerning their workplaces were more likely to maintain work while seeking the treatment they needed.

Third, the fact that the nature of work impacts return to work means that it might be possible for those who must discontinue work at one job to find employment elsewhere. See https://www.disability.gov/employment for a wealth of resources on jobs available to people with disabilities and information on voluntary rehabilitation programs by state.

This study is not intended to suggest that there is no such thing as back pain-related disability. It simply sheds light on the complicated factors that may contribute to how one approaches chronic pain. There are social and psychological influences that can affect the chronic pain patient's decision to continue or stop working. Accounting for these factors is necessary for both the patient and the doctor to determine the best course of treatment.