Assessing work measures of the impact of chronic pain on work

What is the background to this study?

Chronic pain can have a big effect on people’s work. Until now, the impact of chronic pain on work has usually been measured by looking at the number of sick days people take. However, we know from speaking to people with chronic pain that the impacts of their pain on work are much broader. Such impacts range from how productive a person is at work, to how they engage with their colleagues, and even how dealing with pain at work can have an effect on their social and family life.

What did we want to find out?

We wanted to take an organised look at the kinds of questions people are currently being asked in questionnaires about how their pain affects them at work. Our plan was to compare these questions with the kinds of things people said were important to them when interviewed. In particular, we wanted to compare what people said when they were allowed to think and respond freely and not confined to specific questions with limited response options. Comparing the questions currently being asked with the range of impacts people spoke about in interviews should highlight any key things not being asked in existing questionnaires.

What did we do?

We did an online search of medical research journals to look for any studies which used questionnaires to ask about the impact of chronic pain on people’s work. We found 44 of these papers, and we looked through them to find out what questions study participants had been asked to complete (as opposed to the answers to these questions themselves). We then looked for any studies which included people describing the impacts of their chronic pain on work in their own words (mainly interview studies). We found 16 of these studies overall.

We then grouped together the topics covered by questions people were being asked, and what they themselves described as being important, into several areas (or themes).

We compared the themes from the questionnaire studies to the themes from the interview studies to see if there were any important areas not currently being measured in existing questionnaires.

What did we find?

Overall, we identified 42 separate individual themes in the studies we looked at, which we then grouped into 5 broader categories:

Changes to work productivity and working status (including number of sick days taken, reduced working hours, or leaving work altogether)
Workplace environment (including work conditions and working relationships)
The effects of pain (and related symptoms, such as fatigue) on work activity
Psychological factors (including work stress, work as a source of identity, and whether people felt believed when they told others about their condition)
Impacts outside the work environment which were related to work (including difficulties commuting or the impact of pain-related-fatigue on family and social life)

When we considered which impacts were found in which kind of paper, we found that the quantitative papers mainly looked at measures related to the quantity and quality of people’s work (29 out of 42 questionnaires / individual questions). When we compared the impacts measured in quantitative studies to the interview (qualitative) studies, we found an additional 17 impacts which were only found in these qualitative papers and hence which were not being measured by existing questionnaires.

This confirms that existing studies which use questionnaires to measure the impact of chronic pain on work are not currently capturing information in several areas which are nonetheless important to those who live and work with pain.

Why does this matter?

This study identifies that there is an important gap between what current questions asking about chronic pain and work measure, and what people have said are important to them when interviewed. Importantly, it shows that current questionnaires do not capture a broad enough range of impacts of pain on work.

This is an important first step in considering what we will include in our newly designed QUICK questionnaire to quantify the full impact of chronic pain on work. It underlines that there is a need for a new questionnaire which can measure these broader impacts and gives us some early ideas on the kinds of things we will need to discuss further with people living and working with chronic pain in the next phases of the QUICK study.

Who authored this study?

This research is part of the Quantifying the Impact of Chronic Pain on Paid Work (QUICK) study.

This work is taken from an article written by Dr Anne Stagg (Guy’s and St Thomas’ NHS Foundation Trust) and co-authored by a large team of investigators, including Dr Martin Stevens, Dr Elaine Wainwright, Professor Gary Macfarlane, Dr Rosemary Hollick and Dr LaKrista Morton from the Epidemiology Group at University of Aberdeen.