Do you know if your employees experience chronic pain? And if you did, would you know how to help? While chronic pain is increasingly becoming common among American workers, a recent survey of CEOs demonstrates that, while leaders recognize it’s an issue, few know how to discuss the topic with employees — let alone help. To start, they should be ready to support employees by listening, but not by pressuring them to reveal health details. Second, they can focus their organization on preventing work-related pain. Third, they can design jobs with both autonomy and skill variety in mind. Fourth, they can allow flexible work. Finally, they can increase chronic pain management resources in their company.
James thought of it as taking inventory — lying motionless in the dark so as not to trigger an episode. His first few waking moments were spent trying to assess how much pain there would be today. Another sick day would be a problem, but so would working through another day with debilitating pain.
Kiara, James’s manager, was also assessing the consequences of another sick day. A valued team member, James had become increasingly unreliable — missing far too much time and frequently not performing up to standard when he did come to work.
Chronic pain is common in the working population. Studies suggest that, like James, up to 40% of American workers experience chronic pain — pain that persists for more than three months. This exceeds the number of people with cancer, diabetes, and heart disease combined. An aging workforce, extended work hours, and demanding jobs — as well as pain caused by long Covid and limited treatment during the pandemic — all suggest that chronic pain at work will become even more common, and important to manage, in the future.
Anyone can develop chronic pain, however, and people often experience and perceive it differently depending on genetic, biological, social, and psychological factors. Environmental factors, such as physically onerous jobs or chronic stress can trigger it as well. For many workers, complete relief from chronic pain may be impossible.
As a result, chronic pain is associated with increased absence, decrements in job performance, concentration problems, physical limits and displays of impatience toward coworkers and customers. As a salesperson we interviewed in a separate study explained, “Pain limits me because I can’t drive the distances I want to drive. I can’t see the customers I want to see because my back is killing me. It’s so uncomfortable when you’re sitting in one position for a long period of time.” A retail employee noted that, “I have very little patience with people some days. … I am tired of pain and I can be a little snippy, which isn’t good for customer service.”
Even so, chronic pain is often an invisible condition because employees usually go to great lengths to conceal it. It may also be an unstable condition, with employees being pain free on some days and completely debilitated the next. As a result, managers like Kiara may become increasingly frustrated by employees who, for no apparent reason, do not perform up to expectations.
This all can prove expensive for workers and employers. The annual costs of chronic pain due to lost productivity have been estimated to be $216 billion in the United States. When treatment costs are added, the total financial burden of mismanaged chronic pain to the American economy is even higher. And in the worst-case scenarios, individuals living with chronic pain often end up in poverty due to the expense of medical treatment and inability to maintain employment.
Chronic Pain Is a Leadership Issue
Clearly, chronic pain is an issue that affects both employees and companies. But how much do managers really know about the prevalence of chronic pain and how to help employees who experience it?
In September 2020, we surveyed 500 American business leaders on chronic pain. The results demonstrate that American business leaders have limited awareness and knowledge of how to lead those with chronic pain. Although 80% of leaders recognized that chronic pain was a concern for their organizations, the same number (80%) did not know how to deal with employees in pain, and 77% wanted to know what they could do as leaders to help.
Based on our research and what we already know about dealing with other chronic conditions, such as mental health issues in the workplace, we have drawn on an established evidence-based model of prevention, intervention and accommodation to suggest the following five strategies.
1. Be ready to support employees in chronic pain by listening.
When we asked CEOs for suggestions on how they might help employees with chronic pain, listening and effective communication was the most commonly suggested strategy. Yet, many leaders report feeling uncomfortable or ill-prepared to discuss chronic pain and pain disability with their employees, and employees themselves may also feel reluctant to talk about it due to the fear of stigmatization, discrimination, or job loss. However, most of the time such conversations are a critical beginning to finding effective solutions.
We recommend that leaders do not pressure their employees to share information about chronic pain by asking pointed pain-related questions or demanding employees to disclose their pain. However, we also recommend being open to listening and supporting when employees choose to have such conversations.
In addition, employees could feel more comfortable disclosing their chronic pain challenges when they simply know that their leaders value health and safety. For example, asking your employees’ opinions on how health and safety could be improved in your organization can be a good start. If you are unsure about how to handle the situation, you can communicate your willingness to help by simply asking your employees how you could assist them with their pain-related concerns.
2. Focus on preventing work-related chronic pain.
To reduce musculoskeletal injuries, ergonomists commonly recommend ending the practice of putting things on the floor. They point out that when things were stored on the floor, employees often bend down to pick them up. In fact, years of simply teaching employees to bend at the knees not at the back have not reduced injuries. Eliminating the need to bend in the first place is a better solution.
Often, workplaces can be the source of chronic pain. Jobs that involved heavy lifting, standing all day, or working in awkward positions can cause or exacerbate pain. Paying careful attention to work conditions, and identifying and eliminating potential hazards, could prevent chronic pain for many workers even before it happens. For example, if your company has an occupational health and safety expert on staff, do a walkthrough with them to identify situations where pain could develop or occur.
3. Design jobs with autonomy and skill variety.
Job design refers to specifying the job-related duties and responsibilities of employees. Decades of job design research suggests that providing autonomy and putting employees’ range of skills to good use are necessary for healthy and safe work. Autonomy and skill use also have implications for leading chronic pain because employees can choose how and when they do work tasks depending on their ability at a given time. For example, in a study by two of us, an employee explained how autonomy allowed them to keep working: “On days when the pain is at its worst, I am not able to finish my task,” they said. “It’s always on my mind. If I have pain, I try not to start time- and attention-demanding projects.”
This autonomy goes hand in hand with skill variety. Working at a job that requires multiple skills can keep employees with chronic pain functional even when they are experiencing pain. For instance, thanks to skill variety, Raj, a salesperson working in the pharmaceutical industry could still do his job even when he was unable to travel for work because of pain. He noted, “I cancel some of my appointments, [but] I don’t call in sick. I have many other things I can do on my iPad, laptop…They can take up my time.”
As the people responsible for job design in organizations, leaders can consider how autonomy and skill variety in designing each job can help employees with chronic pain.
4. Allow flexible work.
As organizations have learned during the Covid-19 pandemic, for many employees, work does not have to occur in an organization-owned facility. Millions of people made the transition to working from at home. Overall, our research suggests that performance is largely unaffected by remote work, and some aspects of work — such as collaboration — are actually enhanced when working at home.
Chronic pain may mean that an individual can be more productive working from home or working flexible hours that accommodate their physical needs. Although leaders might be wary of being seen to be “playing favorites,” flexible work arrangements can be extended to many employees, increasing overall workplace engagement while offering a particular benefit to employees with chronic pain.
5. Increase access to chronic pain management resources in the organization.
Our research shows that employees require timely access to resources to manage their pain and work. Besides generous benefits packages, resources such as pain support groups in the workplace or purchasing ergonomic furniture can make a big difference. Leaders are typically the ones who allocate resources and make resource-related decisions in the workplace, so they are in the best positions to offer pain-related resources.
How? Many large organizations, such as the United States Armed Forces, have started to offer chronic pain management programs for employees and their supervisors by educating them about pain management, conducting frequent pain assessment within the organization, and providing access to pain relief. Similarly, U.S. Foods implemented innovative initiatives such as tracking musculoskeletal health using wearable technology. The company reports to reduce pain-related insurance claims by 50% percent.
Our research also demonstrates that, while the resources can be available, employees tend to underuse them. Leaders can play an important role in facilitating access. Organizational programs should include explicit training for leaders on how to recognize when employees might be experiencing chronic pain, how to initiate conversations around the issue, and how to refer employees to the appropriate resources. Although leaders may not see health counselling as part of their role, we suggest that helping employees deal with issues that are affecting them and the workplace is the very essence of effective leadership.
Chronic pain is a complex issue with biological, social, and psychological elements. Researchers are still working to better understand chronic pain. However, leaders will be confronted with the issue more commonly in the future, if they haven’t been already. Our five practical strategies can help both employees and organizations. And, as is always the case, effective leadership in this context is based on listening to and learning from employees. Trust them when they reveal chronic pain.