Pain Management Center Back to Work Program
The primary treatment goals for chronic pain patients are:
- Functional restoration
- Decrease utilization of health care resources
- Decreased pain and suffering
For appropriate patients, functional restoration means return to work. The Brigham and Women's Pain Management Center has as part of its treatment continuum a "Back to Work Program."
Success rates for patients returning back to work are highly dependent on timely referrals. The chances of returning to work are as follows:
- Off work for 90 days or less - 94%
- Off work between 90 days and 2 years - 19%
- Off work greater than 2 years - 2%
Identification of other risk factors for delayed recovery that may be present should also lead to earlier intervention. These risk factors in order of importance are:
- Physician conviction of high-risk status
- Poor English proficiency
- Time off work
- Job satisfaction
- Patient and Physician's perception of heavy work
- Anger at "the system"
- Substance abuse
- Previous injuries
- Spouse disabled
Patients with injuries that often cause long term disability such as non-specific low back pain, or RSD should be evaluated for the above mentioned risk factors and referred early if present.
Specific goals of our "Back to Work Program" are
- Targeting specific activity limitations
- Early vocational emphasis
- Specific emphases of Psychological dysfunction and depression
Patients enrolled in the "Back to Work Program" become part of the hospital's volunteer program. This unique feature provides real job simulation opportunities. Most of the departments in the Brigham and Women's hospitals departments are open to the volunteer program. Each prospective job has a D.O.L. description and rating. Patients are encouraged to progress through this program by working around activity limitations, increased endurance and enhancement of their self-esteem.
Back to Work Evaluation
Each patient referred to the Brigham and Women's Hospital Pain Management Center's Back to Work Program is evaluated by our treatment team. The treating team consists of:
- Pain Management Physicians
- Occupational Medicine Specialist
- Nursing
- Occupational and Physical Therapy
- Psychology
- Case manager
- Pharmacist
- Volunteer Director
The assessment determines:
- Functional limitations
- Risk factors as outlined in the overview section
- Early contact with the employer for potential work accommodations
- Willingness of the patient to return to work
Following the assessment a team meeting along with the employer's representative is used to formulate a treatment plan. This treatment plan is for a defined period of time and goal specific.
Back to Work Program
The Brigham and Women's Hospital's Pain Management program has as a fundamental goal, functional restoration of our patients. For patients where return to work is appropriate, our "Back to Work Program" offers a strong vocational emphasis to encourage our patients to return to work. After evaluation by our interdisciplinary team, a time limited intensive 6-8 week program is offered. Each program is designed for the unique needs of our patients. Weekly team meetings are held to evaluate progress and modify the program as required. Case managers or other representative(s) of employers are encouraged to attend. Close coordination with the employer is vital for the success of the program. A critical pathway for a typical patient is provided below. Follow-up after the program is vital to avoid exacerbations of pain and the potential negative behavioral consequences.
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