Vocational Rehabilitation for Chronic Pain Patients

The goal of vocational rehabilitation is a return to work. After an extended period out of work, chronic pain patients become both physically and psychologically deconditioned to the demands and stresses of the workplace. In a pain management program, some time should be allotted to the discussion of back-to-work issues in a group setting. If possible, a vocational rehabilitation counselor should attend the group session and share information on resources with the members. Together, a vocational rehabilitation counselor and a patient can develop an individualized plan that incorporates both long-range employment goals and short-term objectives based on medical, psychological, social, and vocational factors. Vocational rehabilitation counselors are specialists in the assessment of aptitudes and interests, transferable skills, physical capacity, modifications in the workplace, skills training, and job readiness.

The number of recorded work-related disabilities has increased dramatically over the past thirty years. The return-to-work statistics are alarming. Chronic pain patients who have been out of work for longer than a year have an estimated chance of ever returning to full-time employment of <3%; those who have been out of work for longer than two years have <1% chance of ever working again. Insurance carriers are interested in the rehabilitation of these patients because of the enormous expenses they incur. An estimated 5% of all workers' compensation claimants account for 85% of the disability funds distributed. Unfortunately, many patients do not know what options they have for return to work. It is helpful to review what a vocational rehabilitation counselor does and to help group members understand what is involved in a return-to-work determination.

Many chronic pain patients receive workers' compensation benefits or social security disability income. These patients may fear that their benefits will be jeopardized if they return to work. A vocational rehabilitation counselor can help a patient negotiate with an employer a return-to-work trial that will not jeopardize the patient's income.

For example, the counselor can arrange with an employer to hire the patient for a specific period (e.g., three months) during which the employee's productivity will be evaluated. The employer agrees to pay the employee reduced wages that will not jeopardize workers' compensation. In addition, the employer agrees to train the individual and, at the conclusion of the work period, either to hire the individual full time or to write a letter of reference. In this way the patient gains work experience with a letter of reference without jeopardizing disability benefits. Advantages to the employer include the performance of work at lower wages with no obligation to hire on a permanent basis. The vocational rehabilitation counselor acts as a mediator in getting the chronic pain patient "in the door" of a business - and eventually, perhaps, back to work.

One common misconception is that persons receiving compensation benefits are lazy and are not interested in working. In fact, most people on disability leave wish that they were working. In our society work is a valuable part of who we are. We all have a need to accomplish things and to feel useful. Although many chronic pain patients may not have the option of returning to their former place of employment, they should be encouraged to explore other full-time, part-time, or volunteer work opportunities. Patients should become familiar with the Americans with Disabilities Act (A.D.A.) so that they know their rights regarding discrimination due to a pain-related disability. The central theme of the A.D.A. is that a disability that does not interfere with job performance cannot be used to reject applicants. In addition, employers are required to make accommodations for persons with disabilities so that they can work. An outline of the A.D.A. is presented in the appendix of the patient's handbook.

Local vocational resources should be discussed with the group. Patients may find it useful to have, for instance, information on the Job Training Partnership Act (with specific data on state and local funding), veterans programs that help people return to work, and the vocational services offered by the Division of Industrial Accidents.

Patients may not be aware of one employment advantage of persons with disabilities: some large corporations receive tax credits for disabled employees. Thus, individuals with chronic pain may want to consider contacting the disability/equal opportunity office of a corporation rather than the personnel department to improve their chances of being hired.

A vocational rehabilitation counselor can outline various aspects of the rehabilitation process. The components may include a vocational assessment, a transferable skills analysis, a physical capacity evaluation, a work disability assessment, a job analysis, and an employment readiness determination. Research shows that individuals are more likely to return to work if they believe that they will. The therapist should refer persons who believe that their chances of returning to full-time employment are >50% for a vocational rehabilitation functional capacity test.

This article was excerpted from the book Mastering Chronic Pain: A Professional's Guide to Behavioral Treatment. by BW Pain Management Center physician Dr. Robert N. Jamison, Ph.D., published by Professional Resource Press, Sarasota, FL, 1996.