For people who do not read The Spine Journal – that would be most of us – there is an important article on the psychological aspects of recovery from injuries with implications for anyone who deals with workers comp. As many of us have seen, the speed of recovery for an injured worker is often unrelated to the severity of the injury. For some workers, the mind itself becomes a formidable obstacle to returning to productive employment. The Spine Journal tells us why.
Researchers have identified two key psychological phenomena that impact recovery: the first, catastrophizing, is a thought pattern that turns small problems into big ones; by focusing relentlessly on pain and incapacity – whether moderate or severe – injured workers spiral into a self-defeating negativity. They despair of getting better and the despair morphs into a self-fulfilling prophecy: they don’t get better. The second (and often related) factor is fear avoidance: workers with sprains and strains avoid all physical activity – in fear of aggravating the injury – and consequently experience deconditioning and physical deterioration.
It’s easy to imagine how injured workers succumb to these negative spirals: they find themselves confined to their homes, no longer getting dressed and going to work, with too much time to dwell on their symptoms. They fear making the injury worse, so they lapse into total inactivity. After a brief waiting period, they begin to receive indemnity checks – they are now being paid not to work: for workers who do not like their jobs (roughly half the workforce), there is a disincentive to get better. In a word, the mind creates a virtual obstacle course to recovery.
Heal the Body, Heal the Mind
What is the solution? Each workers comp stakeholder has a role to play:
- treating physicians should encourage injured workers to stay active; they also need to avoid over-prescribing of opioids for pain
- claims adjusters need to focus on the attitude of recovering workers, especially regarding those whose negativity impedes their ability to get better
- employers should aggressively use temporary modified duty within the medically necessary restrictions established by the treating doctor. When injured workers get dressed and go to work, they maintain their identity as workers, they stay physically active and the path to recovery remains clear.
Recovery is not simply about body parts; it takes place as much in the mind as it does in the body. A troubled mind can keep the body from healing. With a positive attitude, recovery takes the shortest route from disability to wellness. A positive mind is just what the doctor ordered.