Disease Management of Chronic Pain Improves Employee Productivity and Lowers Healthcare Costs

Dec 4, 2012

Pain may interfere with daily activities, including performance of job-related tasks. The costs associated with these conditions are enormous.


Our previous article, “Disease Management; A Tool for Employers to Manage Healthcare Outcomes” (Health 81 Productivity Management, Vol. 2, No. 1),addressed ways disease management can help employers cope with the rising costs of healthcare.

Disease management uses various interventions derived from evidence-based guidelines to help in the management of chronic illness. These interventions include education for patient self-management, collaboration with the patient’s primary care physician, and nursing support. Disease management has been shown be he effective in improving patient quality of life and health, while reducing costs associated with disease [e.g. inpatient admissions, emergency room visits, etc.). This article focuses on the costs of musculoskeletal and chronic pain.

Musculoskeletal and Chronic Pain

Musculoskeletal and chronic pain includes: headache or migraine, carpal tunnel syndrome, neck pain, back pain, fibromyalgia, somataform pain disorders, complex regional pain syndrome (RSD), and osteoarthritis. These sources of pain originate mainly from muscle (Figure 1) and often affect more than one joint. Pain may interfere with daily activities, including performance of job-related tasks. The costs associated with these conditions are enormous.

Lower Back Pain

Low back injuries and their resultant pain are a major cause of disability in the United States. Approximately 2% of the workforce incurs back injuries each year, making them the most expensive health-care problem for the 30-to-50-year-old age group, and the leading cause of disability for persons younger than 45.(1-2) In any given year, 15% to 20% of the population experience back problems, with recurrence rates of about 50% in the 12 months following an attack. (2)

One study of six large employers in the United States found that low back disorders were the fourth most costly physical health condition. Back problems also have been cited as the most costly condition in terms of lost workdays. Average annual productivity losses per worker with low back pain were estimated at $1,230 for male workers and $773 for female workers in a 1996 study.(3) This translates into an aggregate annual productivity loss of roughly $28 billion, while other experts have suggested annual productivity losses as high as $56 billion.(4)


Migraines, which are characterised by episodes of throbbing head pain, light sensitivity, nausea and vomiting, affect 18% of women and 5.5% of men in the United States.(5) The median frequency of attacks is 1.5 per month lasting for about 24 hours.(6) The direct medical cost due to migraines is approximately $1 billion per year (Table 1), which is low compared with back pain or arthritis. The indirect costs are significantly greater.

Each year, employers lose an estimated $13 to $17 billion in missed workdays and impaired work function due to employees’ migraine pain.(7-8) The majority of costs associated with a migraine fall on the shoulders of employers. Through earlier diagnosis and treatment, costs could be significantly reduced. It is likely that more than 50% of men and women determined to have migraines -from self-reported data- have never received a diagnosis from a physician.(9-11)  Therefore, they have not been prescribed preventive drug treatments for their headaches.

Carpal Tunnel Syndrome

Carpal tunnel syndrome (CTS) is a significant cause of workplace disability. Associated symptoms include pain, numbness, and tingling in the upper arm and hands. Its prevalence in the general population is around 4%, but it is much higher in workplace settings where repetitive motion occurs. Each year, direct medical costs for CTS exceed $1 billion. This is about the same as for migraine, but the costs of disability and lost productivity are much greater. A survey of 30,000 workers affected by CTS reported the median number of lost workdays was 25.(12)

Inadequate Treatment of Chronic Pain

Chronic pain is generally treated in wide variations. It is well known that a significant number of persons with LBP and other chronic pain seek care from non-medical practitioners, such as chiropractors. 83% of patients who had a surgical procedure done to eliminate the pain reported that they still had pain following surgery. Additionally 4 in 10 persons with moderate to severe pain cannot find sufficient relief. It has been shown that proper pain management results in quicker clinical recovery, shorter hospital stays, fewer readmissions, and improved quality of life, all of which lead to increased productivity. Since productivity losses associated with chronic pain are enormous, proper pain management has the potential to save employers significant amounts of money.

Disease Management of Chronic Pain

A population-based approach to chronic pain management should be designed to improve quality of life and functionality, while reducing utilisation of medical care. The Institute for Health and Productivity Management survey of 34 companies with 1.2 million workers found musculoskeletal conditions to be the leading cause of absence from work (IHPM, Vol. 1. No. 3). To tackle this major problem for employers, IHPM is launching the first Center for the Study of Pain Management in the Workplace.

By helping participants understand and treat the source of their respective pain, emergency room visits and unnecessary tests and procedures can be effectively reduced. Results from CorSolutions’ own program include a 28% reduction in overall narcotic utilization and a 54% reduction in physician office visits (productivity savings have not yet been quantified).


Management of chronic pain can reduce total costs from the number one cause of disability and lost workdays in the working age population by directly guiding affected employees to appropriate treatment. Disease management programs for chronic pain have been developed that are cost-effective and help reduce pain while improving quality of life in patients and producing large gains in productivity. Employers who implement such disease management programs will have more employees who are healthy and feel valued because their company has invested in their well-being. Moreover, the company’s bottom line will improve, as employees become more productive. Thus, disease management can play an important role in helping employers take control of their rising healthcare costs and recapture lost productivity.


1. Spengler DM, Bigos SJ, Martin NA, Zeh J,. Fisher L, Nachemson A. Back injuries in industry: a retrospective study, I: overview and cost analysis. Spine 1986;11:241-245.
2. S, Bowyer O, Braen G. et al. Acute low back problems in adults. Rockville, Md:Agency for Healthcare Policy and Research, Public Health Service. US Dept of Health and Human Services; 1994. Clinical Practice Guideline 14, AHCPR Publication 95-0642.
3. Rizzo JA, Abbott TA. Berger ML. The labor productivity effects of chronic backache in the United States. Med Care 1998. Oct;36(19):1471-88.
4. Mitchell LV, Lawler PH. Bowen D, Mute W, Asundi P. Purswell J. Effectiveness and cost-effectiveness of employer-issued back belts in areas of high risk for back injury. J. Occup Med. 1994;36:90-94.
5. Lipton RB, Stewart WF, Diamond S, Diamond ML, Reed M. Prevalence and burden of migraine in the United States;  data from the American Migraine Study II. Headache 2001;41:646-57.
6. Stewart WP, Lipton RB, Celentano DD, Reed ML. Prevalence of migraine headache in the United Stem: relation to age. income, race and other sociodemographic factors. JAMA 1992;267:64-9.
7.Hu XH. Markson LE. Lipton RB. Stewart WF. Berger ML. Burden of migraine in the United States: disability and economic costs. Arch Intern Med. 1999;159;813-818.
8. Osterhaus JT, Gutterman DL, Plachetka JR. Healthcare resource use and lost labor costs of migraine headache in the United States. Pharmaeconomics. 1992;2:67-76.
9. Lipton RB, Stewart MF. Migraine in the United States: a review of epidemiology and healthcare use. Neurology. 1993;43 (6 suppl3):S6-S10.
10. Lipton RB, Stewart WF. Simon D. Medical consultation for migraine: results from the American Migraine Study. Headache. 1998;38:87-96.
11. Calentano DD. Stewart WP. Lipton RB, Reed ML. Medication use and disability among migraineurs. Headache. 1992;32:223-228.
12. Patterson JD, Simmons BP. Outcomes assessment in carpal tunnel syndrome. Hand Clin 2002. May;18(2):359-63, viii.
13. Leigh JP, Seavey W, Leistikow B. Estimating the costs of job related arthritis. J Rheumarol 2001 Jul;28(7):1647-54.

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