Abstract
Introduction
Many studies have documented the high distress rates and their correlates among individuals experiencing persistent pain due to a musculoskeletal disorder (MSD). However, few have adopted a biopsychosocial perspective to understand this issue.
Objective
The first objective of this study was to examine workers’ distress levels before they start work rehabilitation and to compare it to those in a healthy population. The second objective was to assess the correlations between distress and biopsychosocial factors.
Methods
The participants were 228 workers on sick leave due to persistent pain from an MSD and who were referred to an interdisciplinary work rehabilitation program.
Results
The workers had very high distress levels compared to normative data. Also, the results of a multiple regression showed that duration of absence, high occupational stress, perception of disability, and fear of movement and (re)injury were significantly associated with distress.
Conclusions
These results highlight the importance of considering distress not only as a predictor of work disability, but as an independent outcome measure. This shift of paradigm could provide a more comprehensive approach in the understanding of workers’ disability.
Similar content being viewed by others
References
Baril, R., Martin, J.-C., Massicotte, P., & Lapointe, C. (1994). Étude exploratoire des processus de réinsertion sociale et professionnelle des travailleurs en réadaptation. Institut de recherche en santé et en sécurité du travail du Québec.
Limoges, J. (1987). Pourquoi travailler? In J. Limoges, R. Lemaire, & F. Dodier (Eds.), Trouver son travail (pp. 13–27). Montréal (Québec, Canada): CIM Fides.
Jackson, T., Iezzi, A., & Lafreniere, K. (1997). The impact of psychosocial features of employment status on emotional distress in chronic pain and healthy comparison samples. Journal of Behavioral Medicine, 20(3), 241–256.
Ohayon, M. M., & Schatzberg, A. F. (2003). Using chronic pain to predict depressive morbidity in the general population. Archives of General Psychiatry, 60(1), 39–47.
CSST. (2002). Statistiques sur les affections vertébrales, 1998–2001. Québec (Canada): Commission de la santé et de la sécurité du travail.
CSST. (2002). Statistiques sur les lésions en “ITE” du système musculo-squelettique. Québec (Canada): Commission de la santé et de la sécurité du travail.
McCracken, L. M., Spertus, I. L., Janeck, A. S., Sinclair, D., & Wetzel, F. T. (1999). Behavioral dimensions of adjustment in persons with chronic pain: Pain-related anxiety and acceptance. Pain, 80, 283–289.
Plehn, K., Peterson, R. A., & Williams, D. A. (1998). Anxiety sensivity: Its relationship to functional status in patients with chronic pain. Journal of Occupational Rehabilitation., 8(3), 213–222.
Hellström, C., Jansson, B., & Carlsson, S. G. (1999). Subjective future as a mediating factor in the relation between pain, pain-related distress and depression. European Journal of Pain, 3, 221–233.
Hellström, C., & Jansson, B. (2001). Psychological distress and adaptation to chronic pain: Symptomatology in dysfunctional, interpersonnally distressed, and adaptative copers. Journal of Musculoskeletal Pain, 9(3), 51–67.
Naidoo, P., & Pillay, Y. G. (1994). Correlations among general stress, family, environment, psychological distress, and pain experience. Perceptual and Motor Skills, 78, 1291–1296.
Turner, J. A., Jensen, M. P., Warms, C. A., & Cardenas, D. D. (2002). Catastrophizing is associated with pain intensity, psychological distress, and pain-related disability among individuals with chronic pain after spinal cord injury. Pain, 98, 127–134.
Von Korff, M., & Simon, G. (1996). The relationship between pain and depression. The British Journal of Psychiatry. Supplement, 30:101–108.
Walker, J., Sofaer, B. (1998). Predictors of psychological distress in chronic pain patients. Journal of Advanced Nursing, 27(2), 320–326.
Waters, S. J., Keefe, F. J., & Strauman, T. J. (2004). Self-discrepancy in chronic low-back pain: Relation to pain, depression, and psychological distress. Journal of Pain and Symptom Management, 27(3):251–259.
McWilliams, L. A., Cox, B. J., & Enns, M. W. (2003). Mood and anxiety disorders associated with chronic pain: An examination in a nationally representative sample. Pain, 106(1–2), 127–133.
Currie, S. R., Wilson, K. G., & Curran, D. (2002). Clinical significance and predictors of treatment response to cognitive-behavior therapy for insomnia secondary to chronic pain. Journal of Behavioral Medicine, 25(2), 135.
Dysvik, E., Natvig, G. K., Eikeland O., & Lindstrom, T. C. (2005). Coping with chronic pain. International Journal of Nursing Studies, 42, 297–305.
Haugli, L., Steen, E., Laerum, E., Nygard R, & Finset, A. (2003). Psychological distress and employment status. Effects of a group learning programme for patients with chronic musculoskeletal pain. Psychology, Health & Medicine, 8(2), 135–148.
Matthews, G. (2000). Distress. In F. George (Ed.), Encyclopedia of stress (pp. 723–729). San Diego, California: Academic Press.
Lazarus, R. S., & Folkman, S. (1984). Stress, appraisal, and coping. New York: Springer.
Préville, M., Boyer, R., Potvin, L., Perrault C, & Légaré, G. (1992). La détresse psychologique: détermination de la fiabilité et de la validité de la mesure utilisée dans l’enquête Santé Québec. Québec (Canada): Les publications du Québec.
BenDebba, M., Torgerson, W. S., & Long, D. M. (1997). Personality traits, pain duration and severity, functional impairment, and psychological distress in patients with persistent low back pain. Pain, 72, 115–125.
Cano, A., Gillis, M., Heinz, W., Geisser M., & Foran, H. (2004). Marital functioning, chronic pain, and psychological distress. Pain, 107, 99–106.
Daffner, S. D., Hilibrand, A. S., Hanscom, B. S., Brislin, B. T., Vaccaro, A. R., & Albert, T. J. (2003). Impact of neck and arm pain on overall health status. Spine, 28(17), 2030–2035.
Grotle, M., Vollestad, N. K., Veierod, M. B., & Brox, J. I. (2004). Fear-avoidance beliefs and distress in relation to disability in acute and chronic low back pain. Pain, 112(3), 343–352.
Keefe, F. J., Wilkins, R. H., Cook, W. A. Jr, Crisson, J. E., & Muhlbaier, L. H. (1986). Depression, pain, and pain behavior. Journal of Consulting and Clinical Psychology, 54(5), 665–669.
Vowles, K. E., Gross, R. T., & Sorrell, J. T. (2004). Predicting work status following interdisciplinary treatment for chronic pain. European Journal of Pain, 8(4), 351–358.
Vowles, K. E., Zvolensky, M. J., & Gross, R. T. (2004). Pain-related anxiety in the prediction of chronic low-back pain distress. Journal of Behavioral Medicine, 27(1), 77–89.
Sullivan, M. J. L., & D’Eon, J. L. (1990). Relation between catastrophizing and depression in chronic pain patients. Journal of Abnormal Psychology, 99(3), 260–263.
Gauthier, N., Sullivan, M. J., Adams, H., Stanish, W. D., & Thibault, P. (2006). Investigating risk factors for chronicity: The importance of distinguishing between return-to-work status and self-report measures of disability. Journal of Occupational and Environmental Medicine/American College of Occupational and Environmental Medicine, 48(3), 312–318.
Roth, R. S., Geisser, M. E., Theisen-Goodvich M., & Dixon, P. J. (2005). Cognitive complaints are associated with depression, fatigue, female sex, and pain catastrophizing in patients with chronic pain. Archives of Physical Medicine and Rehabilitation, 86(6), 1147–1154.
Samwel, H. J., Evers, A. W., Crul, B. J., & Kraaimaat, F. W. (2006). The role of helplessness, fear of pain, and passive pain-coping in chronic pain patients. The Clinical Journal of Pain, 22(3), 245–251.
McCracken, L. M., Gross, R. T., & Eccleston, C. (2002). Multimethod assessment of treatment process in chronic low back pain: Comparison of reported pain-related anxiety with directly measured physical capacity. Behaviour Research and Therapy, 40(5), 585–594.
Vaeroy, H., Tanum, L., Bruaset, H., Morkrid L., & Forre, O. (2005). Symptoms of depression and anxiety in functionally disabled rheumatic pain patients. Nordic Journal of Psychiatry, 59(2), 109–113.
Williams, R. A., Pruitt, S. D., Doctor, J. N., et al. (1998). The contributions of job satisfaction to the transition from acute to chronic low back pain. Archives of Physical Medical Rehabiliation, 79, 366–374.
Frank, J. W., Brooker A., DeMaio, S. E., et al. (1996). Disability resulting from occupational low back pain. Part II: What do we know about secondary prevention? A review of the scientific evidence on prevention after disability begins. Spine, 21, 2918–2929.
Ektor-Andersen, J., Isacsson S, Lindgren, A., Orbaek P., group TMs-s. (1999). The experience of pain from the shoulder-neck area related to the total body pain, self-experience health and mental distress. Pain, 82, 289–295.
Feuerstein, M., Thebarge, R. W. (1991). Perceptions of disability and occupational stress as discriminators of work disability in patients with chronic pain. Journal of Occupational Rehabilitation, 1(3), 185–195.
Magni, G., Moreschi, C., Rigatti-Luchini S., Merskey, H. (1994). Prospective study on the relationship between depressive symptoms and chronic musculoskeletal pain. Pain, 56(3), 289–297.
Averill, P. M., Novy, D. M., Nelson, D. V., & Berry, L. A. (1996). Correlates of depression in chronic pain patients: A comprehensive examination. Pain, 65(1), 93–100.
Jackson, T., Iezzi A., & Lafreniere, K. (1998). Relations of employment status to emotional distress among chronic pain patients: A path analysis. The Clinical Journal of Pain, 14(1), 55–60.
Loisel, P., & Durand, M. J. (2003). Worker accomodation, clinical intervention and return to work. In T. Sullivan & J. Frank (Eds.), Preventing and managing disability at work. London, ON: Taylor & Francis.
Ilfeld, F. W. (1976). Further validation of a psychiatric symptom index in a normal population. Psychological Report, 39, 1215–1228.
Preville, M., Potvin L., & Boyer, R. (1995). The structure of psychological distress. Psychological Reports, 77(1), 275–293.
Martin, F., Sabourin S., & Gendreau, P. (1989). Les dimensions de la détresse psychologique: Analyse factorielle confirmatoire de type hiérarchique [Dimension of psychological distress: Confirmatory factorial analysis]. International Journal Of Psychology, 24, 571–584.
Mykletun, A., Stordal E., & Dahl, A. A. (2001). Hospital Anxiety and Depression (HAD) scale: Factor structure, item analyses and internal consistency in a large population. The British Journal of Psychiatry; The Journal of Mental Science, 179, 540–544.
Kalliath, T. J., O’Driscoll, M. P., & Brough, P. (2004). A confirmatory factor analysis of the General Health Questionnaire-12. Stress and Health, 20, 11–20.
Harter, M., Reuter, K., Gross-Hardt K., & Bengel, J. (2001). Screening for anxiety, depressive and somatoform disorders in rehabilitation–validity of HADS and GHQ-12 in patients with musculoskeletal disease. Disability and Rehabilitation, 23(16), 737–744.
Coste, J., Le Parc, J. M., Berge, E., Delecoeuillerie G., & Paolaggi, J. B. (1993). French validation of a disability rating scale for the evaluation of low back pain (EIFEL questionnaire). Revue du Rhumatisme Ed. Française, 60(5), 335–341.
Roland, M., & Morris, R. (1983). A study of the natural history of back pain. Part I: Development of a reliable and sensitive measure of disability in low-back pain. Spine, 8(2), 141–144.
Wood-Dauphinee, S. L. (2001). Assessment of back-related quality of life. Spine, 26(8), 857–861.
Beaton, D., & Schemitsch, E. (2003). Measures of health-related quality of life and physical function. Clinical Orthopaedics and Related Research, 413, 90–105.
Al-Obaidi, S. M., Beattie, P., Al-Zoabi B., & Al-Wekeel, S. (2005). The relationship of anticipated pain and fear avoidance beliefs to outcome in patients with chronic low back pain who are not receiving workers’ compensation. Spine, 30(9), 1051–1057.
Woby, S. R., Watson, P. J., Roach, N. K., & Urmston, M. (2004). Adjustment to chronic low back pain–the relative influence of fear-avoidance beliefs, catastrophizing, and appraisals of control. Behaviour Research and Therapy, 42(7), 761–774.
Garratt, A. M., Moffett, J. K., & Farrin, A. J. (2001). Responsiveness of generic and specific measures of health outcome in low back pain. Spine, 26(1), 71–77.
Patrick, D. L., Deyo, R. A., Atlas, S. J., Singer, D. E., Chapin A., & Keller, R. B. (1995). Assessing health-related quality of life in patients with sciatica. Spine, 20(17), 1899–1908.
Kopec, J. A., & Esdaile, J. M. (1995). Functional disability scales for back pain. Spine, 20(17), 1943–1949.
Roland, M., & Fairbank, J. (2000). The Roland-Morris disability questionnaire and the Oswestry disability questionnaire. Spine, 25(24), 3115–3124.
French, D. J., Roach, P. J., & Mayes, S. (2002). Peur du mouvement chez des accidentes du travail: l’Echelle de Kinesiophobie de Tampa (EKT). Canadian Journal of Behavioural Science, 34(1), 28–33.
Kori, S. H., Miller, R. P., & Todd, D. D. (1990). Kinesiophobia: A new view of chronic pain behavior. Pain Management, January/February, 35–43.
Swinkels-Meewisse, E. J. C. M., Swinkels, R. A. H. M., Verbeek, A. L. M., Vlaeyen, J. W. S., & Oostendorp, R. A. B. (2003). Psychometric properties of the Tampa Scale for kinesiophobia and the fear-avoidance beliefs questionnaire in acute low back pain. Manual Therapy, 8(1), 29–36.
Durand, M. J., Loisel, P., Hong, Q. N., & Charpentier, N. (2002). Helping clinicians in work disability prevention: The work disability diagnosis interview. Journal of Occupational Rehabilitation, 12(3), 191–204.
Von Korff, M., Jensen, M. P., & Karoly, P. (2000). Assessing global pain severity by self-report in clinical and health services research. Spine, 25, 3140–3151.
Ferraz, M. B., Quaresma, M. R., Aquino, L. R., Atra, E., Tugwell P., & Goldsmith, C. H. (1990). Reliability of pain scales in the assessment of literate and illiterate patients with rheumatoid arthritis. The Journal of Rheumatology, 17(8), 1022–1024.
Jensen, M. P., Karoly P., & Braver, S. (1986). The measurement of clinical pain intensity: A comparison of six methods. Pain, 27(1), 117–126.
Jensen, M. P., Karoly, P., O’Riordan, E. F., Bland, F. Jr., & Burns, R. S. (1989). The subjective experience of acute pain. An assessment of the utility of 10 indices. The Clinical Journal of Pain, 5(2), 153–159.
Tabachnick, B. G., & Fidell, L. S. (2000). Using multivariate statistics. Boston: Allyn & Bacon.
Wall, P. D., Melzack, R. (1999). Textbook of pain. Edinburgh, Scotland: Churchill Livingstone.
Waddell, G. (1998). The back pain revolution. Edinburgh, London: Churchill Livingston.
Steenstra, I. A., Anema, J. R., Bongers, P. M., de Vet, H. C., Knol, D. L., & Van Mechelen, W. (2006). The effectiveness of graded activity for low back pain in occupational healthcare. Occupational & Environmental Medicine, 63(11), 718–725.
Boyer, R., Preville, M., Legare G., & Valois, P. (1993). Psychological distress in a noninstitutionalized population of Quebec: Normative results of the Quebec health survey. Canadian Journal of Psychiatry. Revue Canadienne de Psychiatrie, 38(5), 339–343.
Légaré G., Préville, M., Massé R., Poulin, C., St-Laurent D., & Boyer, R. (2001). Santé mentale. In G. Légaré, M. Préville, R. Massé, C. Poulin, D. St-Laurent, & R. Boyer (Eds.), Enquête sociale et de santé 1998. Québec (Canada): Les publications du Québec.
Croft, P. R., Papageorgiou, A. C., Ferry, S., Thomas, E., Jayson, M. I., & Silman, A. J. (1995). Psychologic distress and low back pain. Evidence from a prospective study in the general population. Spine, 20(24), 2731–2737.
Magni, G., Caldieron, C., Rigatti-Luchini S., Merskey, H. (1990). Chronic musculoskeletal pain and depressive symptoms in the general population. An analysis of the 1st National Health and Nutrition Examination Survey data. Pain, 43(3), 299–307.
Magni, G., Marchetti, M., Moreschi, C., Merskey H., & Luchini, S. R. (1993). Chronic musculoskeletal pain and depressive symptoms in the National Health and Nutrition Examination. Epidemiologic follow-up study. Pain, 53(2), 163–168.
Watson, P. J., Booker, C. K., Moores L., & Main, C. J. (2004). Returning the chronically unemployed with low back pain to employment. European Journal of Pain, 8(4), 359–369.
Coutu, M. F., Durand, M. J., Loisel, P., Dupuis, G., & Gervais, S. (2005). Measurement properties of a new quality of life measure for patients with work disability associated with musculoskeletal pain. Journal of Occupational Rehabilitation, 15(3), 295–312.
Johnson, S. L. (1997). Therapist’s guide to clinical intervention. San Diego, California: Academic Press.
Krause, N., Dasinger, L. K., & Neuhauser, F. (1998). Modified work and return to work: A review of the literature. Journal of Occupational Rehabilitation, 8, 113–139.
Franche, R. L., Krause, N. (2002). Readiness for return to work following injury or illness: Conceptualizing the interpersonal impact of health care, workplace, and insurance factors. Journal of Occupaitonal Rehabilitation, 12(4), 233–255.
Loisel, P., Durand, M. J., Berthelette, D., et al. (2001). Disability prevention - New paradigm for the management of occupational back pain. Disease Management & Health Outcomes, 9(7), 351–360.
Turk, D. C., Monarch, E. S. (2002). Biopsychosocial perspective on chronic pain. In D. C. Turk & R. J. Gatchel (Eds.), Psychological approaches to pain management: A practitioner’s handbook. New York: Guilford.
Acknowledgements
The preparation of this manuscript was supported by a start-up grant from the FRSQ Health and Society Team program. We are most grateful to all the participants for their time and to the clinicians who so rigorously performed the WoDDI assessment of the participants.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Coutu, MF., Durand, MJ., Loisel, P. et al. Level of Distress Among Workers Undergoing Work Rehabilitation for Musculoskeletal Disorders. J Occup Rehabil 17, 289–303 (2007). https://doi.org/10.1007/s10926-007-9079-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10926-007-9079-y