The price of pain in the workplace; one in four sick days… more than $3 billion in sick leave: the impact of pain calls for a closer look – includes related article on company health benefits

When Louis Harris and Associates, Inc., asked employees and employee benefits managers (EBMs) about pain in the workplace, the alarming cost of pain wasn’t the only startling finding.

The survey revealed widespread misconceptions among EBMs about the extent and impact of work-related pain– misconceptions that could thwart effective benefits planning.

The Harris survey polled about 1,000 full-time employees at companies of all sizes and approximately 300 EBMs at firms with at least 150 workers.’ EBMs were asked to estimate the prevalence of pain conditions in their workforces and how many sick days were due to pain; employees were questioned about the pain conditions they suffer from and actual sick days taken because of pain.

The responses showed significant disparities between the two groups’ perceptions. While EBMs believe that pain conditions affect only about 20 percent of workers, 68 percent of employees reported suffering from pain. Fourteen percent of employees reported they had missed work due to pain in the last year.

According to the employees, pain accounted for an average of three sick days per worker in the last year; yet EBMs estimated that workers who call in sick due to pain miss 9 to 10 days a year.

“This indicates that employers are aware of only the most severe pain that leads to extended time off from work,” says Robert Leitman, executive vice president, Louis Harris and Associates. “They underestimate the number of people who have pain but overestimate the number of sick days taken per employee.”


A few days off a year taken by a large number of people add up faster than one might suspect. When extrapolated to the total full-time workforce in the United States, the survey results suggest that pain accounted for one-fourth of all sick days in the last 12 months, or the equivalent of 50 million lost workdays in 1995.’ Once wages paid for sick time are also calculated, pain-related sick days cost employers more than $3 billion per year. (See table on page 10.)

And that’s the conservative figure. It excludes reimbursement of part-time workers with paid sick leave and full-time workers paid only partially for sick time. Cost of replacement workers is not considered, and disability and worker’s compensation paid due to pain are excluded. The survey does provide some data on pain-related disability. About 8 percent of full-time employees have ever gone on short-term disability because of pain conditions, for an average leave of 17 days.

EBMs believe that pain’s effects go beyond sporadic absenteeism. Roughly two-thirds agreed that pain hurts employee productivity, morale and company profitability, and increases health insurance premiums.

Of course, anything that causes absenteeism impacts the productivity and morale of coworkers and of the missing individual. Not only does the absence of one worker often hamper the ability of others to do their jobs, says Beach Hall, a Michigan-based consultant and retired director of health care plans at General Motors, but quality usually suffers when a replacement worker fills in. In effect, the company ends up paying two employees for the one assignment.


To respond more effectively to the impact of pain in the workplace, Hall advises employers to improve their understanding of the conditions causing employee pain. The survey revealed that employers correctly perceive about only 40 percent of work-related pain and only 31 percent of nonwork-related pain.

This is not surprising given the way that sick time is handled at many companies. Because documentation often is not required for a few days of sick time, EBMs may be unaware of the reasons for sick leave unless a short-term disability claim is filed or disciplinary action is contemplated. “The further you are from the department and supervisory level, the less you know about casual absence,” says Hall. (See sidebar, “Restructuring sick leave policies,” page 11 .)

Even when documentation is required, the difficulty of verifying the presence of pain may encourage workers to give that excuse when misusing sick time. Pain can persist even though no abnormalities are found on a myriad of diagnostic tests. As a result, there is a perception, says Hall, “that if employees can’t figure out what else to say to take off from work, they’re going to say they hurt.” This misuse of sick leave by a few makes matters difficult for employees who really do have pain for which no cause can be found.

“When there isn’t any documentation, you have to take the individual’s word for it,” says Penney Cowan, executive director of the American Chronic Pain Association, based in Rocklin, California. “So there’s always some skepticism.”

Another obstacle both to understanding and addressing the impact of pain may be the lack of coordination of health care benefits, worker’s compensation, disability, and worksite wellness programs. Studies by Louis Harris indicate that in most firms, these services are managed by different, unrelated divisions, says Leitman. Integration of these functions could enable firms to track all aspects of each employee’s use of health care.

Nevertheless, there is disagreement in the employer community about whether it would be beneficial to integrate worker’s compensation and health benefits plans. Legal requirements of worker’s comp require “a separate management style,” according to Hall. Additionally, while the goal of worker’s

compensation programs is returning employees to work, this may not be a consideration in treatment of employees with similar injuries that occurred off the job. Unlike worker’s comp programs, health benefits plans also cover dependents as well as employees. In many firms, about 60 percent of the bill for health benefits is attributable to dependents. “People who worry about health care are worrying about something substantially more macro than worker’s comp,” notes Hall.


Despite the impact of pain on absenteeism and productivity, few firms appear to be focusing on the issue. The Harris survey attempted to measure efforts to prevent or manage pain by assessing the prevalence of worksite wellness programs directed at pain. About 40 percent of EBMs and 45 percent of employees surveyed report that their employers offer wellness programs but only a small minority of these programs have anything to do with preventing occurrence or exacerbation of pain conditions. “Thus, we have a situation that is very costly to employers, with some [EBM] awareness of its impact, but not a very clear response from employers,” Leitman says.

Wellness programs are only one strategy to reduce the costs of pain. Another option is a worksite injury-prevention program to educate employees and evaluate workspaces and equipment to ensure proper use of body mechanics and application of ergonomic principles. “Prevention is easier than correcting injuries,” says Hyacinth Campbell Roberts, RN, health services advisor at Honeywell, Inc., in Minnesota, which has such a program.

Once pain conditions develop, employers need to ensure that their health plans facilitate prompt referral for appropriate treatment–a critical step for preventing acute problems from becoming chronic. Most patients with pain can be helped, but many do not receive appropriate care for months or years, according to J. David Haddox, DDS, MD, medical director of the pain rehabilitation program at the Emory Clinic in Atlanta. Some health plans have policies that obstruct referral to or coverage for proper treatment. Others may include few or no credentialed pain specialists or accredited pain management facilities among their providers.

Data suggest that multidisciplinary pain management is cost-effective. A meta-analysis of 65 studies found that for patients with chronic back pain, treatment in multidisciplinary pain programs resulted in greater likelihood of return to work and reduced use of medication.(3) At Honeywell, when a worker with severe headache was referred to a pain clinic, the employee’s medical expenditures were reduced by $15,000 in one year, says Campbell Roberts. Previously, the worker’s record had been marked by high utilization of emergency room and outpatient services, as well as absenteeism. Because Honeywell, like most large employers, is self-insured, it reaps the savings of proper care.

Employers can also benefit from programs expediting the return of sick or injured employees to the job, even on a part-time or restricted-duty basis. When the Johns Hopkins Institutions evaluated the effectiveness of a return-to-work program following worker’s-compensation-related injuries or illnesses from 1992 to 1995, they found the program reduced payments for lost wages by 60 percent.

Expediting even limited return to employment can prevent long-term disability. Studies of workers with low-back pain have shown that the longer a person is away from work, the less likely he or she is to return. Only half of those who miss 6 months of work for low-back pain return to full-time employment. This figure drops to 30 percent for those out of work for one year and to 5 percent for those who miss work for two years as a result of low-back pain, says Haddox.

Clearly, effective management of pain represents an opportunity for employers to increase productivity, morale and profitability. “They can increase productivity by reducing pain-related absenteeism, improve quality because absentee replacements generally impact quality, and can contain their health care costs through better management of pain,” concludes Hall.

Pain costs more than $3 billion annually in sick leave

Among the 1,000 employees surveyed by Harris, pain was the reason for 14 percent of sick days taken in the last year. Extrapolating that percentage to the 120 million full-time employees in the United States shows how quickly the costs of pain add up.

Full-time employees

calling in sick annually 120 million

Full-time employees

calling in sick due to pain 16.8 million

Total number of

pain-related sick days 50.4 million days

(Mean of 3 per employee)

Costs due to lost

work days from pain* >$3 billion

COPYRIGHT 1996 A Thomson Healthcare Company

COPYRIGHT 2004 Gale Group

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