• Elizabeth Hengstebeck, Steven Roskos, Karen Breejen, Bengt Arnetz, and Judy Arnetz.
• Michigan State University, Department of Family Medicine, 788 Service Rd., #B120, East Lansing, MI 48824, United States. Electronic address: elizabeth.hengstebeck@hc.msu.edu.
• Scand J Pain. 2017 Oct 1; 17: 397-402.

Background And AimsSome 100 million adults in the United States suffer from chronic pain. While research to date has focused primarily on pain interference with physical and psychological function and its effects on employment, few studies have examined the impact of pain interference on social functioning and its effects on employment. The aims of our study were to (1) evaluate the association between pain interference with ability to work and actual employment status among working age adults with chronic pain; and (2) evaluate pain interference with four types of functioning - cognitive, physical, psychological, and social - as possible mediators of pain interference with the ability to work.MethodsData were collected via a self-selected sample of individuals visiting the American Chronic Pain Association (ACPA) website. The final dataset included 966 respondents. We examined the association between pain interference with the ability to work and employment in a population with chronic pain. We then analyzed pain interference with four types of functioning, physical, psychological, cognitive, and social, for their impact on the ability to work.ResultsPain interference with ability to work was significantly inversely associated with employment status, i.e., the less that pain interfered with one's ability to work, the greater the likelihood of being employed. Moreover, pain interference with ability to work was a stronger predictor of employment status than an individual's rating of their pain intensity. Pain interference with social functioning partially mediated the effects of pain interference with cognitive and physical functioning and fully mediated the effects of pain intensity and pain interference with psychological functioning on pain interference with the ability to work. Results suggest that pain interference with social function may be a significant contributor to pain interference with ability to work in working age adults with chronic pain.ConclusionsIn the development of effective solutions to address the economic and societal burden of chronic pain, this paper highlights the role of social function as an important, yet frequently overlooked, contributor to chronic pain's effect on the ability to work. Our findings underscore the importance of an integrated biopsychosocial approach to managing chronic pain, especially when addressing ability to work. From a clinical standpoint, assessing and managing pain intensity is necessary but not sufficient in addressing the far-reaching negative consequences of chronic pain.ImplicationsThe development of interventions that improve social function may improve the ability to work in adults with chronic pain. Likewise, sick leave should be prescribed restrictively in the management of chronic pain since it may further interfere with social functioning.PerspectiveThis study highlights the importance of the assessment of pain interference with social function as a part of a comprehensive biopsychosocial approach to the evaluation and management of patients with chronic pain. Interventions that improve social function may improve the ability to work in this population. In addition, sick leave should be prescribed restrictively in the management of chronic pain since it by itself interferes with social functioning.Copyright © 2017 Scandinavian Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

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