What about people who do function WITH chronic pain?

Well, what about those? Most researchers would suggest there aren’t many of them.  A quick review on PubMed will only give you a few useful hits, however it is estimated that about 70% of all people suffering from chronic nonspecific musculoskeletal pain manage to stay functioning at work. In actual fact this may in many cases be for the better, as we know that work may enhance physical fitness, provide income and social participation and may even work therapeutically for the individual.[1]

From this perspective, calling in sick to work may lead to avoidance of further activities which in turn may lead to deconditioning with all negative consequences described in literature.

As clinicians and researchers, we realized that our current knowledge of workers with chronic pain was largely based on a subgroup that we have studied very extensively – those who come in for rehabilitation. However, we know close to nothing about the largest group: they are understudied and not seen in (tertiary) rehabilitation. In other words what distinguishes workers who are in rehab, sick and off work from those who remain working? What could be learned from the group who stay at work?

Therefore, our research team studied whether workers with chronic pain who remained working differed in functional capacity compared to workers who were on sick leave and compared to healthy workers. Additionally, we wanted to know which factors would relate to functional capacity.

We tested three groups (cross sectionally) consisting of 942 people on functional capacity, health experience, work load, physical activity, and for those with pain, kinesiophobia, disability, pain level, self efficacy.[2]  Just a few calls to the media were enough to fulfill our inclusion number of workers with pain who were anxious to tell their stories!

We found that workers who were on sick leave performed significantly lower on functional capacity tests such as lifting, overhead work, static tests, but not on aerobic capacity. There were significant relationships between work load, age, gender, self reported physical activity and disability, but not with pain level.

We concluded that these results provided additional insight in a relatively disregarded group of workers which is larger than would be expected. Of course, cross sectional data does not prove any causality between sick leave and deconditioning, and a next step would be to do so, however, there appeared many significant and large differences that should not be disregarded.

About Remko Soer

Remko is a physical therapist and human movement scientist working at the Center for Rehabilitation and the Groningen Spine Center of the University Medical Center Groningen in The Netherlands. He works as a clinician with patients with non-specific chronic musculoskeletal pain.  Remko’s PhD looked at the validity of functional capacity evaluations in both social and rehabilitation medicine. Besides his work and three kids and the oldest being three years old, he has absolutely no time to do anything for himself.


[1] de Vries HJ, Brouwer S, Groothoff JW, Geertzen JH, & Reneman MF (2011). Staying at work with chronic nonspecific musculoskeletal pain: a qualitative study of workers’ experiences. BMC musculoskeletal disorders, 12 PMID: 21639884

[2] Soer R, de Vries HJ, Brouwer S, Groothoff JW, Geertzen JH, & Reneman MF (2012). Do workers with chronic nonspecific musculoskeletal pain, with and without sick leave, have lower functional capacity compared with healthy workers? Archives of physical medicine and rehabilitation, 93 (12), 2216-22 PMID: 22772082


  1. After reading the article, the concern I would have is that no mention was made of the type of pain that was suffered. Without identifying the location and/or reasons behind it, are you confusing a correlation with a causation here?

    Those who have upper limb pain would be significantly more capable of returning to work than say those with lower back or leg pain, especially if the job involved long periods of standing or sitting. In order to properly understand the differences between those who endure pain and continue to work versus those who are not at work you first have to eliminate all other factors which do not contribute to the area you are looking at.

    In addition to this, as individuals we all have our own internal pain tolerances and capacities which are not linked in any way to physiology, so I would be concerned that those who choose to work may in fact simply have a higher pain tolerance than those who don’t, which would create misleading test results as well.

    It may just be an oversight, and all of this may have already been taken into account, but it was not mentioned in the article and I would have thought this highly important in order to establish a control to ensure better results.

    I do however commend you for entering into this area, as it certainly is an often ignored one, and I applaud anyone who continues to search for answers in an area that most simply dismiss as “you just need to live with it and think positive” which sadly professionals in the area of pain management seem to say all too often.

  2. I totally agree with you Leonie! This was me too, gave work everything and was left with nothing in the tank when I got home, and made my condition worse.

    Remko Soer Reply:

    Dear Paulee and Leonie,

    You are both addressing a very true and necessary point. We actually performed a study to the rationales behind staying at work. My colleagues performed many interviews on those suffering from chronic pain. Many indeed see financial necessity as an important reason to stay at work, however, on the contrary, their also appeared many people who stated that their work was important to maintain in social activities, keep physically active and stated work as an important value for life. So work addresses both sides of the coin. Of course there remain many items unanswered, but we did manage to identify some important factors of which we gained valuable information to use in our daily rehabilitation setting.

    Our studies can be downloaded free (dissertation H.J. De Vries) in the attached link.

    With kind regards,

  3. I am really suprised and interest to see you here, Remko, with a new nice subject and outcomes of your good research! Greetings from Bonaire!

  4. Interesting study. However, I think an important factor to consider when looking at those with chronic pain who are still working is whether they are working due to financial necessity and how this affects their capacity outside of work. Many people I’ve met with chronic pain force themselves to keep working. They use up all their energy and functional capacity at work and are a complete wreck when they get home, unable to do any house work, hobbies, social activities or even look after children. I suffered like this for around a year before my partner told me to stop working so I’d have a chance to improve. I am fortunate that I have a partner with a good income that we can manage on.

    Given that chronic pain conditions are difficult to diagnose and document, many are unable to qualify for a Disability Support Pension and even those that do qualify often find that it’s not enough to cover living expenses. Add in dependent children, mortgage repayments etc. and it becomes very difficult for someone in chronic pain to make that decision to stop work and therefore lose their income in order to regain their health. Some people are lucky and have a partner or family member who can provide enough support to allow them to stop work. Some are lucky enough to be able to find part-time/casual work that allows them to work at the level of functionality they have. For many though, they are often forced to remain in full-time work and spend all their available energy on that to the detriment of their life outside of work.

    I think any research into people with chronic pain who are still working must consider their overall functionality and capacity – both at work and outside of work, with sustainability of capacity and quality of life being key factors – within the context of their financial and living situation.

  5. This is a wonderful area of research. I’ve had periods where I haven’t been able to work because of pain (CRPS) but have been working consistently four days a week for two years now. In some ways I was lucky though I had a job that were ok with me working lesser hours for more than two years and i had insurance to keep my income coming in. That meant I could very gradually pace up the hours. Work made my pain so much worse for so long but I was determined to get back to it and it sure was worth it in the long run. With a less understanding employer I might not have been able to achieve this.
    I totally agree with Michele’s comments too. I was lucky to have a great medical team and already knew how to work within a medical system and did lots of my own research. I asked so many questions too…. (I’m lucky they all spent the time with me to answer them all). I kept up some form of exercise the whole time too (albeit limited at times). It all pays off.

  6. Really interesting. Was there any difference in the two groups in regard to psych factors such as self-efficacy?

  7. Lesley Singer says

    good point. i am a physiotherapist as well and i believe i have been overlooked for a job due to my chronic pain but I believe the profession or job you do is a big factor as although I believe I was overlooked in one area I can still work any number of hours elsewhere and this certainly is a big factor in my being able to keep working throughout. therefore I think it also depende on the job market which at times is very tied to education level.

  8. Michele Wensman says

    I agree this is a great topic to study. I am a physical therapist who has struggled with chronic pain for many years. I think it really depends on the type of job one has and their education level. Many have not been fortunate enough to have a college degree or enough education or financial support to allows them to transition into something less physical or more optimal for their specific limitations. Other folks without knowledge of the medical field or alternative treatments are at a disadvantage in navigating through it or evaluating what to have and not to have done and what to do for themselves. It would be interesting to look at the education level, and socioeconomic factors at play. Obviously motivation to stay active plays into this greatly but I can see how some people get stuck due to insufficient support systems, lack of knowledge, and financial resources even when they might be motivated.

  9. Lesley Singer says

    Hi great work. It is the first time i have read about those who remain at work. As a clinician what I am wondering is are these people who stay at work different from the people we are trying to get back to work. In other words can we use these same reasons or themes to get people back to work. I personally think it is harder to get people back to work (these are the people we see in rehab often) compared to getting people to stay at work . Those who stay at work maybe don’t often get seen in rehab or maybe some do as your study shows. Some use the medical system to help keep them working but I suspect the majority of those who remain at work do not go regularly to rehab.(I say this although I have lived with chronic neuropathic pain for over 10 years and I do go regularly for chronic pain rehab as maintenance and this definitely helps keep me in the workplace) I enjoyed this paper very much

  10. Claire Robinson says

    Hi, this is very interesting & makes a lot of sense. But my question is this: how many chronic pain sufferers who have musculoskeletal pain & who are capable of working have been ‘let go’ from a job due to their condition? I am one of those – I was made redundant from a job because of my pain. The company were solicitors & were clever enough to let me go for another justifiable reason other than the truth. They did not support me emotionally which made me stressed, which caused me pain. They thought they knew what was causing my pain (rather than to listen to me & trust my findings & research) & blamed my social activities outside of work as the perpetuating factor. When I was able to socialise it was due to the reasons stated in this article – to be sociable, to do things which made me happy & were a good distraction. Holding down a job when suffering from an invisible condition is extremely hard. I work unbelievably hard to stay well & am succeeding. I used to live with acute pain in my lower torso & legs 24/7 for years. Now I get the odd ‘twinge’ & flare up but I am managing things exceptionally well & I’ve done so with very little help. Employers need to be educated about people like me whose pain ‘might’ affect their work at some point or other. I want to work & am able to work but only with the right support.

  11. This is the subject of my PhD – well, not so much remaining at work as “living well” with chronic pain. But all of the participants in my study were working in paid or unpaid work, it was almost their personal definition of wellbeing. You’re absolutely right, there is very little known about the relatively large group of people who manage their pain well, remain active and engaged in normal life, and yet have pain of moderate to severe intensity. It seems to me there can be undue focus on how to reduce or abolish pain almost to the exclusion of learning how it is that people live full, rich and productive lives alongside their pain. Interestingly, in the chronic pain management centre where I worked until recently, many people attended the centre functionally very limited – but quite cardiovascularly fit. In other words, fitness doesn’t necessarily translate into function.

  12. Author! Author! What a marvelous idea to study those who are doing everything they can be maintain functionality while in pain. I am not making a judgement about those who need to be on disability, but know personally how myself and others have endured to great lengths to be able to “maintain” our life styles and jobs. Hoping more research about this neglected population lies ahead. Your own personal ability to deal with your invisible disability makes a huge difference in what you do each day. Thanks for your work, Remko.