1. Chronic Pain and Employment
Veronica Ball BSc OT
Clinical Case Manager
The Fit for Work Team
www.fitforworkteam.org
Veronica Ball
Occupational Therapist
Clinical Case Manager
www.fitforworkteam.org

2. Areas to be explored
• Individuals moving from unemployment to
employment, voluntary work or training
using PMP and a job broker (Pilot 1)
• Additional interventions
PMP/Mindfulness/CBT service without a
job broker (Pilot 2)
• NHS Innovation challenge : Unexplained or
Unresolved Pain Pilot including Case
Managers and Employment support

3. Medically Unexplained Physical Symptoms
• It is estimated that medically unexplained
physical symptoms are the main reason
for between 15% and 19% of GP
consultations in the UK
• And up to 70% of people suffering with
MUPS will also suffer from depression
and/or anxiety disorders
www.rcpsych.ac.uk

4. DWP From Pain to Prospects
Individuals moving from unemployment
to employment, voluntary work or
training using PMP and a job broker

5. • Job Centre Plus
• 30 People changed from ESA to JSA
– Taken off long term health benefits
• Chronic pain is the main barrier to work
• Comprehensive face to face assessment - GP/OH
Physician
• Interventions
– Clinical review, GP communication
– Pain Management Programme
– Employment support/vocational rehabilitation
DWP From Pain to Prospects

6. Activity prior to Intervention
•34 referred to service from DWP
•24 taken into the service
•17 letters to GPs to consider diagnosis and/or start/change medication
•15 referred for Pain Management Programme (8 first cohort)
Pain diagnoses
•4 - Fibromyalgia (one diagnosed pre pilot)
•4 - Regional myofascial pain
•12 - Neuropathic pain ‘element’ (one diagnosed pre pilot)
•2 - CRPS type 1
•2 - Surgical interventions – ‘made things worse’.
Outcomes
•5 of 8 completed first Pain Management Programme (PMP)
•PHQ-9, GAD-7 and PSEQ all improved
DWP From Pain to Prospects

7. Vocational Outcome Final March 14th 2014
Paid employment 8
Voluntary work 2
Vocational Training 2
Total (12 set by JCP) 12 (40%)
Work Programme return to work rate is 5-8%
Work Programme - official statistical summary. DWP. 2013. https://www.gov.uk/government/organisations/department-for-work-
pensions/series/work-programme-statistics--2#the-latest-release
DWP From Pain to Prospects
Outcomes for those not returning to work/training
18 people who volunteered for the service did not enter paid work/volunteering or vocational
training
11 maintained contact with the team but were discharged with no clear plans for return to work
4 withdrew from or lost contact with the service
1 person died from a cause unrelated to the chronic pain condition

8. Case Study
• George was out of work for many years, he was diagnosed
with Fibromyalgia
• He struggles with day to day activities,
• He has dyslexia which affects his ability to sequence events
and difficulties with reading & writing
• Issues loss of his own business, anxious about the future &
how he was going to provide for his family
• He was supported by a Job Brooker to develop his CV, Job
application, and a referral for Business start-up
• He was employed by b-inspired as a Premises Officer he
manages his health condition & work.

9. Pain to prospects
• “I think with the scheme I have gained confidence everything
has fallen into place” Female, age 34, out of work for 13years
now working in the education sector
• “I have more confidence very good, excellent would be the
word. I would recommend the scheme to others” Male age 51,
out of work for 4 months, now working in the retail sector
• “I would say go for it, I would recommend the project to
others” Male age 56, out of work for 12years. Now
volunteering in the charity sector
• “Magic ! More confidence in myself, health is improving
slowly, you get the help you need” Male age 45, out of work
for 17years. Now working in the food sector

10. NHS Innovation Challenge
Exploring additional interventions
PMP/Mindfulness/CBT service without a
job broker

11. IAPT/GP identifies
and refers UUPP
patient
Assessment day
Initial assessment by Fit
For Work Case Manager
based on
biopsychosocial model
Agree intervention
pathway
Action plan agreed
GP review of clients
Group Pain
Management
Programme
7 sessions
Mindfulness (MBCT)
8 sessions
Online Pain Management
Programme
26 units
Medication or
healthcare unmet
need
Discharge
Assessment
documents
repeated and
compared with
initial assessment
Inform IAPT/GP of
discharge
Pilot2

12. • Referred via GP or IAPT services
• Clients with unexplained or unresolved pain
symptoms
• Assessment and range of interventions PMP,
self-directed computer based PMP &
Mindfulness based Cognitive therapy (MBCT)
Unexplained or Unresolved Physical Pain Pilot

13. Fit for work Team
•Case managers :Information Advice & Guidance (IAG)
supported by a GP & Occupational Health Nurse
•Regular supervision, cases were reviewed with clinical
staff & outcomes monitored
Open Mind IAPT
•Nurses/Social Workers/CBT therapists delivered
Mindfulness MBCT following training specifically in Pain
Management
•Regular supervision, cases reviewed and monitored
DWP From Pain to Prospects

14. Referral criteria
Inclusion
•Patients with Unexplained pain or not
responding to regular therapy
•Pilot targeted people of working age as UUPS
prevalence is high in this group
Exclusion
•Patients with cancer pain
•Acute referrals
•Patients receiving other active intervention

15. Interventions
Assessed by Case Manager given choice of 3
programmes
•Group pain Management
•Mindfulness CBT
•Self –directed computer based programme

16. Scoring tools
Pre assessment – self reported
•Pain detect
•Pain Self Efficacy Questionnaire
•EQSD
•PHQ-9
•GAD-7
•IAPT Phobia scale
•Work & Social Adjustment scale

17. Safety /Risk identification
• FFWT GP review if
• Pain detect >18
• Red flags (as per NICE guidelines for painful
conditions)
• Personal/Health/Work/ Other
• Self harm ideation
• Alcohol or substance misuse

18. Additional interventions
107 clients referred : 56% from IAPT Therapist and 44% from GP
•60% Female Vs 40% Male
•34% of clients were aged 30-44 46% of clients were aged 45-59
•59% were BME
•68% of clients were unemployed
•Average length of time in the service = 19 weeks
•Main reasons for referral into the service: MSK Back/Neck & Fibromyalgia
Number who chose
programme
Number who attended Finished entire programme
Pain Management
Programme
23 16
13
(57% of those who chose the
programme)
(81% of those who attended)
Mindfulness Therapy
25 23
16 (64% of those who chose
the programme)
(70% of those who attended)
Online Pain
Management
Programme
16 16
8 (50% of those who chose
the programme and
attended)

19. Additional interventions Outcomes
Max. score for PHQ-9 = 27 Max. score for GAD-7 = 21
Max score for EQ-5D VAS = 100 Max score for PSEQ = 60

20. • “It helped me to accept the pain I’m going through and show the way to
manage the pain”
• “I realised I’m not suffering alone”
• “Personally made me feel better that there was someone listening”
• “Mindfulness should be in schools to help people later in life to cope. It
certainly would help to reduce stress and its associated health effects”
• “I thought Mindfulness would be a waste of time. Now it’s the best thing that
has happened to me in years”
• “Mindfulness helped me more than I has hoped, because in the time that I
have been attending the course, I have nearly stopped my pain medication”
Clients comments who attended the PMP & Mindfulness

21. IAPT/GP
identifies and
refers UUPP
patient
Assessment day
Initial assessment by Fit
For Work Case Manager
based on biopsychosocial
model
Agree intervention
pathway
Action plan agreed
GP review of clients
Group Pain
Management
Programme
7 sessions
Mindfulness (MBCT)
8 sessions
Discharge
Assessment
documents
repeated and
compared with
initial assessment
Inform
IAPT/GP of
discharge
Unemployed Clients
Job support:
•CV writing
•Job search support
•Interview skills
•Job clubs
Employed Clients
Case Management Support:
•Debt advice
•Confidence building
•Legal advice
•Employer liaison/ mediation
•Exercise referral
New Journey

22. Unexplained or Unresolved Pain Pilot
• 1st
programme completed April 2016 awaiting results
• 8 people attended with the option of either a Pain
Management Programme or Mindfulness sessions
• The new journey includes interventions from Case managers
trained to support individuals through either the
unemployed or employed route.
• Other issues related to Unemployed people can include
housing, debts, chronic health conditions, substance misuse
which often need resolving before individuals consider going
back into a job role.

23. Any questions
Veronica Ball
Clinical Case Manager
Fit for Work Team