Case Study: Cool, calm and in control

Stefanie Garber

A worker's confidence and approach to self-management can make the difference between a successful return to work and permanent incapacity.
Case History

Mr R was working as a press operator at Deluxe Products when his back pain started.

Mr R grew up in Wodonga. After dropping out of high school in grade 10, he became a chef’s apprentice. Mr R loved the hustle and bustle of the kitchen but higher pay eventually lured him to Deluxe Products.

At first, his pain was manageable. His role required long periods of sitting but also occasional lifting, which would sometimes cause a twinge in his back.

Over the next three years, the pain escalated to a sharp sting, like a knife. Every six months or so, he was forced to take a week off work to recover.
In February 2007, at the age of thirty-two, his lower-back pain became so intense that he rushed to the emergency room.

His injury put him off-work for two weeks. When he returned, it was to limited duties, working four hour days. This continued until early 2009 when the company terminated his position.

Multiple treatments were trialled without much improvement in Mr R’s condition. Exercise hurt so he avoided it as much as possible. A year later, spinal surgery was recommended. Feeling desperate, Mr R took the surgeon’s advice and had part of the disc removed. When this made little difference, he underwent a second spinal surgery, a spinal fusion, in late 2010.

Mr R struggled to cope. He could not shower or perform daily tasks without assistance. His frustration drove a wedge between him and his family. A near sedentary lifestyle meant Mr R gained fifteen kilograms. As his suffering increased, his dose of opiates for pain relief crept steadily upwards, up to 600 mg of OxyContin a day.

Mr R became increasingly depressed. On some days, he contemplated suicide.

In early 2012, Mr R decided to take matters into his own hands. He started seeing a psychologist who helped him re-build his bond with his girlfriend and son. He also started working with a rehabilitation physician to decrease his opiate dosage. The physician and psychologist encouraged him to develop practical strategies to cope with his injury, including a more active lifestyle. He found himself focusing on positive things in his life, such as his relationships and his love of cooking.

Today, his struggles are far from over. Mr R continues to suffer from ongoing pain and limited movement. He is unlikely to ever return to work as a press operator and possibly not to full time work.

However, the positive changes he pursued have aided his rehabilitation enormously. If his recovery continues over the next year, he has a good chance of returning to employment. He may even get back into a kitchen and take on less physically-demanding cooking roles.

Key Learnings

The more in control a patient feels, the more likely they are to make a successful return to work.

Multiple areas of the brain are engaged when we feel pain, including areas governing our mental and emotional states.

The evidence increasingly shows that emotional distress can amplify our perception of pain.

The brain adapts and re-wires when changes in the nervous system are detected, a phenomenon known as neuroplasticity. When we are distressed, neuroplasticity sensitises the brain to be hyperaware of pain messages.

Helping a client feel more in control could help prevent the development of chronic pain and re-wire their brain to reduce their experience of pain.

In particular, Return to Work professionals can help people:

  • Understand how much their recovery depends on self-management and a positive attitude. Patients should be aware of the need to heal mentally. Return to Work Professionals can advise clients of the benefits of psychological treatment and mind-body therapies, such as yoga. Exercise, healthy relationships and hobbies can also improve a client’s wellbeing.
  • Understand the return-to-work process. When the process is efficient and streamlined, clients will feel a sense of control and forward momentum.
  • Be fully informed about the potential downside of their medical treatments. Opiates can make a person feel dull and listless, limiting their motivation to exercise and socialise. This can lead to depression. Clients should be encouraged to discuss side effects with their doctor and potentially minimise their intake of opiates.
  • Be provided with extensive information about potential surgery. Spinal surgery in the absence of sciatica usually has a limited success rate but surgeons tend to suggest it anyway. Desperate patients agree without fully understanding the risks. An unsuccessful surgery can leave the patient feeling powerless and weaker than before. It is therefore vital that patients are fully informed before making a decision about surgery. Clients should speak to their doctors and request a second opinion if necessary.

Ultimately, a client who feels in control of their own recovery is in a much better position to return to work than one who is demoralised and has lost all hope.

Published 13 April, 2013 | Updated 14 April, 2015