Barriers to rehabilitation and return to work for unemployed chronic pain patients: A qualitative study Shilpa Patel * , Kay Greasley, Paul J. Watson Department of Health Sciences, Division of Anaesthesia and Pain Management, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, United Kingdom Received 3 May 2006; received in revised form 21 December 2006; accepted 21 December 2006 Available online 22 February 2007 Abstract This paper explores the perceived barriers to return to work presented by unemployed patients with chronic musculoskeletal pain. The findings are based on one to one in depth semi-structured interviews conducted with patients from four sites in the UK. Interview data were recorded from 38 patients (15 male, 23 female) aged between 29 and 62 years the sample included patients who had participated in a vocational rehabilitation scheme, those who had refused to participate and a naı ¨ ve group. Patients were in receipt of long-term social welfare benefits (incapacity benefits) and recruited via local Job Centres. The mean duration of work absence was over 5 years. The data was transcribed and analysed by means of thematic analysis. Several themes were identified as barriers to return to work from the data including pain related issues, uncertainty (both financial and physical), the healthcare system, interaction with benefits providers, perceptions of employers and personal limitations. The uncertainty and the pain condi- tion itself were the overarching barriers from which other obstacles stemmed. This is the first qualitative study of long term unem- ployed benefit recipients with chronic pain. Others authors have reported psychosocial factors as barriers to work among disabled populations however, this qualitative study has identified barriers specific to unemployed chronic pain patients. The themes iden- tified will help with the planning and development of future initiatives for returning chronic pain patients to employment. Ó 2007 European Federation of Chapters of the International Association for the Study of Pain. Published by Elsevier Ltd. All rights reserved. Keywords: Work rehabilitation; Unemployment; Chronic pain; Musculoskeletal; Wage compensation; Psychosocial; Qualitative research 1. Introduction Chronic pain affects one in five adults in Europe resulting in substantial healthcare and social benefit costs (Pain in Europe, 2003). In 1998 the indirect costs associated with back pain in the UK were approxi- mately £10.7 billion made up mainly of lost production and wage compensation payments (Maniadakis and Gray, 2000). In 2004, 8.6% of the working population in the UK was unemployed due to sickness or disability and 7.7% were in receipt of benefits (Department of Work and Pensions, 2004) many due to musculoskeletal pain (Waddell, 2004; Waddell et al., 2002). Despite improvements in treatment and the publication of guide- lines on how to manage common conditions such as back pain many countries have large numbers of people dependent on social security benefits who have not worked for many months or even years (Waddell et al., 2002). The longer these people remain out of work the less likely they are to ever return causing consider- able cost to the social benefits system. There has been a considerable amount of research into factors which are associated with disability due to 1090-3801/$32 Ó 2007 European Federation of Chapters of the International Association for the Study of Pain. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.ejpain.2006.12.011 * Corresponding author. Tel./fax: +1 16 258 8317. E-mail address: sp73@le.ac.uk (S. Patel). www.EuropeanJournalPain.com European Journal of Pain 11 (2007) 831–840