“I struggle to deal with employees who are not dealing well with their pain. They often complain to me about their doctor, talk about their investigations and are very wary about doing things that might hurt. Please help me...”

We asked some of our readers to tell us about the issues they deal with on a day to day basis. This is one of a series of articles dealing with these common challenges. Here is our response:

You have difficulty with the group of people that doctors and employers also have the most difficulty with. The person who is distressed and anxious about their health and pain can find themselves in an increasingly complicated situation.

In summary:

• Recognise the condition and what is occurring.
• Talk to the person concerned and acknowledge their distress.
• Let them know that is going to make the situation more difficult for them but you will be there for them.
• Ensure they get good quality advice about their pain and condition, and quality advice about being active.

This person is distressed. It is impacting upon the way they behave and they are full of fear about their situation. Psychological distress often makes pain seem worse. If that fear and distress is not clearly identified, the patient is likely to establish a cycle of unresolved, chronic pain and their return to work progress will be limited.

People who have non-specific problems such as non-specific lower back pain and who are distressed about it, are more likely to try to pursue a specific medical diagnosis. They want to know exactly what the scan says and often want another scan to update an assessment of their condition. They often end up with lots of tests; going around in circles with different doctors. They may end up on opiates for pain relief. They’re more likely to have surgery and the surgery is less likely to be successful.

Verbalising pain, extra complaints about pain and distress when talking about pain tends to get the person more investigations and more treatment, as the doctor doesn’t know what else to do. It’s assumed that the person has a more severe condition, whereas their misinterpreted pain-distress is really at the heart of the matter.

So the first step is: understanding what is happening.

Understanding the issue will put you in the best possible position for addressing it.

And the second step is: acknowledging it.

This doesn’t mean suggesting to the person they have a less serious problem, but acknowledging their anxieties. It means talking with them to identify their greatest worries, which might be anything from fear they won’t be able to resume their normal life or work, or that they may have a serious disease such as cancer, or a condition that will disable them for life.

Step three: addressing the issues.

Once you become clear about what the issues are, you have the opportunity to address them. You can’t deal with what you don’t understand. Let the person know you want to help them. Tell them it’s a difficult situation, but you will work with them to help resolve it.

Help and encourage them to find a medical or treating practitioner they trust and can relate to. This may be the primary general practitioner, or their GP may wish to refer them to somebody else. Few medical practitioners have the confidence, knowledge, and time to influence difficult patients and bring an end to the cycle of medical investigations. Good advice and explanation takes a long time with a distressed person, and may take multiple consultations.

Treating practitioners are often insufficiently knowledgeable about non-specific pain and lack experience in getting people back to activity. A musculoskeletal or sports physician may be the right person to clearly explain the importance of getting back to activities at home and work. If the person likes sports, sending them to a sports team’s doctor can enhance that doctor’s credibility. A psychologist can also be valuable in helping the person to understand the causes of their pain distress and health anxiety.

At the workplace it’s important that colleagues are aware of the situation and provide support. Clear boundaries need to be set up and the person may benefit from a regular opportunity to voice their concerns. A five-minute meeting, once a week, provides the person confidence and a structure within which to discuss any problems and address any issues that arise. These people often have low levels of self-confidence and consequently can have difficulty discussing problems.

Lastly, look after yourself.

Have a colleague you can discuss the case with, get ideas from others and seek assistance if you need it. Employees with difficult problems are hard to deal with; if you’re alone in your role it can get on top of you.