Researchers discover clear link between work-related orthopedic injuries and psychiatric disorders in work comp disability patients


By Stephen M. Pfeiffer, PhD

Several months ago, thiscolumntouched on the importance of medical and psychological evaluations in

workers comp disability

cases where the patient’s injuries are likely to incur psychological trauma. Delving more deeply into the relationship between work-related injuries and psychological distress, researchers have found that, among orthopedic and musculoskeletal injuries sustained throughout industrial societies worldwide, those that lead to chronic pain and disability not only incur the greatest compensatory costs, but are also the most likely to be complicated by biopsychosocial factors.

According to a study published in the

Journal of Occupational and Environmental Medicine

in May 2002, chronic pain disability – particularly that associated with orthopedic and musculoskeletal injury -- is “a complex psychophysiological behavior pattern that prevents simple component analyses of psychological, social and physical factors.” At the same time, however, the condition also demands clear psychopathological identification for the sake of successful rehabilitation and return-to-work among patients. Study results revealed that overall incidences of psychiatric disorders were significantly elevated in these patients compared with base rates in the general population. A majority (64%) of patients in the study were diagnosed with at least one current disorder, compared with only 15% among the public at large.

Without a mental health component, the study’s authors argue, rehabilitation programs for chronic pain disability patients are “doomed to failure,” due to the many recovery roadblocks that frequently arise as a result of anxiety, depression and other forms of emotional distress. However, under current claims evaluation systems, it can be difficult to identify and precisely diagnose such disorders in conjunction with physical injury; and as noted in our previous column on the subject, this in turn reinforces the importance of psychological evaluation in chronic pain cases to help ensure that both workers and employers are treated fairly – and that claimants receive the care they need to achieve a full recovery.

Blending forensics, psychology and medical evaluation techniques for accurate diagnoses in workers comp claims

In recent years, additional studies (such as that published in the

Annals of General Psychiatry

in February 2010) have confirmed the broad incidence of orthopedic injuries among workers, as well as the connection between such injury and psychological distress in those suffering from chronic pain. And with statistics showing such work-related injuries affecting nearly 85% of the adult population over the course of their careers, the issue of proper diagnosis and care options for related psychiatric disorders deserves marked attention. With experience as a clinical psychologist, forensic psychologist and

Qualified Medical Evaluator

, I am able to help distinguish the complex symptoms of psychophysiological behavior resulting from chronic pain, and to report my findings in a manner that is accessible to medical, legal and lay persons alike. Learn more about Qualified Medical Evaluator services by contacting

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