Dr Coralie Wales, researcher and advocate spent more than a decade working as a health professional within the compensation systems in NSW and became aware of the strident inequities that exist for people injured and in chronic pain. She made a submission to the NSW Government Inquiry into the Workers Compensation System in 2012.
“In summary, in this submission I suggest that we need to start thinking about minor injuries differently. We need to increase the awareness of ALL stakeholders of the risk of acute pain becoming chronic, and the circumstances in which this is likely to occur. Ongoing arguments and the application of out-dated models to explain pain will continue to compromise the health and wellbeing of the scheme and all its stakeholders. Major recommendations include public education campaigns to increase awareness in the community about how to manage acute pain so that the risk of progression to chronic pain is reduced. Other recommendations include providing comprehensive and tailored education and awareness programs about chronic pain, not only for injured workers but particularly for the claims and health professional staff who serve them. Only then will we start to see real health and wellbeing outcomes not only for this group of NSW workers but for the scheme as well.”
Unfortunately none of the submissions resulted in changes which acknowledged the systemic bullying that occurs around people in chronic pain. The system remains overwhelmingly discriminatory against people in pain.
Rehabilitation while you are in the system - a practical perspective
It is well known that stressful events in life make pain worse.Fighting for your rights in compo systems is chronically stressful and chronic stress can make you sick.
(If you want to read some scientific literature about this click the button on the right - "stress and the immune system" - This paper is a meta-analysis of all the scientific literature about the impact of stress on the immune system and is a great overview of how the immune system works).
It might be a good idea to get yourself an advocate to fight for you, and concentrate on yourself. Rehabilitation is usually covered in Workers Compensation and is provided as needed. The trick is to find out how to choose rehabiltiation that is really going to help you.
Chronic pain is very poorly understood in Workers Comp systems. This is because the tradition for such claims is that there must be a medical diagnosis for the claim to be seen as "legitimate". This is fine if the persistent pain is due to an injury that hasn't healed, or a traumatic injury like a crush or fracture that is really bad, gets infected or some other nasty scenario. But the reality is that minor injuries that are classified as "strains and sprains" can heal but leave ongoing and disabling pain. In NSW alone minor injury claims which resulted in permanent impairment cost a staggering $109 million (WorkCover NSW 2008). It is these cases that provide doctors with a real challenge, as they are expected to note a diagnosis and traditionally "Persistent Pain" is not considered to be a diagnosis.
The following video is an interview with Wendy Berkeley who has navigated her way through workers compensation.
Another problem is that in cases of persistent pain due to a minor injury, some health professionals can give the impression that the pain "is all in your head", "you should just get on with it" and other such unhelpful comments or insinuations. We actually know that there are nervous system changes that occur the longer that pain continues, which then start to contribute to the pain experience. And guess what, chronic stress, which occurs when a claim becomes the subject of an argument, makes pain much worse.
However, if you are in such a situation, it is important to know what you can do to facilitate your own healing process. Firstly, you may be referred to a "rehabilitation provider" who is given the task of managing your rehabilitation needs. This person will be a health professional, qualified at University, perhaps an Occupational Therapist, a Physiotherapist or a Rehabilitation Counsellor or a Psychologist. Their role is not to provide treatment as such, their role is to assess your needs and then recommend to the insurer what treatment you need to recover from your pain. The way these systems work, you are supposed to have access to a rehabilitation provider quite early, but unfortunately, if there has been a minor injury (so called), i.e. if you haven't had a fracture or dislocation or something like that, you may not be offered that referral to a provider.
Very importantly, you may be referred for an exercise program. Not all exercise programs are the same. Before commencing any exercise program it is best to discuss what exercise is appropriate for your condition with a health professional who has a lot of experience with helping people in pain and who really know what they are talking about. It can be hard to find such providers. Perhaps read THIS before you start looking or if you are having trouble finding someone.
Australian health authorities recommend that everyone, regardless of whether or not they have persistent pain, should aim to do at least 30 minutes of moderate intensity physical activity everyday. This doesn't mean however that you would necessarily start on 30 minutes. If you have been out of action even for one or two months, you will have to start small and build up slowly. Many people start on levels of 5 minutes or less, then gradually build up over time. Examples of moderate exercise activity could include a walk or cycling or hydrotherapy (exercise in warm water usually under supervision).
Unfortunately, some exercise providers you may be referred to in Workers Compensation systems do not understand this principle. It is important that YOU do. If you are referred to a gymnasium, for example, it is important that you feel confident that the person who is supervising the program is an expert in chronic pain, and has explained the physiology of the SENSITISED CENTRAL NERVOUS SYSTEM. Ask them about it. Not all providers understand this important phenomenon and it is critical that the person selected to supervise you does.
Some people with persistent pain may fear exercise because it has caused them pain in the past or because they fear that they may be causing further injury. With reassurance and support from your doctor and a healthcare professional (e.g. physiotherapist) you can develop an individual exercise program that is more suitable for you. As you build strength, your pain can decrease. GO SLOW, you are more likely to succeed if you do. Going hard often leads to flaring up, then having to take time off then trying again too hard, flaring up, and so on. What a vicious cycle.
It is so important not to overdo your activities (pace yourself), especially on the days you feel ‘good' as this may make the pain worse the following day. If you do experience a flare up after exercise it might mean that you have increased too quickly or there may be a particular exercise that isn't right for you just yet.
There are well-informed exercise providers around Australia. Identifying them is the important part. There are physiotherapists who help teach their clients to set meaningful goals and then share some of the strategies necessary to gradually build up over time so that they can successfully and sustainably get back to their goals.
Ruth White is one such physio. This video might help you make good choices that work for you in the compensation environment. Ruth starts discussing "good physio" at 7:45 mins into the video.
It is best to get this kind of help earlier rather than later. Look for a physio who has a philosophy that each person is an individual, and that the client is the expert in their own pain, so there is a respectful relationship set up where the client becomes the decision maker about what exercises are right and what are not and the health professionals become resource people, teaching the client tricks and strategies to help then achieve THEIR goals. Ensure that your physiotherapist is trained to understand the Sensitive Central Nervous system. (Very important!). There are organisations these days who understand the nervous system and chronic pain. Ask questions of your health professionals to find out whether they are right for you.