In a recent two-part article for Rabble.ca (Jan. 5, Jan. 7, 2017), Penney Kome argues that failure to properly treat and prevent chronic pain in the workplace is the real issue behind the prescription opioid crisis.
Tracing the increase in U.S. workers’ musculoskeletal disorders (MSDs), also known as repetitive strain injuries (RSIs), and impact on workers’ compensation costs back to the ’80s with constant pressure to increase productivity, Kome points to factors affecting office and “blue-collar” workers: introduction of the computer, deregulation, and union-busting. The author details the pharmaceutical industry’s role in fraudulently promoting opioids as a miracle cure safe for long-term use and their subsequent over-prescription by physicians. On the positive side, Kome finds that finally the “entire medical establishment seems to be working on finding other ways to deal with chronic pain”, including non-drug therapies.
Given that most workers with RSIs return to the same jobs, prevention of (re-)injury means fixing the workplace – and ergonomic improvements have proven a tough sell. While some employers recognized the benefits to both their business’ and employees’ well-being of introducing workplace modifications, the U.S. business lobby was able to stymie both ergonomics regulations and federal tracking of RSI incidence. Also noted: an invisible injury, RSIs are prey to gender and socioeconomic biases, with medical literature on the 1990s MSD epidemic and the 2016 opioid epidemic often attributing pain to psychogenic factors rather than workplace duties.
Where does Ontario stand?
Work-related musculoskeletal disorders account for more than 40% of allowed WSIB lost-time claims (but many more are never reported). While Ontario has a MSD Prevention Guideline (2007) with a revised version under development, there is no section in the Occupational Health and Safety Act or Regulations that specifically addresses workplace ergonomics or MSD hazards. Although the Ministry of Labour has increased inspection and educational activities regarding ergonomic hazards, labour has long argued that ergonomic regulations are needed to prevent repetitive strain injuries.
Treatment options open to injured workers have been restricted by funding and benefit cuts
“…the time injured workers stay on benefits, coupled with very high health and drug costs, is increasing the financial pressure on the system beyond anticipated levels…” (C. Morton, Deputy Minister of Labour, to the Standing Committee on Public Accounts, Feb. 24, 2010)
Critics pointed out that the subsequent WSIB 2010 Narcotics Strategy restricted payment for prescribed long-acting narcotics (with an exemption for those in the Serious Injuries Program or with occupational disease) while proposing no alternative treatment and disregarding the treating doctor’s orders.
Since 2009 spending on drug benefits has declined by almost 30%, with many injured workers struggling to get even non-narcotic prescriptions covered by the board. WSIB data obtained by IAVGO Community Legal Clinic through a freedom of information request also shows that funding for rehabilitative services (including physiotherapy) often recommended by the injured worker’s own doctor but not provided by Board-affiliated doctors dropped by 40% between 2005 and 2014.
[Note: The upcoming RSI Awareness Day Conference (Feb. 28) will address both prevention and compensation aspects]
- Mojtehedzadeh, Sara. 2016 Jun. 10. “WSIB Critics Say Spending Cuts are ‘Devastating’ Injured Workers.” Toronto Star
- Hershler, Cecil. 2015. Work Injuries, Chronic Pain and the Harmful Effects of Worksafebc/WCB Compensation Denial. Vancouver, Canadian Centre for Policy Alternatives. BC Office.
- MacDonald, Noni E. et al. 2011, Nov. 8. “Better Management of Chronic Pain for All [Editorial.” CMAJ 183(16):1815
- Institute for Work and Health. MSD Prevention (resources) Toronto:IWH