Chronic Pain Policy 25-030 | Effective Date: March 17, 2016

Purpose

The purpose of this policy is to:

• Define the point at which pain becomes chronic;
• Communicate how WorkSafeNB makes decisions related to claims for chronic pain; and
• Provide guidelines for managing claims that result in chronic pain as a complication of a compensable injury.

Scope

This policy applies to all injured workers who:

• Are entitled to compensation under the WC Act; and
• Have a compensable workplace injury;
• Are at risk of developing chronic pain; or
• Are diagnosed with chronic pain during the treatment of, or after recovery from, a compensable injury.    

Statements

1.0 General

When workers are injured in an accident arising out of and in the course of employment, WorkSafeNB may provide benefits, such as medical aid, loss of earnings, and return to work services, as required.

WorkSafeNB is required by legislation to determine the necessity, character, and sufficiency of medical aid to be provided to injured workers. This means that WorkSafeNB determines the:

• Need for medical aid treatments and examinations;
• Type of medical aid required to effectively treat a compensable injury; and
• Extent to which medical aid is required to achieve significant functional improvement.

WorkSafeNB may also provide injured workers with rehabilitation to lessen or remove barriers resulting from the injury that may limit opportunities for injured workers to return to work. In providing rehabilitation, WorkSafeNB may take measures and make expenditures it determines necessary to help an injured worker return to work.

WorkSafeNB’s commitment to providing the right care, by the right provider, and at the right cost is outlined in Policy 25-001 Medical Aid - Principles. These principles, and related policies and standards, guide staff and health care providers in the management of compensable injuries according to best practices.

Workers who suffer a workplace accident or disease also suffer from acute pain resulting directly from the injury. During the early stages of rehabilitation, this pain is expected and is a normal and healthy response to the healing of that injury. As rehabilitation progresses, the worker’s pain should improve.      

WorkSafeNB recognizes that despite its best efforts to prevent chronic pain, acute pain may sometimes develop into chronic pain. In some cases, chronic pain is diagnosed when an injured worker’s recovery exceeds the usual healing time for the compensable injury. When this occurs, the chronic pain is regarded as a complication of the compensable injury and WorkSafeNB manages it accordingly.       

WorkSafeNB considers chronic pain to be a treatable condition and believes that most injured workers with chronic pain can be rehabilitated.

2.0 Applying for Benefits

WorkSafeNB adjudicates claims for compensation by using section 7 of the WC Act and Policy 21-100 Conditions for Entitlement – General Principles. For a claim to be accepted, information must show that:

• There was a personal injury;
• The personal injury was caused by accident; and
• The accident arose out of and in the course of employment.

Pain in the absence of a personal injury by accident is not accepted as a compensable claim.

However, when an injured worker claims compensation benefits for chronic pain after treatment for a compensable injury has concluded and the claim has been closed, WorkSafeNB determines entitlement to compensation benefits by determining whether the claim for chronic pain is related to:

• The original claim (recurrence of injury);
• A pre-existing condition; or
• A non-compensable condition.

Based on the weight of the evidence, WorkSafeNB either:

• Determines that there is no entitlement to further treatment or benefits; or
• Accepts that the chronic pain is a complication of the original injury, and provides appropriate treatment and loss of earnings benefits.

3.0 Managing Claims Involving Chronic Pain

When a personal injury by accident is accepted as a compensable claim, WorkSafeNB provides benefits as appropriate.

WorkSafeNB also focuses on identifying risk factors linked to the development of chronic pain and implements early intervention strategies such as work conditioning, education, and early and safe return to work strategies to prevent the onset of chronic pain.

To assist in prevention and identification of risk factors, WorkSafeNB:

• Applies the medical aid principles in all cases, ensuring that injured workers receive the right care, delivered by the right provider, and for the right cost;
• Provides medically effective treatment by using Policy 25-014 Medical Aid Decisions;
• Uses criteria and guidelines to identify factors that could be predictors for the development of chronic pain; and
• Encourages and assists the injured worker to exercise and continue regular activities when possible, in an effort to restore functional ability and to prevent deconditioning.       

3.1 Loss of Earnings

If a worker develops chronic pain subsequent to a compensable injury and has a reduction in functional capacity that affects earning capacity, the worker may be entitled to continued loss of earnings benefits.

To determine entitlement to continued loss of earnings benefits, WorkSafeNB uses:

• Medical evidence to determine if the chronic pain is a consequence of the compensable injury, or another non-compensable cause;
• Evidence of the injured worker’s current functional ability, activity level, and earning capacity to determine if there is evidence of a work restriction;
• Evidence gained during treatment and rehabilitation initiatives, including the results of medical and functional assessments, to determine that the injured worker actively participated; and
• Policy 21-101 Conditions for Entitlement – Pre-existing Conditions when establishing if there is a relationship between a pre-existing condition and the chronic pain.

In situations where the injury and resulting chronic pain causes a permanent work restriction or reduced functional capacity that affects the worker’s earnings, WorkSafeNB determines the estimated capable earnings of the injured worker and pays benefits accordingly. If there is no work restriction or reduced functional capacity identified by WorkSafeNB, the injured worker is not entitled to loss of earnings benefits.

3.2 Treatment and Return to Work

When an injured worker develops chronic pain as a result of the compensable injury, WorkSafeNB determines the need for and extent of treatments to be provided based on the injured worker’s functional capacity and not on the pain itself.

WorkSafeNB determines if treatments are successful by measuring whether there is improvement or deterioration with respect to:

• Restoring function when the injured worker has a return to work goal;
• Maintaining function so that injured workers can stay at work when there is evidence that function is deteriorating; and/or
• Improving or maintaining quality of life, as it relates to function, for those injured workers who are unable to work in any capacity.

When managing claims with chronic pain, WorkSafeNB ensures that injured workers receive appropriate, necessary, and effective medical care based on the principles outlined in Policy 25-014 Medical Aid Decisions.