Chronic Pain Management Policy 25-030 | Effective Date: October 29, 2024

Policy

Workers who experience a workplace injury 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 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.

WorkSafeNB recognizes that despite its best efforts to prevent chronic pain, acute pain may sometimes develop into chronic pain. When this occurs, the chronic pain is regarded as a complication of the compensable injury and WorkSafeNB manages it accordingly.

Chronic pain is a treatable condition and most workers with chronic pain can participate in rehabilitation and achieve functional gains and increased quality of life.

Interpretation

1. To be compensable, chronic pain must be related to the compensable injury, which could be:

• A primary compensable injury, which is an injury caused by an accident arising out of and in the course of employment;
• A secondary injury, which is an injury that occurs as a direct consequence or complication of a primary compensable injury; or
• A subsequent injury, which is an injury that occurs during rehabilitation.

For assistance with adjudicating chronic pain, please see Policy 21-108 Conditions for Entitlement – Secondary and Subsequent Injuries and Policy 21-101 Pre-existing Conditions.

2. Chronic pain is not accepted when it is the result of a non-compensable condition. 

3. Based on the weight of the evidence, WorkSafeNB either:

• Determines that chronic pain is not the result of the compensable injury and therefore there is no entitlement to further treatment or benefits; or
• Accepts that the chronic pain is a complication of the compensable injury and supports appropriate treatment and benefits.

Managing claims involving chronic pain

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

• Applies Policy 25-001 Medical Aid Principles in all cases, ensuring that 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;
• May use published criteria and guidelines to identify factors that could be predictors for the development of chronic pain; and
• Encourages and assists the worker to exercise and continue regular activities, when possible, in an effort to restore functional ability and to prevent deconditioning.

5. WorkSafeNB supports a multidisciplinary approach to determine the need for and extent of treatments to be provided. Treatment may include one or more of the following: medical management; physical conditioning; return to work supports; pain management; ergonomic consultation or other therapeutic interventions. 

6. WorkSafeNB may use standardized measures to determine the effectiveness of the treatment and adjust the treatment as needed for recovery and return to work goals. These include:

• Measures of pain;
• Psychosocial outcomes;
• Functional outcomes; and
• Health care utilization.

7. To determine functional outcomes, WorkSafeNB may measure whether there is improvement or deterioration with respect to:

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

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

9. In situations where the compensable injury and resulting chronic pain causes a reduced functional capacity or permanent work restriction, WorkSafeNB determines if there is any entitlement to compensation benefits for loss of earnings. If there is no reduced functional capacity or work restriction identified by WorkSafeNB, the worker is not entitled to compensation benefits for loss of earnings.

Previous versions

• Policy 25-030 Chronic Pain release 4, effective March 17, 2016
• Policy 25-030 Chronic Pain release 3, effective March 19, 2014
• Policy 25-030 Chronic Pain release 2, effective February 19, 2009