A group approach to navigating pain for home health workers

Let's be honest--pain is universally regarded as an unpleasant experience. Modern approaches to understanding pain recognize that its causes go beyond physical damage to the body. Pain is a bio-psycho-social experience where physical injury, thoughts, emotions, and behavioral coping strategies all contribute to how pain is experienced in the brain. Pain can produce common side effects, including anxiety, depression, fatigue, insomnia, limitations in work and life experiences, work disability, and even substance use and abuse. The debilitating nature of pain is such that the fourth-century philosopher and theologian St. Augustine of Hippo declared pain humankind's greatest evil because of how it interferes with fulfilling our will.

According to the National Institute of Neurological Disorders and Stroke, there are three primary types of pain: acute, episodic and chronic. Acute pain is short-lived and ends when the cause of the pain is treated or healed. Episodic pain occurs at intervals and may be associated with medical conditions. Meanwhile, chronic pain is a debilitating condition that affects work and life activities and lasts longer than three months or the expected healing time.

In 2021, one in five U.S. adults (51.6 million persons) experienced chronic pain. The prevalence of chronic pain in the US poses risks to the health and well-being of the workforce. This is particularly true for home health and personal care aides, an occupational slated to grow by 22 percent over the next decade.

Home health and personal care aides (i.e., home care workers) are at risk for pain and its associated challenges. According to the Bureau of Labor Statistics, 3.7 million home health and personal care aides worked in the U.S. in 2022. These workers are vital in monitoring and caring for people with disabilities or chronic illnesses and helping them with daily activities. Their work, which often includes assisting with tasks such as moving, bathing, dressing, and housekeeping, can result in or contribute to injuries and chronic pain. As home health and personal care aides often work as individual providers in clients' residences, they frequently lack health and safety training and supervision provided by many employers. When combined, these demographics place home care workers at elevated risk for injury and pain. Such problems may lead to work and life limitations and work-related disability, or even opioid use/misuse and early mortality.

At the Oregon Institute of Occupational Health Sciences, researchers recently pilot-tested a program in partnership with the Service Employees International Union 775 Benefits Group (Seattle, WA). The Community of Practice and Safety Support for Navigating Pain (COMPASS-NP) program involved ten weekly supportive group meetings designed to provide home care workers with resources, tools, and support to slow the progression of work-related chronic pain and its associated problems. The study is a pain-focused adaptation of the original evidence-based COMPASS program that was adopted by the Oregon Home Care Commission. That program provides home care workers access to training, ergonomic tools, and peer support to reduce the risk of injuries and improve health and well-being.

In the pilot study, 19 home care workers participated in the ten-week online group program focused on workplace safety, ergonomics and pain management. Pain self-management strategies were adapted with permission from The Pain Survival Guide, co-authored by Dennis Turk (co-investigator on the project). Participants met once a week for scripted, peer-led group conversations. Lessons included education on ergonomics, safety and pain self-management. Each meeting also involved individual and group goal setting and social support activities to help workers with challenging work or pain-related problems.

"During these meetings, we're introducing participants to important safety and ergonomic concepts as well as cognitive-behavioral strategies designed specifically for pain management," said Dr. Ryan Olson, an occupational health psychologist at the University of Utah and the Oregon Institute of Occupational Health Sciences. "These strategies include activity pacing and rest, or the breaking up of work to allow time to rest and recuperate. Another strategy we use is challenging thinking errors such as catastrophizing and choosing healthy coping strategies in addition to whatever support, guidance, or treatments they're receiving from a physician or another medical professional."

According to Olson, the pilot study's results were among the best the research team had ever seen. Participants reported moderate to large reductions in pain interfering with work and life activities. Additionally, participants reported increased use of ergonomic tools and techniques and small reductions in pain medication use. The Journal of Occupational and Environmental Medicine recently published a paper co-authored by Olson and the research team describing these results in detail.

"The primary goal of the COMPASS-NP program is to reduce pain's interference with work and life; our results were promising," Olson said. "One way the program does that is by helping participants use these cognitive behavioral strategies to address chronic pain as a combination of physical, emotional, and social experiences."

While the results of the COMPASS-NP pilot study are promising, Olson and the research team are conducting a randomized controlled trial with workers from Washington, Oregon, and Idaho that will more fully test the program's efficacy among home care workers with chronic pain. 

The US Bureau of Labor Statistics estimates that the home health and personal care sector will grow at a much faster rate than the general labor market in the next decade Given the physically demanding nature of the work, these individuals are at risk for injuries that could result in chronic pain, work limitations, and disruptions to everyday life activities. There is a need to provide these workers with strategies and tools to prevent injuries and effectively manage chronic pain. At the Oregon Institute of Occupational Health Sciences, researchers on Professor Olson’s team are working alongside home care providers to understand the issues and lay the groundwork for future solutions.

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This work was funded by the Oregon Healthy Workforce Center, a NIOSH Center of Excellence for Total Worker Health. This work is also partly supported by the Oregon Institute of Occupational Health Sciences at Oregon Health & Science University.

The study team: Ryan Olson, Ph.D., Jennifer Hess, Ph.D., Dennis Turk, Ph.D., Miguel Marino, Ph.D., Courtney Donovan, M.P.H., Stacy Stoffregen, Ph.D., Ivanna De Anda, B.A., Rachel Springer, M.S., and Elizabeth Nguyen-Kearns, M.H.P.