Accommodation and Compliance Series:
Employees with Chronic Pain
JAN’s Accommodation and Compliance Series is designed to help employers determine effective accommodations and comply with Title I of the Americans with Disabilities Act (ADA). Each publication in the series addresses a specific medical condition and provides information about the condition, ADA information, accommodation ideas, and resources for additional information.
The Accommodation and Compliance Series is a starting point in the accommodation process and may not address every situation. Accommodations should be made on a case by case basis, considering each employee’s individual limitations and accommodation needs. Employers are encouraged to contact JAN to discuss specific situations in more detail.
For information on assistive technology and other accommodation ideas, visit JAN's Searchable Online Accommodation Resource (SOAR) at http://AskJAN.org/soar.
How prevalent is chronic pain?
Chronic pain has been said to be the most costly health problem in America. According to a recent USA TODAY/ABC News/Stanford University Medical Center poll, almost one in five Americans suffer from chronic pain (Sternberg, 2005).
What is chronic pain?
While acute pain is a normal sensation triggered in the nervous system to alert you to possible injury and the need to take care of yourself, chronic pain is different. Chronic pain persists. Pain signals keep firing in the nervous system for weeks, months, even years (National Institute of Neurological Disorders and Stroke, 2011).
What are the symptoms of chronic pain?
Living with chronic pain can lead to loss of appetite, depression, and exhaustion. The pain associated with chronic pain usually overwhelms all other symptoms.
What causes chronic pain?
Chronic pain can be caused by headaches, low back pain, cancer pain, arthritis pain, neurogenic pain (pain resulting from damage to the peripheral nerves or to the central nervous system itself), psychogenic pain (pain not due to past disease or injury or any visible sign of damage inside or outside the nervous system) (National Institute of Neurological Disorders and Stroke, 2011).
How is chronic pain treated?
Medications, acupuncture, local electrical stimulation, and brain stimulation, as well as surgery, are some treatments for chronic pain (National Institute of Neurological Disorders and Stroke, 2011). Depression is often associated with chronic pain and may need to be treated as a separate, but related, condition.
Is chronic pain a disability under the ADA?
The ADA does not contain a list of medical conditions that constitute disabilities. Instead, the ADA has a general definition of disability that each person must meet (EEOC Regulations . . ., 2011). Therefore, some people with chronic pain will have a disability under the ADA and some will not.
A person has a disability if he/she has a physical or mental impairment that substantially limits one or more major life activities, a record of such an impairment, or is regarded as having an impairment (EEOC Regulations . . . , 2011). For more information about how to determine whether a person has a disability under the ADA, visit http://AskJAN.org/corner/vol05iss04.htm.
Note: People with chronic pain may develop some of the limitations discussed below, but seldom develop all of them. Also, the degree of limitation will vary among individuals. Be aware that not all people with chronic pain will need accommodations to perform their jobs and many others may only need a few accommodations. The following is only a sample of the possibilities available. Numerous other accommodation solutions may exist.
Questions to Consider:
- What limitations is the employee with chronic pain experiencing?
- How do these limitations affect the employee and the employee’s job performance?
- What specific job tasks are problematic as a result of these limitations?
- What accommodations are available to reduce or eliminate these problems? Are all possible resources being used to determine possible accommodations?
- Has the employee with chronic pain been consulted regarding possible accommodations?
- Once accommodations are in place, would it be useful to meet with the employee with chronic pain to evaluate the effectiveness of the accommodations and to determine whether additional accommodations are needed?
- Do supervisory personnel and employees need training regarding chronic pain?
- Activities of Daily Living:
- Allow use of a personal attendant at work
- Allow use of a service animal at work
- Make sure the facility is accessible
- Move workstation closer to the restroom
- Allow longer breaks
- Refer to appropriate community services
- Provide access to a refrigerator
- Depression and Anxiety:
- Develop strategies to deal with work problems before they arise
- Provide sensitivity training to coworkers
- Allow telephone calls during work hours to doctors and others for support
- Provide information on counseling and employee assistance programs
- Allow time off for medical treatment
- Reduce or eliminate physical exertion and workplace stress
- Schedule periodic rest breaks away from the workstation
- Allow a flexible work schedule and flexible use of leave time
- Allow a self-paced workload
- Provide parking close to the work-site and an accessible entrance
- Install automatic door openers
- Provide an accessible route of travel to other work areas used by the employee
- Move workstation close to other work areas, office equipment, and break rooms
- Muscle Pain and Stiffness:
- Implement ergonomic workstation design, e.g., ergonomic chair and adjustable workstation to alternate between sitting and standing
- Reduce repetitive tasks or interrupt the tasks with other duties
- Provide carts and lifting aids
- Modify work-site temperature and/or dress code
- Use fan/air-conditioner or heater at the workstation
- Allow work from home during extremely hot or cold weather
Situations and Solutions:
An appointment secretary was reprimanded for poor attendance due to chronic pain. She was provided periodic rest breaks when at work and allowed telecommuting part-time.
A human resources manager had chronic pain due to a car accident. The individual was having difficulty getting to work on time. He was accommodated with a flexible schedule to allow more time to access public transit.
A switchboard operator with chronic pain and fibromyalgia was accommodated with flexible scheduling, rest breaks, and an adjustable workstation. The adjustable workstation allowed her to alternate between a sitting and standing position.
An individual with chronic pain due to a back injury was having difficulty sitting throughout the day. She was accommodated with a reclining workstation.
A medical technician with chronic pain was restricted from doing repetitive work. He was required to perform typing throughout the day. He was transferred to another job requiring less repetition.
An assembly line worker with chronic pain was having difficulty standing for long periods. He was accommodated with a sit-lean stool and anti-fatigue matting.
There are numerous products that can be used to accommodate people with limitations. JAN's Searchable Online Accommodation Resource (SOAR) at http://AskJAN.org/soar is designed to let users explore various accommodation options. Many product vendor lists are accessible through this system; however, upon request JAN provides these lists and many more that are not available on the Web site. Contact JAN directly if you have specific accommodation situations, are looking for products, need vendor information, or are seeking a referral.
EEOC Regulations To Implement the Equal Employment Provisions of the Americans With Disabilities Act, as Amended, 29 C.F.R. § 1630 (2011).
National Institute of Neurological Disorders and Stroke. (2011). NINDS chronic pain information page. Retrieved December 28, 2011, from http://www.ninds.nih.gov/disorders/chronic_pain/chronic_pain.htm
Sternberg, S. (2005). Chronic pain: The enemy within. Retrieved December 28, 2011, from http://www.usatoday.com/news/health/2005-05-08-chronic-pain-cover_x.htm