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Rehabilitation of the Injured Worker with Pain

Educational Objectives. Understand the concepts of injury and the role of the physician in rehabilitation of the injured worker with painRecognize the complexity of the pain processList the stages of disability in workers compensation injury systemIdentify the frequent problems in the evaluation

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Rehabilitation of the Injured Worker with Pain

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    1. Rehabilitation of the Injured Worker with Pain Sridhar V. Vasudevan, M.D. Clinical Professor of P.M.& R. Medical College of Wisconsin Milwaukee, WI

    2. Educational Objectives Understand the concepts of injury and the role of the physician in rehabilitation of the injured worker with pain Recognize the complexity of the pain process List the stages of disability in workers compensation injury system Identify the frequent problems in the evaluation & management of work injuries Discuss the strategies useful in effective and efficient rehabilitation of the injured worker

    3. DEFINITIONS INJURY WORKER RESIDUALS OF INJURY ACUTE PAIN CHRONIC PAIN CONCEPTS OF DISABILITY REHABILITATION LIMITATION / RESTRICTION CONCEPTS OF DISABILITY

    4. Definitions / Concepts INJURY A mental or physical harm to an employee caused by accident or disease. It includes damage to or destruction of artificial members (hearing aids, eye glasses )

    5. Definitions / Concepts WORKER Employee covered by the workers compensation laws of the State of Wisconsin. (Wis. Chapter 102 ) At the time of the injury, the employee should be performing services OUT OF and INCIDENTAL TO the employment The injury is not intentionally self inflicted

    6. Definitions / Concepts RESIDUALS OF INJURY Pain Weakness Decreased range of motion- Stiffness Deformity Amputation Decreased endurance (All leading to “ Disability from Work “)

    7. Definitions / Concepts ACUTE PAIN A warning of a physical condition needing correction Is biologically meaningful, useful, time limited An UNPLEASANT Sensory AND Emotional EXPERIENCE which is primarily associated with tissue damage or described in terms of such damage or both ( I.A.S.P. )

    8. Definitions / Concepts CHRONIC PAIN A condition that lasts beyond its healing period ( 3 to 6 months ) and is associated with significant lifestyle alterations including : loss of employment, decreased physical, social, and recreational activities, psychological changes and disability Frequently associated with D’s that include: Drug misuse, Depression, Deconditioning, Disuse, Dysfunction & Disability that exceeds identifiable objective pathology

    9. Definitions / Concepts CHRONIC PAIN Persistent or recurrent acute pain of sufficient duration and intensity to adversely effect the function of the person (WMS) NOCIOCEPTION – Tissue injury PAIN – Unpleasant sensory experience SUFFERING – Emotional consequence of pain anxiety, fear, depression PAIN BEHAVIOR – What a person says, does, or does not do, that indicates pain

    10. CONCEPTS OF DISABILITY PATHOLOGY Is the change occurring from injury and the response of the body Altered Anatomy and / or Physiology Example: Lumbar strain, Disc herniation with radiculopathy, rotator cuff tendinitis

    11. CONCEPTS OF DISABILITY IMPAIRMENT The anatomic, physiologic, psychologic abnormalities or loss that are medically determinable by objective means May be temporary or permanent Examples: Decreased range of motion, decreased sensation / strength, absent reflexes, abnormal MRI / EMG, depression, decreased cognition

    12. CONCEPTS OF DISABILITY LIMITATION OF FUNCTION Those functions that could be POTENTIALLY limited due to the impairment (s) Example: Inability to do overhead work, Inability to lift over 20 lbs. avoid twisting

    13. CONCEPT OF DISABILITY DISABILITY Task-specific inability to perform specific function that may be related to the role of the patient Example: Inability to perform heavy construction job

    14. REHABILITATION A treatment PROCESS concerned with the medical, physical, psychological, social, emotional, and vocational aspects of the individual. It focuses on maximizing FUNCTION and assisting in the assumption of USUAL ROLES, in individuals with impairments that compromise function

    15. DEFINITION / CONCEPTS LIMITATION Activities that “ CAN’T” be done due to Anatomic loss- amputation, contracture Functional loss-vision, hearing, sensory loss Subjective symptoms- pain, fatigue, dizziness Motivation- secondary gain, FEAR, stress avoidance

    16. DEFINITION / CONCEPTS RESTRICTION Activities that “ SHOULD NOT” be done as they may: Delay healing Aggravate condition Accelerate course of disease Precipitate symptoms Provide safety threat to employee and co-workers

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