Pain Management & Job Safety

How might you treat a patient suffering from chronic pain that was employed in a safety-sensitive job?

The issue of use of medications in the workplace, especially in safety-sensitive jobs is of widespread concern. Whether the individual uses prescription or over-the-counter medication, there is a possible risk to themselves and others.

Knox Todd, M.D.:

Any therapeutic decision involves a weighing of risk versus benefit, and many analgesics have at least the potential to cause mental status changes that could affect workplace safety. To most people this question would seem to refer to the use of opioids for chronic non-malignant pain. While in the opioid titration phase certainly many side effects of opioids, including drowsiness, are problematic. With chronic use, however, most of these effects, with the notable exception of constipation, will resolve.

I can imagine no more safety-sensitive activity than driving a motor vehicle through crowded streets and here, we have the benefit of a number of studies suggesting that chronic opioid use does not impair driving performance. On the benefit side of the equation, one must also consider the known risk of impairment resulting from sleep disturbances associated with undertreated pain. Drowsy driving is a major and well-recognized cause of motor vehicle crashes.

Thus, in general, concerns about workplace safety should not alter pain therapies, except in the opioid titration phase. However, in the care of patients with pain, individuals vary, and it is incumbent on the practitioner to monitor and carefully document the impact of his or her therapies on physical and mental function.