Pain Prolongs Sickness Absence in Mental Health Disorders: Study of 72,349 Electronic Health Records

Background

Pain is one of the most prevalent health complaints throughout life, substantially affecting daily functioning, quality of life, and work participation. Globally, approximately 20% of people experience pain, and associations between pain and sickness absence are well established. However, pain is scarcely investigated in the context of mental disorders. This study examined the association between pain and sickness absence duration in workers sick-listed with mental health disorders.

Methods

We analysed the consultation notes of 72,349 sickness absence episodes due to mental disorders, registered at a Dutch occupational health service between 2010 and 2019. Natural language processing (NLP) with regular expressions (Regex) was applied to identify pain-related keywords in physicians’ notes. Cox proportional hazards regression was used to assess the association between pain and sickness absence duration, adjusted for age and sex, stratified by ICD-10 diagnosis.

Results

Pain was identified in 11,952 (17%) sickness absence episodes in mental health disorders, with the highest prevalence in burnout (ICD-10 Z73.0; 18%) and adjustment disorders (ICD-10 F43.2; 17%), and the lowest in acute stress reaction (ICD-10 F43.0; 11%). Overall, pain was associated with longer sickness absence: median duration was 159 days without pain versus 171 days with pain. Cox regression confirmed that pain was significantly associated with longer time to return to work (HR: 0.93 [95% CI: 0.91–0.95]), most markedly in depression (ICD-10 F32; +50 days), post-traumatic stress disorder (ICD-10 F43.1; +51 days), other somatoform disorders (ICD-10 F45.8; +44 days), and adjustment disorders (ICD-10 F43.2; +9 days). No significant association was found in burnout (ICD-10 Z73.0; +14 days).

Conclusions

Pain is significantly associated with longer sickness absence episodes with mental health disorders. Highlighting the need for assessing pain in sick-listed workers with mental health disorders.

Key messages

• Pain prolongs sick leave in mental health disorders, adding weeks to recovery highlighting the need to integrate pain assessment and management to speed return to work and improve outcomes.

• Pain most strongly delays return to work in depression and PTSD (50+ extra days), but not in burnout. Diagnosis-specific pain screening may optimise occupational care.