The impact of anxiety/depression symptoms on return to work in patients with chronic neck or back pain: a longitudinal cohort study from the Norwegian neck and back registry.

BACKGROUND

Chronic musculoskeletal pain is among the leading causes of non-fatal health loss, sickness absence and disability. These patients frequently present with co-occurrent symptoms of anxiety and/or depression (A/D). Return to work (RTW) is an important measure of functional recovery, but the longitudinal impact of A/D on RTW in patients with chronic pain is less understood.

METHODS

This study investigates the association between A/D symptoms and RTW among sick-listed patients referred to multidisciplinary physical medicine outpatient clinics with chronic neck or back pain (n = 3291), using comprehensive follow-up data from Norwegian national registers. The contribution of A/D symptoms to non-RTW was calculated using population attributable fractions (PAF), with self-reported pain intensity as reference.

RESULTS

The prevalence of case level A/D symptoms was 56.8%. There was an association between case level A/D symptoms and non-RTW at 12 months both in the unadjusted model (RR 1.32, 95% CI 1.22-1.44) and after adjustment for sociodemographic factors and symptom severity (RR 1.12, 95% CI 1.03-1.23), and PAF was estimated to be 6.6% in the fully adjusted model. In a separate model with adjustment for the same variables, there were no association between pain intensity and non-RTW (RR 1.02, 95% CI 0.93-1.11).

CONCLUSIONS

The results suggest that A/D symptoms are more important than pain intensity for RTW at 12 months in sick-listed patients with chronic neck or back pain, irrespective of self-reported severity of musculoskeletal symptoms and sociodemographic factors. Approximately 7% of non-RTW cases could be attributed to case level A/D symptoms. Addressing A/D symptoms as part of assessment and treatment is essential to improve RTW outcomes in patients with chronic neck or back pain.