The Smart Patient's Guide to
Managing Pain in the Workplace

When Your Chosen Profession Takes a Toll on Your Health

One construction worker’s journey through pain, opioids, and more.

If you or a family member work in the construction industry, the opioid crisis may hit a little closer to home than you’d like. While opioid overdoses have affected every sector of the American workforce, prevalence seems to have hit the construction industry especially hard. Not only do construction workers have a higher risk of dying from opioids than paid workers in other fields, but the problem is widespread: Between 2007 and 2012, more than 7,400 construction workers across 21 states died from an opioid overdose.

The problem has become so devastating that in 2019, the Chicago Regional Council of Carpenters and the International Union of Operating Engineers Local 150 sued several drug companies, including prescription opioid manufacturer Purdue Pharma. According to a press release from the Chicago Regional Council, “The lawsuit seeks…to recover the unions’ substantial costs relating to the opioid epidemic, which has disproportionately affected their membership of more than 30,000 carpenters and 23,000 engineers throughout Illinois, Northern Indiana, and Eastern Iowa and has led to the loss of union members at an alarming rate.”

Opioids are one of the most prescribed medications to those working in the construction industry for pain (Image: Unsplash: Silvia Brazzoduro)

What’s Going On?

The nature of construction work means that pain caused by injuries and overuse is common. As the Midwest Economic Policy Institute’s Policy Director, Frank Manzo IV, MPP, noted in a recent Institute brief:

Construction is one of the most physically demanding and dangerous occupations in the United States. The injury rate for construction workers is 70% higher than the national average for other occupations….Opioids account for about 20% of all total spending on prescription drugs in the construction industry, which is 5-10% higher than its share of spending in other industries.

Ed Maher, Communications Director of the International Union of Operating Engineers Local 150, noted that construction “is an industry that takes a heavy toll on your body. The nature of the work puts a strain on your nerves, back, and joints.” Because opioids are also generally accessible and relatively inexpensive, they are regularly prescribed to and used by pain-plagued construction workers. In fact, 44% of all construction workers’ compensation claims involving prescriptions included at least one opioid, according to the Institute brief.

Demographics and age may also play a role. “For historical, structural, and cultural reasons, men are more likely to be opioid users, and construction is a male-dominated workforce,” Manzo told PPM. Workers over the age of 40 are more likely to receive opioid prescriptions than their younger colleagues; the median age of a US construction worker is 42. Indeed, the rate of substance use disorders is close to 16% among construction workers, significantly higher than the national average of 8.6%, according to the National Safety Council.

Financial concerns may also drive opioid use. “In the aftermath of the recession, there was less construction work available in many sectors, so workers did what they could to work [on] as many jobs as possible,” Manzo explained. “Construction work is [also] seasonal; if you’re injured toward the end of the season, you only have a few weeks to earn money for your family.” While the industry has recovered from the worst of the recession, overworked and/or injured workers worried about making money have a common “pop a pill and get back to work” mentality, he said.

Elmer G. Pinzon, MD, MPH, DABIPP, medical director, president, and owner of University Spine & Sports Specialists in Knoxville, Tennessee and member of the PPM Editorial Advisory Board, noted that, “job satisfaction, pre-existing psychological issues (eg, depression, anxiety, post-traumatic stress disorder), limited education, repetitive job duties, and inadequate employment skills,” might also contribute to the problem.

One Worker’s Story

Mike, 56, lives in the Indianapolis area. He has worked in the construction industry as an architectural and structural draftsman for about 15 years, and “was on job sites all the time.” Mike was diagnosed with fibromyalgia more than 25 years ago, and he has had arthritis since childhood. He’s also had carpal tunnel syndrome in both hands, back pain, and leg problems. “I’m a mess,” he laughs.

When the pain from fibromyalgia ended his drafting career in 1997, Mike opened his own handyman business. While the variety of jobs he performed prevented repetitive strain injuries, the physical labor took a toll. At one point, he weighed 235 pounds, and drank and smoked, “all because of nerves and pain. I was numb for a while.” In 2001, he quit drinking and smoking, and lost about 40 pounds.

Still, the pain persisted, and from about 2004 to 2014, “I was taking 12 prescriptions a day,” he recalls. This included up to 10 doses of the opioid Darvocet (dextropropoxyphene), later switching to multiple daily doses of Vicodin (hydrocodone bitartrate and acetaminophen).

Non-Drug Treatments

By 2014, Mike’s back pain was so severe that he was walking with a cane. At his first visit to the Indianapolis, Indiana Polyclinic as a patient under PPM Contributer Dmitry M. Arbuck, MD, he could barely bend his back. After an examination, the clinic’s anesthesiologist/interventional pain management physician injected Mike with a nerve block (an anesthetic), then performed a surgical procedure to destroy the tissue in Mike’s sciatic nerve, preventing pain signals from travelling to the brain.

These interventions were more successful than Mike could have ever hoped. “I was told it would last six to eight months. It’s been five years.” Over the next two years, he received several other nerve blocks, relieving pain and reducing inflammation, which allowed Mike to benefit from other treatments. “Without nerve blocks, I wouldn’t have been able to do physical therapy or exercise,” he points out.

Unlike many of his colleagues in the construction industry, Mike has health insurance, which makes treatments like nerve blocks and physical therapy affordable. “Without my wife’s insurance, we’d be in the poorhouse,” he says. On FAIR Health Consumer, a searchable database that estimates healthcare costs, a single nerve block injection in Indianapolis would cost an uninsured worker upwards of $800.

These interventions, as well as cortisone shots, has allowed Mike to need fewer prescription pain medications. Today, he takes a small dose of the partial-agonist opioid buprenorphine (partial agonists activate the opioid receptors in the brain to a lesser degree than full agonists), as well as Flexeril (cyclobenzaprine), a muscle relaxant, and Duexis, a combination of ibuprofen and famotidine (anantacid and antihistamine).

In addition, Mike uses several non-drug treatments. Twice a year, he meets with a pain psychologist, who’s helped him identify and avoid pain triggers. Mike also sees a chiropractor every four or five weeks and exercises regularly. His regimen has allowed him to run his own business, compete in sporting competitions, and lose an additional 50 pounds—all without much pain.

Updated on: 10/22/19
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