First EFIC® Symposium Societal Impact of Pain - SIP

60
Eric X. Jensen
Dr. med Eric X. Jensen
Specialist in Internal Medicine FMH,
Medicolegal Expert SIM & SGV
Medical Director Medizinisches Zentrum
Römerhof, 8032 Zürich,
Switzerland
Medicolegal aspects of chronic pain
disorders in the Swiss social insurance
system
Long term working disability resulting from
chronic pain disorders represents an
increasing burden to the Swiss social
insurance and welfare system. 16% of all Swiss
suffer chronic pain and every sixth of them are
unable to work therefore. 2006 the direct and
indirect costs related to working disability in
Switzerland summed up to 25-30% of the
national gross domestic product. Meanwhile
over 50’000 persons in Switzerland are
entitled to a disability pension, representing a
global amount of 5.5 billions of Swiss Francs
per year. In about 12% of all cases pain is
directly associated with the work occupation,
affecting mostly the musculoskeletal system
(lower back in 55%, shoulders in 48%, upper
limbs in 36%, lower limbs in 31% and the neck
in 22% of all cases). Chronification of pain is
often related to social und contextual factors
such as poor education, monotonous and/or
strenuous work, fear of disease, low motivation
to return to work resulting from negative
financial incentives, but also to medical
factors such as inappropriate diagnostic or
therapeutic workup and management as well
as inadequate long sick leave leading with time
to physical (and mental) deconditioning. The
chances of successful work reintegration
diminish dramatically with time, being of less
than 18% after one year off work. The
assessment of working eligibility in Switzerland
bases on legal considerations, about what can
be reasonably expected from patients with
chronic pain disorders. Recognized reasons for
a reduced working capacity are security issues,
objectively impaired physical or intellectual
performance, risk of further health
deterioration or psychiatric comorbidities. The
evaluation is however problematic in cases of
chronic pain without any somatic origin resp.
detectable organic lesion such as in chronic
somatoform pain disorder, fibromyalgia,
chronic fatigue syndrome etc. In these cases
the Swiss medicolegal system has established
specific criteria (such as presence of other
severe physical or psychiatric comorbidities,
proven therapeutic resistance to standard
treatment, social isolation etc.), which must be
fulfilled, to entitle the patient to financial
compensation.