Occupational Stress and Well-Being in Military Contexts

Peter D. Harms, Pamela L. Perrewé

• Publisher: Emerald Publishing Limited
• Year: 2018
• Print ISBN: 9781787561847
• eBook ISBN: 9781787561854
• Topic: Medicine
• Subtopic: Occupational Therapy

Volume 16 of Research in Occupational Stress and Well Being is focused on how stress and well-being shape the experiences of military personnel both in and out of the combat zone. The book examines the connections between life in or after the military and employee stress, health, and well being. 

Chapters in this volume include veterans' transitions into the workplace, work-family issues for military couples as well as children of parents in the military, post-traumatic stress disorder, psychopathy and emotion, the role of stress and well-being on performance in the military, resilience and stress interventions in military organizations and the use of drugs by soldiers and veterans as a coping mechanism for chronic pain. 

The book showcases the work of the best researchers and theorists contributing to this field to provide a multidisciplinary and international collection that gives a thorough and critical assessment of knowledge, and major gaps in knowledge, on occupational stress and well being with a view to shaping future research both in military and civilian research literatures.

PAIN IN THE CIVILIAN AND MILITARY WORKPLACE

Ethan W. Gossett and P. D. Harms

ABSTRACT

Acute and chronic pain affects more Americans than heart disease, diabetes, and cancer combined. Conservative estimates suggest the total economic cost of pain in the United States is $600 billion, and more than half of this cost is due to lost productivity, such as absenteeism, presenteeism, and turnover. In addition, an escalating opioid epidemic in the United States and abroad spurred by a lack of safe and effective pain management has magnified challenges to address pain in the workforce, particularly the military. Thus, it is imperative to investigate the organizational antecedents and consequences of pain and prescription opioid misuse (POM). This chapter provides a brief introduction to pain processing and the biopsychosocial model of pain, emphasizing the relationship between stress, emotional well-being, and pain in the military workforce. We review personal and organizational risk and protective factors for pain, such as post-traumatic stress disorder, optimism, perceived organizational support, and job strain. Further, we discuss the potential adverse impact of pain on organizational outcomes, the rise of POM in military personnel, and risk factors for POM in civilian and military populations. Lastly, we propose potential organizational interventions to mitigate pain and provide the future directions for work, stress, and pain research.

Keywords: Pain; stress; military; protective factors; PTSD; opioid

Pain is the most expensive medical condition in the United States (Gaskin & Richard, 2012; Institute of Medicine Committee on Advancing Pain Research & Education, 2011). At an annual cost between $560 and $635 billion, pain costs more than the combined cost for heart disease ($309 billion) and cancer ($243 billion) (Gaskin & Richard, 2012). Furthermore, the cost of lost work productivity associated with pain ($299–335 billion), not medical treatment, has the greatest economic impact.

Most of the early investigations into the impact of pain on lost productivity focused on absenteeism (Blyth, March, Nicholas, & Cousins, 2003). However, mounting evidence suggests reduced productivity at work due to chronic pain, or presenteeism, has a much larger impact on overall work effectiveness than absenteeism (Blyth et al., 2003; Gaskin & Richard, 2012; Leeuwen, Blyth, March, Nicholas, & Cousins, 2006; Pohling, Buruck, Jungbauer, & Leiter, 2016). Chronic pain may impact productivity in direct and obvious ways, such as limiting physical activity or interfering with attention. Or, it may indirectly reduce work productivity by decreasing emotional well-being, given prior work suggests that poor emotional well-being is associated with detriments in job performance (Adler et al., 2006). Although investigation into the avenues through which chronic pain influences presenteeism, absenteeism, and other organizational outcomes is still in its infancy, a few recent studies have begun investigating these mechanisms (Byrne & Hochwarter, 2006; Christian, Eisenkraft, & Kapadia, 2015; Ferris, Rogers, Blass, & Hochwarter, 2009).

Pain is a dynamic process influenced by biological, psychological, and social factors (Edwards, Dworkin, Sullivan, Turk, & Wasan, 2016; Gatchel, Peng, Peters, Fuchs, & Turk, 2007). Biological factors (e.g., biomechanical stress) undoubtedly impact pain conditions, but biological factors alone have proven to be poor predictors of pain and disability, particularly in chronic conditions. Decades of clinical and experimental pain research strongly suggests that emotional well-being influences pain processing. In addition, prior work suggests organizational factors (e.g., occupational stress, leadership, and job demands) affect emotional well-being (Harms, Krasikova, Vanhove, Herian, & Lester, 2013; Tetrick & Winslow, 2015). Thus, organizational factors which impact emotional well-being may also indirectly impact pain.

The military provides an ideal population to study the biopsychosocial model of pain as it relates to the work environment for three primary reasons: (1) serving in the military is commonly associated with heavy physical demands and elevated risks for musculoskeletal injuries; (2) consistently rated as one of the most stressful occupations, military personnel are vulnerable to determinants in emotional well-being and psychological functioning, such as post-traumatic stress disorder (PTSD) and depression; and (3) prescription opioid misuse (POM) in current and former military service members has risen dramatically in recent years and may be associated with physical and psychosocial work hazards.

DYNAMICS OF PAIN

Pain is an unpleasant subjective sensory and affective experience influenced by biological, psychological, and social factors (Edwards et al., 2016; Staud, 2012; Woolf, 2010). Although commonly seen as nuisance, perception of pain is an adaptive function essential for survival. This is evident in patients who frequently injure themselves unintentionally, develop infections, and even die due to medical conditions which cause deficits in pain perception. In contrast, chronic pain patients suffer from severe and intractable pain that can last for months, years, or even decades (Gatchel et al., 2007). This can lead to significant decrease in physical, psychological, and social functioning. Patients with chronic pain often become disabled and unable to work, which furthers the distress associated with chronic pain.

Pain was initially viewed by medical professionals as a symptom of actual or potential tissue injury proportional to the degree of injury or noxious stimulation (Edwards et al., 2016; Gatchel et al., 2007). Early experimental research discovered pain receptor fields and pathways which activated and elicited pain when stimulated with various noxious stimuli (Melzack, 1996). Although pain pathways have biological underpinnings (e.g., pain receptors and sensory neurons), cognitive and effective brain processes modulate and influence the culminated pain experience (Garcia-Larrea & Peyron, 2013). Beecher (1946) first noticed the discrepancy between injury and pain when treating World War II soldiers. Despite suffering severe physical trauma on the battlefield, many soldiers reported little or no pain and required relatively low levels of pain medication. This was in stark contrast to military patients he treated in domestic clinics who required greater pain medication for lesser injuries. Thus, he surmised that additional contextual mechanisms must also influence pain perception.

Melzack and Wall (1965) supported Beecher’s speculation with their Gate-Control Theory of Pain. While this theory has since been amended and elaborated upon (see Staud, 2012), it posited that additional mechanisms modulate pain at the level of the spinal cord. Input from other neurons in the peripheral and central nervous system could either open or close the gate (i.e., activate or block spinal transmission neurons). An open gate would transmit nociceptive signals to the brain and a closed gate would prevent transmission. Thus, activation of nociceptive fibers in the peripheral nervous systems may or may not translate to conscious pain perception (Staud, 2012).

From an evolutionary perspective, pain modulation is an adaptive trait (Staud, 2012). When trying to fight or escape from a predator, it may be advantageous to inhibit pain, since immediate survival takes precedence over tending to tissue damage. In contrast, facilitating pain to heal and avoid further tissue damage may be more advantageous after the passing of threat. Thus, the context in which pain occurs influences the perception and evaluation of pain and, in turn, directs behavior. Psychological factors (e.g., attention and emotion) and social factors (e.g., social support and work stress) associated with pain modulation will be discussed in subsequent sections (Edwards et al., 2016).

Classification of Pain

Pain can be categorized in different ways, such as duration and body site, but the most concise way to conceptualize pain may be by a mechanism-based classification system (Loeser & Melzack, 1999; Woolf, 2010). In this respect, pain can be separated into three categories: nociceptive (transient), acute (inflammatory), and chronic (pathological). The antecedents and consequences of each type of pain vary, and biopsychosocial factors influence all types of pain. Pain that progresses into a chronic state appears to be strongly influenced by psychological and social factors (Gatchel et al., 2007).

Nociceptive Pain

Nociceptive pain is the immediate and overwhelming pain associated with intense noxious stimuli, such as heat, cold, pressure, or chemical (Woolf, 2010). Nociceptive pain is transmitted through a series of neurons that stretches from sensory receptors (nociceptors) in tissue to transmission neurons in the spinal cord and ultimately to a matrix of multiple brain centers, collectively known as the pain matrix (Garcia-Larrea & Peyron, 2013). Garcia-Larrea and Peyron (2013) conceptualize the pain matrix as a composite of three interdependent neural networks and their psychological correlates: the nociceptive, perceptive-attentional, and reappraisal-emotional networks.

The nociceptive network, or sensory-discriminative network, conveys the location and intensity of the stimulus and is associated primarily with increased activation in the somatosensory cortex of the brain. Stimulation of the nociceptive network alone does not elicit pain and is not associated with the unpleasantness or emotional response to pain. Conscious perception of pain is dependent on integration of noxious stimuli by the second-order perceptive-attentional network. Initial cognitive evaluation, appraisal, and modulation of pain are also associated with activation in the perceptive-attentional network. This network, which is also activated during other cognitive and effective processes independent of pain, conveys the unpleas...

Table of contents

• Cover
• Title
• Processing War: Similarities and Differences in PTSD Antecedents and Outcomes Between Military and Civilian War Survivors
• Cold-Blooded Killers? Rethinking Psychopathy in the Military
• Measuring Job Performance in the Army: Insights from Evidence on Civilian Stress and Health
• Work, Stress, and Health of Military Couples Across Transitions
• Fighting for Family: Considerations of Work–Family Conflict in Military Service Member Parents
• Examining Veteran Transition to the Workplace Through Military Transition Theory
• Psychosocial Health Prevention Programs in Military Organizations: A Quantitative Review of the Evaluative Rigor Evidence
• Pain in the Civilian and Military Workplace
• Index