Obstacles and facilitators of return to work among people with persistent pain who receive benefit payments: an in-depth interview study

Background : Persistent pain is a major cause of work disability and early retirement, posing considerable challenges to welfare systems. The process of returning to work is complex and multifaceted, often becoming more difficult as the duration of absence increases. Most research on facilitators and obstacles for returning to work has focused on individuals on sick leave; less is known about those who are unemployed and receiving benefit payments. The aim in this study was to explore the obstacles and facilitators faced by participants with persistent pain, who are attempting to return to work while receiving benefit payments. Methods : In this descriptive qualitative study, we used purposive sampling from a cohort study on the impact of being unemployed due to persistent pain. Semi-structured interviews were conducted using a topic guide, audio-recorded, transcribed verbatim and analysed using the Framework method. Results: We interviewed 29 participants, of whom 13 had partly or fully returned to work, while 17 had not. Themes emerged around participants’ experiences of obstacles and facilitators: 1) Norwegian Labour and Welfare Administration, 2) healthcare, 3) psychological, 4) pain, and 5) perceptions of work. For facilitators, additional themes of ‘luck’ and ‘disability pension’ emerged. Conclusion: While struggling with pain and coexisting health issues, participants experienced overwhelming system and contextual obstacles. Key facilitators included fortuitous encounters with supportive welfare system staff and personal attributes such as psychological flexibility and determination. Our findings highlight areas of the welfare system that could be improved to provide more empathetic and person-centred pathways for people with persistent pain wanting to return to work.