Patients referred from a multidisciplinary pain clinic to the social worker, their socio-demographic profile and the contribution of the social worker to the management of the patients
Authors: Aho Heli , Kauppila Timo , Haanpää Maija 
Published: October 2010

Abstract

Background and aims
Social factors and social environment shape the pain behavior of patients. Social workers support pain treatment in a multidisciplinary pain clinic by altering the social environment of a patient. Even though a social worker in a multi-professional care team contributes to the care of select, severely pain-afflicted patients extensively, neither the patient socio-demographic status nor interventions by social workers have been systematically documented. Only individual case histories have been published. Developing social work activities, which have potential financial consequences, for example, requires charting the current situation prior to systematic research into the efficacy of individual social work interventions.

Methods
This study systematically details the performance and work volume of the social worker, as well as the socio-demographics of patients during a 16-month period in a multidisciplinary pain clinic of a university hospital.

Results
Fifty-five patients were included. Twenty-nine were women and 26 men. They were about 10% of all patients seen at the pain clinic during the same time. Most of the patients were at their middle age. The largest group of subjects worked in public or other services. The second largest group consisted of those working in stores, hotels and restaurants. Over half of the subjects worked in the service industry. Since the subjects had scant vocational education, they worked mainly in manual labor. Most of the patients had problems with making a living, signifying that a major number of the patients visited the social worker because of financial problems. About half of the patients were indebt and three were undergoing debt counseling. Of homeowners, 21% were indebt, while the portion of those living rented accommodation was almost two thirds. All patients seen by the social worker received some form of public assistance. Over half of the patients had participated in rehabilitation assessment. The social worker saw 39 patients once, one patient twice and 15 patients three or more times. The duration of a visit was typically 1–2 h. The issues of a patient are addressed by contacting authorities and negotiating with other health care staff. According to the used ‘SOSU’ classification data, the social situation was charted for 49 patients, while the benefits and assistance provided by the Social Insurance Institution of Finland was discussed with half of the patients. The social worker discussed employment based pension with about a third of the patients. Social assistance, the last-resort economic assistance under social welfare, was considered with one fifth of the patients. Psychosocial work was recorded for 19 patients, comprising longer-term, supportive discussion.

Conclusions
The majority of the patients is of active working age but their working capacity is often decreased. However, they have difficulties in getting compensation for reduced ability to making a living. Hence, they have economic difficulties of various types and need counselling and support.
The main duty of the social worker appeared to be advising the patient in using the social welfare system, as the clients turned out to constitute a marginalized group.