title: Medically unexplained chronic pain in Australia: difficulties for rehabilitation providers and workers in pain.
abstract: In Australia, evidence of an ageing population and a skills shortage are imminent challenges for employers [5,50]. A further concern arises from the work injury and motor accident compensation schemes, where many claims for soft tissue injuries result in permanent impairment depriving the community of otherwise productive workers [85]. In many cases, it is chronic pain that becomes the major barrier to a return to productive work.
  
  
  OBJECTIVE
  This study will review the operation of rehabilitation within Australian Workers' and Motor Accidents compensation systems in order to identify values and attitudes underpinning the vocational rehabilitation ethos. The models underlying current practice will also be identified.
  
  
  METHODS
  A comprehensive review of published literature and policy documents was undertaken.
  
  
  RESULTS
  We identified a variety of contextual factors that influenced progress back into the workforce for people living with persistent pain. The conceptual models underpinning these factors within rehabilitation systems were explored. They were all driven by a strong focus on early return to work and at the same time the sustainability of rehabilitation as a profitable industry.
  
  
  CONCLUSIONS
  Implications of these findings on the relationship between the rehabilitation provider and the person in pain are discussed. Rehabilitation professionals are influenced by and in turn influence the context in which chronic pain is experienced. Empirical data about the experiences of vocational rehabilitation professionals in Australian personal injury rehabilitation systems is lacking, yet the implications of the cost of chronic pain to the nation are significant. It is recommended that rehabilitation providers increase their awareness of the perhaps unforeseen traps within the various practice models they might be using on the goal of sustainable return to work for people living with pain.
authors.affiliation: Faculty of Health Sciences, University of Sydney, Lidcombe, NSW, Australia. coralie@coraliewales.com
authors.forename: Coralie
authors.initials: C
authors.lastname: Wales
authors.forename: Lynda R
authors.initials: LR
authors.lastname: Matthews
authors.forename: Michelle
authors.initials: M
authors.lastname: Donelly
mesh_terms: D001315:Australia; D002908:Chronic Disease; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008297:Male; D009784:Occupational Diseases / Q000175:diagnosis* / Q000534:rehabilitation; D010146:Pain / Q000175:diagnosis* / Q000503:physiopathology / Q000523:psychology / Q000534:rehabilitation; D014942:Workers' Compensation