An Exploratory Study of the Biological, Psychological, and Social Impact of Employment Versus Disability in Chronic Low Back Pain

Background: Chronic low back pain (CLBP) directly causes reduced work productivity and increased absenteeism, disability, and health care costs. However, further research is necessary to identify whether employment correlates with better health outcomes for workers with CLBP. Objective: We aimed to explore differences in biological, psychological, and social variables between individuals with CLBP who have employment and those who receive disability benefits. Methods: This exploratory cross-sectional study used data from adults with nonspecific CLBP (15 employed and 10 receiving disability benefits) who are part of an ongoing study of epigenetics and gene expression signatures of racial and socioeconomic status disparities. Data were collected on depressive symptoms, perceived injustice, internalized stigma, social support, life orientation, pain intensity, pain interference, and various measures of biological aging. Results: On average, unemployed individuals (receiving disability benefits) reported significantly higher levels of internalized stigma of chronic pain (t₂₃ = −2.282, p = .016), pessimism (t₂₃ = −2.646, p = .007), insomnia severity (t₂₃ = −4.201, p < .001), perceived injustice (t₂₃ = −4.108, p < .001), depressive symptoms (t₂₃ = −4.195, p < .001), pain intensity (t₂₃ = −4.195, p < .001), and pain interference (t₂₃ = −5.288, p < .001), but lower pain resilience (t₂₃ = 3.422, p = .001) than participants who were employed. On average, participants receiving disability benefits had GrimAge epigenetic age acceleration, while employed participants had epigenetic age deceleration (t₂₁ = −2.256, p = .017). Conclusion: Among individuals living with CLBP, employment may be associated with a more positive health outcome. To foster an active and healthy workforce, it is essential to understand the biological, psychological, and social factors affecting employment status when addressing CLBP.