Marianne MacDonald has felt her body go into spasms and collapsed on the job, been wheeled out of work on an ambulance stretcher, and lost several positions - one just a couple of days after starting it because, she says, someone in human resources noticed she had ticked the "yes" box beside the question: "Do you have chronic pain?"
Now working in Regina as a manager of a group home for people with intellectual disabilities, Ms. MacDonald has days when she feels as if her back is on fire and her neck and shoulders are twisted up in knots. But she says she mostly keeps quiet about how she's feeling.
"Sometimes I will tell my employer that I'm in a huge amount of pain and that it might affect my work that day," says Ms. MacDonald, whose health problems began seven years ago after a car accident. "There are some days when I've gone into work and they've sent me home because I was in so much agony,"
Ms. MacDonald is one of thousands of Canadians struggling to cope with chronic pain on the job. The debilitating effects can have major repercussions for them as they try to just keep working, never mind advance their careers, while battling persistent pain caused by injury or disease.
"There's no question about it. Chronic pain presents tremendous challenges for people who are trying to build and maintain a career," says Barry Ulmer, executive director of the Edmonton-based Chronic Pain Association of Canada, an Edmonton-based non-profit organization working to advance understanding and treatment of chronic pain.
Nearly one in five Canadians - 18 per cent - suffers from chronic pain, according to a 2008 Nanos Research survey of 4,000 Canadians, which defined it as moderate to severe pain lasting more than three months.
It can, in fact, go on for years. And it takes its toll. The Nanos survey found employees with chronic pain missed an average of 28.5 work days a year. The national annual average for work absences, according to 2008 Statistics Canada figures, is seven days.
Nearly half of sufferers in the survey - 47 per cent - said their job responsibilities had been reduced, and a third said they had lost a job. As well, nearly half said they seen their annual income drop as a result of their pain, according to Nanos, which did the survey for painexplained.ca, a chronic pain awareness campaign led by the Chronic Pain Association, Canadian Pain Society, Canadian Pain Coalition and the Association québécoise de la douleur chronique (Quebec Association for Chronic Pain).
Perhaps the biggest challenge for workers with chronic pain, Mr. Ulmer says, is hanging on to their jobs. They are often let go because they call in sick more frequently. Even when they do hang on, sufferers often find their careers stalled as managers stop sending important projects their way and they gain a reputation for being unreliable, the experts say.
"The problem is that, even when they're at work, they're often not fully productive because their pain makes it hard for them to focus on their work, or they have physical limitations that prevent them from performing certain tasks that would normally be part of their job description," he says. "So they become perceived as slackers and complainers."
Dr. Mary Lynch, director of the pain management unit at the Queen Elizabeth II Health Sciences Centre in Halifax, says it's not unusual for workers with chronic pain to be ostracized by other employees.
"This may be due in part to the fact that pain is invisible and many people can't imagine what it's like being in pain all the time," says Dr. Lynch, who is also president of the Canadian Pain Society.
"So they start thinking that their co-worker who keeps leaving early because of chronic pain must just be malingering to avoid doing work. And that just adds another layer of suffering for a person who is already in a lot of pain."
Some workers prefer to hide their pain from bosses and co-workers. "They may be afraid they're going to be stigmatized, and seen as a liability rather than an asset," says Debra Wolinsky, senior director of clinical operations at employee assistance program provider PPC Worldwide Canada EAP Services Ltd. in Burnaby, B.C. "And some people just don't like talking about their health issues at work because they see it as a personal matter."
It's not surprising that many people with chronic pain - close to 30 per cent, according to Nanos - also become depressed or experience other mental health problems, Dr. Lynch says. "This can make them even more withdrawn and isolated."
But chronic pain does not have to be a career killer, the experts say. With both employers and employees taking steps, there are ways for chronic pain sufferers to stay on the job and remain productive.
For this to happen, employees need to step forward and tell their manager about their health problem, Ms. Wolinsky says.
Employees are under no obligation to reveal details of their health issues, says Stuart Ducoffe, an employment and labour lawyer at Woolgar VanWiechen Ketcheson Ducoffe LLP in Toronto, but if they don't tell their employer about their chronic pain, they run the risk of having their bosses think they're incompetent.
Mr. Ducoffe points out that, in most cases, chronic pain would be seen as a form of disability that employers would have a legal obligation to accommodate.
Accommodation can range from adapting a workstation to allowing an employee to work from home or in a less-demanding job.
Heather Divine, president of the Chronic Pain Association of Canada, says it's a good idea for employees to keep a "pain diary" tracking what times of day they tend to suffer, what helps them feel better, and when they're most productive. "Then you can ask for changes in your work based on this information."
Accommodating often means passing on some responsibilities to other staff, so it's important to head off any resentment, says Antoinette Blunt, president of Ironside Consulting Services Inc. in Sault Ste. Marie, Ont.
"It's not a bad idea for the employee with chronic pain to share some information with co-workers and let them know he or she is interested in working hard and being part of the team, but is limited by a medical condition," she says.
Ms. Divine recalls her own experience with chronic pain in the 1990s, when she was working as a nurse. To accommodate her, the department supervisor put her on desk duty. "Then she asked everybody in our unit if they were okay with me working at the desk, and not one of my fellow workers protested," says Ms. Divine, who is no longer working. "That arrangement allowed me to stay in my job for another nine months, and getting everyone's buy-in prevented any negative talk at work."
Ms. Divine says having a supervisor act as her advocate also went a long way toward ensuring co-workers were supportive.
Sufferers may have to take extended time off. To stay on the career track during long absences, workers should make an effort to keep in touch with bosses and co-workers, Toronto career coach Daisy Wright suggests.
"Check in on projects and, if you're physically up to it, ask if there's something you can do from home," Ms. Wright suggests. "If there are work-related seminars you can attend while you're on leave, then by all means go. It's all about showing your employer that, even though you can't work right now, you're making the effort to stay in the loop and you're still interested in what's happening at work."
But the relationship shouldn't be a one-way street, Ms. Divine says. Employers should also make an effort to stay in touch with workers who are off for long periods, she says.
"Show them you care and they'll be even more loyal to you when they return to work," she say. "Send them a card or call them regularly to see how they're doing. That's what my supervisor did when I was off sick, and it really helped lessen my feelings of isolation."
After living and working with chronic pain for seven years, Ms. MacDonald says she has learned a few job survival strategies. People with chronic pain can be forgetful and unfocussed, she says, so she is diligent about writing down what she needs to know and do at work. She is also alert to signs that a pain attack might be coming, and takes breaks to pre-empt the onset of pain.
"I'm very lucky to have a great employer who understands what I'm going through and is okay with me taking a break when I need it," she says.
Still, she admits work continues to be a struggle. There are days when all she wants to do is lie down, but a constant fear of not being able to hang on to her current job - which she started only last August - often compels her to just grin and bear it.
"I just put a smile on my face and do what needs to be done," Ms. MacDonald says. "Then I go home and cry."
Coping with the pain
Tell them: You don't have to reveal the details of your health condition, but it's important to let your boss know about your chronic pain so adjustments and accommodations can be made.
Connect your boss: Chronic pain can be difficult to understand, so the pros suggest asking your doctor, therapist or a counsellor with your company's employee assistance program to speak with your employer about your pain, and how it affects your ability to work.
Seek accommodation: Help can come in a variety of forms, from changing your workstation to changing your hours or job, sharing the workload, taking frequent breaks or working from home.
Keep a pain diary: Write down details, such as when attacks occur and what helps to ease them. Use this to come up with accommodations at work.
Get co-workers' support: Some work you're no longer able to do may be passed on to colleagues. To reduce resentment, let them know you're working hard but are limited by your medical condition.
Stay in the loop: If the pain forces long absences, remind your boss and co-workers that you're still part of the team by checking in on work while you're off and, if you can, attending work seminars and important meetings.
Be accommodating: The law requires it in most cases of chronic pain, generally considered a disability. Beyond meeting your legal obligations, accommodating a worker's health needs also allows you to retain a valued employee.
Be your employee's advocate: By showing you understand and support a worker suffering from chronic pain, you'll be preventing negative talk and encouraging other employees to be as supportive.
Show you care: Send a get-well card and call regularly to see how a sick worker is feeling. This helps the employee feel like part of a team, and builds loyalty.
18%: Canadians who suffer from chronic pain
33%: Canadians with chronic pain who say they have lost a job because of it
13%: Chronic pain sufferers who say they have lost hours at work because of it
4.6: Average number of hours a week of lost productive time
28.5: Average annual number of work days absent because of chronic pain
47%: Sufferers who have had their responsibilities reduced because of chronic pain
49%: Those who have seen their annual income drop as a result of chronic pain
$12,558: Average income drop
$23-billion: Annual lost wages by those who have become unemployed because of chronic pain
$14.7-billion: Annual lost productivity costs as a result of employees having to take time off because of chronic pain
30%: Chronic pain sufferers who become depressed or have other mental health problems as a result
Sources: Nanos Research, Donald Schopflocher, research statistician, University of Alberta, Dr. Mary Lynch