Without the White Coat
By Dr. Florentino Alerta II

STRESS in the workplace… dealing with it

A lot of practicing physicians encounter employees or workers having different signs and symptoms that are usually due to stressful situations in the workplace. However, none of them can totally address their patient's illness; they may do but only for a supportive measure. Usually, they recommend analgesic for headache but never dwelt on the totality of the problem of the patient. It is very important to know what really triggers the symptoms caused by workplace stress caused by the employee's job description that had been knocking down the human body coping up mechanisms. Actually, it is not just ordinary practitioner or a specialist in some field of studies that can address this problem. Some may take it as a hard pill to swallow, but the reality really hurts… it is Occupational Health Practitioner or simply placed as the Occupational/Industrial Medicine Specialist that can expertly address this problems. Any work-related illness, something that came up from or as a result of one's job, anything that have to do with one's occupation or work is the specialty field of Occupational Medicine. (and YES we all undergo the   training in Occupational Health and Safety, and some special fields like Ergonomics.)

Stress in the job will either manifest as a group of symptoms like muscle aches and pains or just a shooting or rising in the blood pressure, just simply being edgy at work, epigastric pain or just a plain peptic ulcer.   Remember that this signs and symptoms are caused by occupational overuse syndrome that is reversible. Many establishments like banks, may they private or government owned, don't have any programs to address this occupational hazards. Pity is greatly seen on government run offices and agencies that have a large population of employees and don't even have a retainer physician that could have addressed this miniscule medical problem like influenza and migraine.

If we look at all the occupational hazards that dwell around the ordinary work place the most common syndrome that we mostly see is the overuse syndrome manifested by the repetitive motion of the employee's jobs description. Pain always presents as a clinical feature, which is related to the activity of work, relieved by rest, keeps on recurring, and is reversible. The activity is unaffected, and there is no sensorimotor impairment seen in Stage I of Occupational Overuse Syndrome (OOS), in Stage II there is sleep disturbance, a (+/-) sensorimotor impairment, and decrease in activity performance, Stage III when there is sleep disturbance and sensorimotor impairment and decrease in activity   and light tasks performance. The main goal of treatment is to quickly relieve the pain and to sustain the recovery for the patient to prevent the progression of pain from acute form to chronic form. For management and the employer the main goal is to return lost hours and regain income, thus improving work output. Management is primarily geared to pain relief with the help of pain medications. Approach to management is multimodal in strategy as soon as pain is categorized to severe, moderate and mild in form. For mild pain it is advisable to start with a celecoxib 200 mg BID (twice daily) or tramadol 50mg PRN. For moderate acute pain an intramuscular injection of ketorolac combined with celecoxib 200mg BID with tramadol 50mg PRN, for the severe form of pain IM or intra articular injection of ketorolac with 200mg celecoxib twice daily and combination of 50mg of tramadol. Remember surgical intervention if pain management won't work may not affect long term outcome. When dealing with acute pain secondary to OSS always rule out the secondary causes like fibromyalgia, myofascial pain and the so-called Chronic Fatigue Syndrome. The personality profile is seen in workers that have repetitive jobs, those maintaining one position in the job and those that are “frequent users”. Effective treatment is multifaceted in nature, there is always the prevention of recurrence by doing activity planning, work area organization, microbreaks and on the job exercise. (Do you think the ordinary physician or general practitioner can handle this?) Remember, your friendly occupational health practitioner can address problems in the work place especially stress.