Construction workers experience more injuries—and pain—than most other workers, and relief can be difficult to find

Construction work is physically demanding and dangerous, with some of the highest injury, illness and fatality rates across all occupations. In 2020, for example, 41,400 of the 10.3 million construction workers in the United States experienced nonfatal workplace injuries due to falling, slipping or tripping.

As a result, construction workers often seek pain relief from opioids, both licit (such as oxycodone and hydrocodone preparations) and illicit (such as heroin and fentanyl). Studies from the Centers for Disease Control and Prevention have found that the opioid epidemic has disproportionately affected the industry, with construction workers having the highest rates of drug overdose death—about three times the rate of the average worker.

Now, the first study of its kind, led by Dr. Aurora Le, an associate professor of health behavior with the Texas A&M University School of Public Health, has provided answers for a related question: Could nonpharmacological pain management approaches — those that don’t involve medication prescribed by a health care provider — provide pain relief for U.S. construction workers?

“We believe that this is the first study examining the familiarity and utilization of nonpharmacological pain management among U.S. construction workers,” Le said. “And there are many options: physical therapy, occupational therapy, over-the-counter medications, chiropractic care, acupuncture and acupressure, meditation, topical ointments, music therapy, cognitive behavioral therapy and spiritual healing, among others.”

For their cross-sectional pilot study, funded by the National Institute for Occupational Safety and Health(NIOSH) and published in the American Journal of Industrial Medicine, Le and colleagues from NIOSH, the University of Michigan and George Mason University surveyed 195 construction workers about their familiarity and use of nonpharmacological pain management approaches.

“We did not ask workers about the source pain because our focus was not to conduct an intervention but rather understand how they manage it,” Le said. “Our survey instrument was adapted from multiple sources, including a study on nonpharmacological pain management approaches used by health care workers in Nigeria and the NIOSH Quality of Worklife questionnaire.”

Participants were workers in the U.S. construction industry at the time the survey was given, were 18 years old or older, could consent and take the survey in English, and were recruited nationally through social media campaigns, industry stakeholders (trade and labor unions, business owners, trade organizations, and The Center for Construction Research and Training) and chain referral sampling (wherein current participants help recruit prospective participants).

The survey was administered electronically from August to November 2022 and had 15 questions concerning work-related pain, location of pain (arms, legs or back within the last 12 months), whether they sought medical care for the pain and if they were prescribed an opioid, participants’ familiarity with and use of both pharmacological and nonpharmacological pain management approaches, job benefits, and union status.

The researchers assessed differences in familiarity and use of nonpharmacological and pharmacological pain management approaches, by demographics, then examined the most influential factors related to pharmacological pain management use and modeled potential reductions in use.

“Eighty-five percent of participants reported having pain or discomfort in the past year, and 72 percent reported using pharmacological pain management approaches, including 19 percent who reported using opioids,” Le said.

Familiarity with nonpharmacological approaches differed significantly by gender, education, work experience and job title. The most common of the 37 factors that predicted using pharmacological and non-pharmacological pain management approaches were training on the risks of opioids, job benefits for unpaid leave and paid disability and familiarity with music therapy, meditation or mindful breathing, and body scans. Female participants were found to have much higher odds of using nonpharmacological approaches, and minority participants more frequently reported spiritual and religious healing approaches to manage their pain than their non-Hispanic White counterparts.

“Based on these findings, we estimate that nonpharmacological approaches could result in an estimated 23 percent reduction in pharmacological pain management approaches,” Le said. “This information could help workplaces adopt methods or interventions reduce pain among construction workers without the use of prescription opioids.”

By Ann Kellett, Texas A&M University School of Public Health

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