Abstract
Presenteeism has been noted to be associated with cognitive factors of pain, such as pain catastrophizing (PC) and pain self-efficacy (PS). Pain perception differs by gender, so it is important to consider gender differences when examining the association between cognitive factors of pain and presenteeism. This study aimed to examine the association between presenteeism and cognitive factors of pain, taking gender differences into account. A cross-sectional survey of 305 workers was conducted using a self-administered questionnaire that included items on pain status, PC, PS, and work performance. Multiple logistic regression analysis was used to test whether PC and PS independently influence presenteeism, separately for men and women. Logistic regression analysis showed that PC was extracted in men, and the group with severe PC had higher odds of presenteeism (odds ratio 6.56, 95% confidence interval [CI] 1.83–23.40). Contrarily, PS was extracted in women, with higher odds of presenteeism in the moderate (odds ratio 2.54, 95% CI 1.01–6.39) and low (odds ratio 5.43, 95% CI 1.31–22.50) PS groups than in the high PS. This study showed that the cognitive factors of pain related to presenteeism may differ by gender.
Keywords: Presenteeism, Pain catastrophizing, Pain self-efficacy, Work functioning, Gender differences
Introduction
Presenteeism is a condition in which an employee attends work despite having health problems that affect their ability to perform. It is a major concern for corporate management1,2,3,4). Presenteeism results in annual losses of labor productivity, which can cause health-related cost compared to absenteeism, which is being absent or on leave from work2). Cognitive and emotional factors such as anxiety, depressive symptoms, and psychological stress reportedly influence presenteeism5). Positive work engagement has been linked to reduced presenteeism among employees6). Chronic musculoskeletal pain with overlapping psychosocial and maladaptive coping mechanisms such as low back pain and stiff shoulders influence the worsening of presenteeism7,8,9,10). Pain involves not only nociception but also cognition and emotions11). “Cognitive factors of pain”, which are impressions and perceptions of pain, contribute to the chronicity of pain12). Cognitive factors of pain include (but are not limited to) coping style, psychological distress, fear of movement, functional self-efficacy, pain control, depression, and catastrophizing. The fear-avoidance model suggests that chronic pain can arise through two different paths based on the perception of pain experience12).
One chronic pain process is the negative interpretation of the pain experience pain catastrophizing, which increases anxiety and fear of pain and leads to avoidance behaviors. Avoidance behaviors lead to disuse dysfunction that contributes to psychological stresses, and gradually reduces pain tolerance, leading to chronic pain. Pain catastrophizing as a factor considered at the beginning of the fear-avoidance model is an important predictor of pain chronicity. As a result, pain catastrophizing, which strongly influence pain chronicity, may be an important cognitive factor in relation to pain and presenteeism.
Another cognitive process occurs when pain is effectively relieved, preventing the development of chronic pain. The patient is in this second process not fearful or anxious about the experience of pain and, in fact, may have an optimistic, positive attitude toward the pain. This positive attitude toward pain may involve pain self-efficacy13). Pain self-efficacy, which the degree of confidence to independently manage the experience of pain and maintain one’s abilities for everyday activities, was associated with good health-related quality of life and low levels of life disability in patients with chronic pain14, 15). Recently, pain self-efficacy has been suggested to have an interaction in the association between pain intensity and work dysfunction in workers with pain, with those with higher pain intensity but higher pain self-efficacy having less work dysfunction16). Furthermore, a mediating effect has been identified between psychosocial factors such as fear, catastrophic thinking, and depressive symptoms and functional impairment in adult patients with chronic low back pain15). These findings suggest that pain self-efficacy may be an important factor in the relationship between pain and presenteeism.
Pain catastrophizing and pain self-efficacy are influenced by past and current pain experiences17, 18). Even individuals without pain complaints at the time may have these cognitive factors related to pain19, 20). However, most previous studies reporting an association between pain and presenteeism involved patients or workers with specific complaints, such as back pain or headache. In comparison, there are few studies of workers without pain complaints7, 21). Examining the relationship between perceived cognitive factors of pain and presenteeism in the target population, which includes workers with specific pain and without current pain, will contribute to the development of measures aimed at reducing and preventing pain and reducing presenteeism for all employees.
Regarding gender differences in sensitivity to pain, it was previously thought there were no differences between men and women. However, recent studies have reported that women are more sensitive to pain than men22, 23). In addition, women’s pain is varied, and women are considered to be at higher risk for chronic pain and pain experiences24). Gender may play a role in cognitive factors related to pain. Therefore, taking gender into account is necessary when examining presenteeism and pain. Despite some scattered reports that adjust for gender in multivariate analyses examining the association between pain and presenteeism, and studies that only included women25, 26), we have not found any articles that perform detailed gender comparisons.
Based on these findings, we hypothesize that the association between pain catastrophizing and pain self-efficacy and presenteeism will differ by gender. The purpose of this study was to examine the association between pain catastrophizing, pain self-efficacy and presenteeism in a gender-specific manner in a group of workers with and without current pain.
Subjects and Methods
Study design and setting
We conducted a cross-sectional study using a self-administered battery of questionnaire on pain and working conditions among workers in regional companies. This study was conducted between February 1, 2020 and July 6, 2020. The following information was explained to the participants, and their consent to the study was obtained by responding to the questionnaire: The questionnaires were self-administered and anonymous, so individuals will not be identified (protection of personal information); participation was voluntary, and no social disadvantage would be incurred by the participants’ cooperation or lack thereof, or by the content of their responses; and no remuneration was be given for research cooperation.
This study was approved by the Research Ethics Committee of Saitama Prefectural University (receipt number 19518).
Participants
The purpose of this study was explained to member companies (49 companies) belonging to the General Incorporated Foundation, which aims to support the resolution of management issues related to healthcare, welfare, and the environment in Japan, and cooperative companies were solicited. The study involved workers from 14 companies (4 medical and welfare, 4 service, 3 manufacturing, 2 retail, and 1 education) who voluntarily agreed to participate. The exclusion criteria for the study participants were those who were undergoing treatment for malignant neoplasms, neurological disorders after cerebrovascular diseases, and rheumatoid arthritis at the time of the survey.
Questionnaire
Gender, age, current treatment history, weight, height, length of service years, final education, employment status, type of industry, and work contents were investigated. Body mass index (BMI: weight [kg]/height [m]2) was also calculated using weight and height.
Evaluation of pain
Participants were asked to select the site of pain that most interfered with their work or daily life during the past month from the following areas: head, neck and shoulder, lumbar region, hip joint, knee joint, foot region, and others. Those without pain were asked to select “no pain”. For the pain intensity of the most painful area, the participants were asked to choose the average pain level in the last month from 0 (no pain at all) to 10 (the most severe pain experienced in the past) on the Numerical rating scale (NRS). They were asked to select the pain duration from the onset of pain to the present on a 6-point Likert scale, which was as follows: “less than 1 month”, “1 month”, “2 months”, “3 months”, “4 months”, and “≥5 months”. For those who responded “no pain”, no response was required for the pain intensity and pain duration items. In a previous survey in Japan, the chronic phase of pain was defined as the period lasting at least 3 months from the onset of pain14, 16, 27). In this study, we categorized participants as having no pain, acute pain with onset fewer than 3 months, or chronic pain with onset over 3 months.
Pain catastrophizing
The Japanese version of the 13-item pain catastrophizing scale (PCS), which measures rumination, magnification, and helplessness in three subscales, was used28, 29). The survey consisted of seven questions that assessed the level of impairment of workers’ present work functioning compared to a time when they were in good physical condition. The assessment used a five-point Likert scale ranging from “not at all” to “almost every day”, with a higher score indicating stronger pain catastrophizing. In this study, we used the cutoff values for the indicates clinically relevant level of pain catastrophizing as described in the PCS User Manual17), and defined a PCS score of ≥30 and <30 as severe and mild pain catastrophizing, respectively.
Pain self-efficacy
The Japanese version of the 10-item pain self-efficacy questionnaire (PSEQ) was used13, 30). Participants were asked to indicate the extent to which they had experienced each of the 10 thoughts on a 7-point Likert scale, where 0=not at all confident and 6=completely confident. In this study, the degree of pain self-efficacy was classified into the following three categories based on the PSEQ score: 0–19 points as low, 20–39 points as moderate, and 40–60 points as highly intense.
Presenteeism
The degree of labor productivity due to presenteeism was evaluated using the Work Functioning Impairment Scale (WFun), which assesses the degree of impaired work functioning not associated with a specific disease31,32,33). The survey consisted of seven questions that assessed the level of impairment of workers’ present work functioning compared to a time when they were in good physical condition. The assessment used a five-point Likert scale of not at all, ≥1 d a month, ≥1 d a week, ≥2 d a week, and almost every day. The total score for each participant ranged from 7 to 35 points, with a high score indicating low productivity due to presenteeism. A WFun score of ≥14 is considered an indication of whether a person is experiencing labor dysfunction34), and in this study, those with a WFun score of ≥14 were considered having the presence of presentism.
Statistical analyses
Participants were categorized into two groups by gender for sociodemographic factors, pain status, pain catastrophizing, pain self-efficacy, and presenteeism status. The abovementioned factors were compared using the Mann–Whitney U test for nonparametric data and Fisher’s probability test for categorical data.
In this study, the primary variable under investigation was the presence of presenteeism. The explanatory variables were the degree of pain catastrophizing (0: mild, 1: severe) and pain self-efficacy (represented by dummy variables for medium and low, based on high), with gender acting as the effect modifier. The adjustment variables included pain site (no pain, head, neck and shoulder, lumbar region, hip joint, knee joint, foot region, other), pain intensity (measured by the NRS), pain duration (no pain, acute phase, chronic phase), age, and BMI (kg/m2). Additionally, all factors that showed gender differences in the demographic characteristics of the participants were added to the adjustment variables.
Multiple logistic regression analyses, including effect modifiers and adjustment variables, were conducted on all participants to examine the association between pain catastrophizing, pain self-efficacy, and presenteeism and whether gender was a significant association. When multiple logistic regression analyses of all participants showed a significant association with gender, we conducted a multivariate analysis with the same conditions, dividing the participants into men and women. Statistical analysis software IBM SPSS Statics version 21 (IBM, Armonk, NY, USA) was used to analyze the data, and the significance level was set at 5%.
Results
There were 371 survey collaborators to whom the questionnaires were distributed. The total number of analyzed participants was 305 (valid response rate: 82.2%), which was obtained by excluding 28 participants who did not fill out the questionnaire from the 333 participants who responded to the questionnaire (response rate: 89.8%) (Fig. 1).
Fig. 1.
Flow chart of the study participants.
There were no respondents who met the exclusion criteria based on current treatment history. The number of men was significantly higher than that of women stratified in terms of age, BMI, and final education, and, in length of years of service, men were significantly employed longer than women. Regarding employment status, men were significantly more likely than women to be in a regular employment. It was noted that the types of industries men and women work in tend to differ from each other. In terms of the most common work demands, 60.9% of men and 51.9% of women worked at desks, and this difference was not statistically significant. The variables that displayed significant gender differences among the participants in this study include “working years”, “education”, “employment status”, and “industry”. These were included as adjustment variables (Table 1).
Table 1. Comparison of demographic characteristics between men and women.
| N (%) or median (IQR) | Overall (n=305) | Men (n=174) | Women (n=131) | p-value | |
|---|---|---|---|---|---|
| Age (yr) | 39.0 (30.0–50.0) | 42.0 (31.3–51.0) | 37.0 (28.5–49.0) | ***a | |
| Age (groups) | n.s b | ||||
| 20–29 yr | 73 (23.9) | 34 (19.5) | 39 (29.8) | ||
| 30–39 yr | 80 (26.2) | 44 (25.3) | 36 (27.5) | ||
| 40–49 yr | 70 (23.0) | 45 (25.9) | 25 (19.1) | ||
| 50–59 yr | 67 (22.0) | 39 (22.4) | 28 (21.4) | ||
| ≥60 yr | 15 (4.9) | 12 (6.9) | 3 (2.3) | ||
| BMIc | 22.0 (20.0–24.2) | 23.4 (21.5–26.0) | 20.3 (19.1–22.2) | ***a | |
| Working years | 6.0 (2.0–13.0) | 7.5 (3.0–16.8) | 5.0 (2.0–9.0) | ***a | |
| Education | |||||
| High school graduation | 39 (12.8) | 14 (8.0) | 25 (19.1) | ***a | |
| University graduation | 249 (81.6) | 146 (83.9) | 103 (79.2) | ||
| Graduate degree | 17 (5.6) | 14 (8.0) | 3 (2.3) | ||
| Employment status | |||||
| Regular employment | 261 (85.6) | 162 (93.1) | 99 (75.6) | ***a | |
| Industry | ***b | ||||
| Medical and welfare | 101(33.1) | 45 (25.9) | 56 (42.7) | ||
| Service industry | 80 (26.2) | 64 (36.8) | 16 (12.2) | ||
| Retail | 51 (16.7) | 24 (13.8) | 27 (20.6) | ||
| Manufacturing | 51 (16.7) | 23 (13.2) | 28 (21.4) | ||
| Education and support | 22 (7.2) | 18 (10.3) | 3 (2.3) | ||
| Work demands | |||||
| Desk work | 174 (57.0) | 106 (60.9) | 68 (51.9) | n.s b | |
| Standing job | 75 (24.6) | 44 (25.3) | 32 (24.4) | ||
| Other | 56 (18.3) | 26 (14.9) | 32 (24.4) | ||
***p<0.001, n.s: non-significant.
aMann–Whitney U test, bFisher’s exact probability test, cBody Mass Index, calculated as weight (kg) divided by height (m) squared.
Regarding the pain status of the participants, the site of pain, the most common complaints for both men and women were in the neck and shoulders, followed by the lower back and head. the median NRS for pain intensity were 3 (IQR: 2–5) and 4 (IQR: 2–6) for men and women, respectively. Regarding the duration of pain, 43.7% of men and 46.6% of women were in pain for >3 months since the onset of pain (Table 2).
Table 2. Comparison of pain site, pain intensity and pain duration between men and women.
| N (%) or median (IQR) | Overall (n=305) | Men (n=174) | Women (n=131) | p-value | |
|---|---|---|---|---|---|
| Pain sitec | |||||
| No pain | 57 (18.7) | 37 (21.3) | 20 (15.3) | n.sb | |
| Head | 36 (11.8) | 16 (9.2) | 20 (15.3) | ||
| Neck and shoulder | 87 (28.5) | 48 (27.6) | 39 (29.8) | ||
| Lumbar region | 63 (20.7) | 41 (23.6) | 22 (16.8) | ||
| Hip joint | 12 (3.9) | 7 (4.0) | 5 (3.8) | ||
| Knee joint | 15 (4.9) | 7 (4.0) | 8 (6.1) | ||
| Foot region | 16 (5.2) | 10 (5.7) | 6 (4.6) | ||
| Other | 19 (6.2) | 8 (4.6) | 11 (8.4) | ||
| Pain intensity (NRS) d | 3 (2–5) | 3 (2–5) | 4 (2–6) | n.sa | |
| Pain duratione | |||||
| No pain | 57 (18.7) | 37 (21.3) | 20 (15.3) | n.sb | |
| Acute phase | 111 (36.4) | 61 (35.1) | 50 (38.2) | ||
| Chronic phase | 137 (43.9) | 76 (43.7) | 61 (46.6) | ||
n.s: non-significant.
aMann–Whitney U test, bFisher’s exact probability test, cThe site of pain that most interfered with their work or daily life during the past month, dNumerical rating scale: 0 (no pain) to 10 (greatest pain experienced in the past), eNo pain: No onset of pain in the last month, acute phase: <3 months after onset, Chronic phase: ≥3 months from onset.
The median WFun scores were 14 (IQR: 9–18) and 13 (IQR: 8–16) for men and women, respectively, showing no significant gender difference in presenteeism status. Regarding the status of cognitive factors of pain, the median PCS scores for pain catastrophizing were 19 (IQR: 10–26) and 20 (IQR: 12–27) for men and women, respectively, showing no significant difference by gender. 16.7% of all participants had severe pain catastrophizing. The median PSEQ scores for pain self-efficacy were 36 (IQR: 26–45) and 37 (IQR: 27–46) for men and women, respectively, showing no significant difference by gender. 42.3% of all participants had a “low” degree of pain self-efficacy (Table 3).
Table 3. Comparison of presenteeism and cognitive factors of pain between men and women.
| N (%) or median (IQR) | Overall (n=305) | Men (n=174) | Women (n=131) | p-value | |
|---|---|---|---|---|---|
| Work Functioning Impairment Scale (WFun) scores | 13 (9–17) | 14 (9–18) | 13 (8–16) | n.sa | |
| The presence of presenteeismc | 142 (46.6) | 88 (50.6) | 54 (41.2) | n.sb | |
| Pain catastrophizing scale (PCS) scores | 19 (12–26) | 19 (10–26) | 20 (12–27) | n.sa | |
| Pain catastrophizingd | Severe | 51 (16.7) | 27 (15.5) | 24 (18.3) | n.sb |
| Mild | 254 (83.3) | 147 (84.5) | 107 (81.7) | ||
| Pain self-efficacy questionnaire (PSEQ) scores | 36 (26–46) | 36 (26–45) | 37 (27–46) | n.sa | |
| Pain self-efficacye | High | 37 (12.1) | 20 (11.5) | 17 (13.0) | n.sb |
| Moderate | 139 (45.6) | 83 (47.7) | 56 (42.7) | ||
| Low | 129 (42.3) | 71 (40.8) | 58 (44.3) | ||
n.s: non-significant.
aMann–Whitney U test, bFisher’s exact probability test, cThe WFun score of 14 or higher was considered the presence of presenteeism, dThe PCS score of 30 or higher was considered severe and less than 30 was considered mild, eThe PSEQ score of 40–60 was considered high and 20–39 was considered moderate, and 0–19 was considered low.
Results of multiple logistic regression analyses of all participants, including effect modifier and adjustment variables, based on those with high pain self-efficacy, those with moderate pain self-efficacy showed odds ratio 2.36 (95% CI: 1.34–4.18) and those with low pain self-efficacy were showed odds ratio 3.69 (95% CI: 1.57–9.15). Those with severe pain catastrophizing based on those with mild pain catastrophizing showed an odds ratio of 3.36 (95% CI: 1.53–7.83). The “gender” as effect modifier was based on men, with women showing an odds ratio of 0.51 (95% CI: 0.27–0.96) (Table 4).
Table 4. Multiple logistic regression analysis with effect modifiers and adjustment variables of the relationship between presenteeism and cognitive factors of pain in all participants.
| Overall | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Univariate | Multivariate model 1f | Multivariate model 2g | ||||||||
| ORa | 95% CIb | pc | ORa | 95% CIb | pc | ORa | 95% CIb | pc | ||
| Pain self-efficacyd | ||||||||||
| High | 1.00 | 1.00 | 1.00 | |||||||
| Moderate | 2.54 | 1.54–4.18 | *** | 2.32 | 1.35–4.04 | *** | 2.36 | 1.34–4.18 | *** | |
| Low | 5.98 | 2.65–13.5 | *** | 3.82 | 1.60–9.63 | *** | 3.69 | 1.57–9.15 | *** | |
| Pain catastrophizinge | ||||||||||
| Mild | 1.00 | 1.00 | 1.00 | |||||||
| Severe | 3.87 | 2.00–7.53 | *** | 3.27 | 1.55–7.19 | *** | 3.36 | 1.53–7.38 | ** | |
| Gender | 0.62 | 0.44–0.98 | * | 0.51 | 0.27–0.96 | * | ||||
Objective variable: presence of presenteeism, ***p<0.001, **p<0.01, *p<0.05.
aOdds ratio, b95% confidence interval, cp-value, dThe PSEQ score of 40–60 was considered high, 20–39 was considered moderate, and 0–19 was considered low, eThe PCS score of 30 or higher was considered severe, and less than 30 was considered mild, fThe model includes pain self-efficacy and pain catastrophizing as explanatory variables and gender as effect modifier, gThe model includes pain self-efficacy and pain catastrophizing as explanatory variables, and effect modifier as gender, and as adjustment variables, “pain site: no pain, head, neck and shoulder, lumbar region, hip joint, knee joint, foot region, other”, “pain intensity, numerical rating scale: 0 (no pain) to 10 (greatest pain experienced in the past)”, “pain duration, no pain: no onset of pain in the last month, acute phase: <3 months after onset, chronic phase: ≥3 months from onset”, “working years”, “education”, “industry”, “employment status”, “BMI”, and “age”.
As per the results of the multivariate logistic regression analysis conducted on all participants, it was observed that gender had a significant association with the outcome. Therefore, the participants were divided into two groups, i.e., men and women, and another multivariate logistic regression analysis was conducted. It was found that men who had severe pain catastrophizing had an odds ratio of 6.56 (95% CI: 1.83–23.40), while no significant association was observed between pain self-efficacy and the outcome. Contrarily, women were, based on those with high pain self-efficacy, those with moderate pain self-efficacy were showed an odds ratio of 2.54 (95% CI: 1.01–6.39) and those with low pain self-efficacy 5.43 (95% CI: 1.31–22.50), but no significant association was shown for pain catastrophizing (Table 5).
Table 5. Multiple logistic regression analysis of the relationship between presenteeism and cognitive factors of pain in men and women.
| Men | Women | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Univariate | Multivariatef | Univariate | Multivariatef | ||||||||||
| ORa | 95% CIb | pc | ORa | 95% CIb | pc | ORa | 95% CIb | pc | ORa | 95% CIb | pc | ||
| Pain self-efficacyd | |||||||||||||
| High | 1.00 | 1.00 | 1.00 | 1.00 | |||||||||
| Moderate | 2.29 | 1.19–4.39 | * | 2.33 | 0.98–5.31 | n.s | 2.76 | 1.26–6.06 | * | 2.54 | 1.01–6.39 | * | |
| Low | 5.52 | 1.80–17.00 | ** | 3.45 | 0.93–12.80 | n.s | 6.64 | 2.04–21.60 | *** | 5.43 | 1.31–22.50 | * | |
| Pain catastrophizinge | |||||||||||||
| Mild | 1.00 | 1.00 | 1.00 | 1.00 | |||||||||
| Severe | 5.71 | 2.05–15.90 | *** | 6.56 | 1.83–23.40 | *** | 2.91 | 1.16–7.26 | * | 2.27 | 0.73–7.07 | n.s | |
Objective variable: presence of presenteeism.
***p<0.001, **p<0.01, *p<0.05, n.s: non-significant.
aOdds ratio, b95% confidence interval, cp-value, dThe PSEQ score of 40–60 was considered high, 20–39 was considered moderate, and 0–19 was considered low, eThe PCS score of 30 or higher was considered severe, and less than 30 was considered mild, fAs adjustment variables, the following factors were taken into account: “pain intensity” measured on a numerical rating scale with values ranging from 0 (no pain) to 10 (the greatest pain experienced in the past), “pain duration” classified as “no pain” (if there was no onset of pain in the last month), “acute phase” (if it occurred within 3 months after onset), or “chronic phase” (if it lasted ≥3 months from onset), “working years”, “education”, “industry”, “employment status”, “BMI”, and “age”.
Discussion
The findings of this study suggest there is a gender difference in the association between pain catastrophizing, pain self-efficacy, and presenteeism in workers.
Work functioning of participant
The status of occupational dysfunction in a study of workers in seven large companies that employed the same presenteeism assessment method as this study, with a mean WFun score of 15 points, was similar to that of the participants in this study35). Additionally, a previous study involving workers in the manufacturing industry reported median scores of 14 and 13 for men and women, respectively, which was comparable to the presenteeism status of the participants in this study36).
Relationship between cognitive factors of pain and presenteeism in allover the participants, including no pain workers
The International Association for the Study of Pain defines pain as “An unpleasant sensory and emotional experience associated with, or resembling that associated with actual or potential tissue damage”11). It has been reported that the brain activity areas for actual pain experience and pain expectation were nearly identical37). It can be interpreted that pain should be recognized as encompassing the sensory and emotional discomforts experienced in the state before actual onset of pain. This also suggests the presence of a cognitive factor related to pain for unpleasant experiences in conditions that do not involve actual pain but predict the onset of pain. Psychological factors related to pain are cognitive factors derived from past and present experiences17, 18). Individuals’ beliefs about pain persist even without pain complaints19, 20). In this study, pain catastrophizing and pain self-efficacy were also assessed in participants who did not experience pain within the last month. The results showed that both cognitive factors of pain were associated with presenteeism, even when participants without current pain were included in the analysis. This finding suggests that, regardless of the presence or absence of pain in workers, ascertaining the degree of perceived factors related to pain is associated with presenteeism in the overall workforce.
Association of presenteeism with cognitive factors of pain in men workers
Multiple logistic regression analysis showed that sever pain catastrophizing was significantly associated with presenteeism among men workers. However, there was no significant relationship between pain self-efficacy and presenteeism. Prior reports suggest that men tend to prioritize actions such as persisting in their work, supporting their workplace, and engaging with colleagues more than women when experiencing physical discomfort or the activities come at the expense of their health38). This suggests that men are more likely to attend work even when they are ill because of their social roles and expectations, and may attend work regardless of their confidence in their ability to work during pain. However, it is thought that even when employees attend work while experiencing pain, if they have severe pain catastrophizing, their attachment to pain increases due to excessive anxiety and fear of pain, which tends to impair their work performance compared to normal conditions. These findings suggest that identifying men workers with severe pain catastrophizing that interpret pain in an overly pessimistic manner may be one important factor in the construction of countermeasures against presenteeism. Reducing pain catastrophizing involves alleviating the exaggerated negative thoughts and emotions related to pain. This can be achieved by gaining an objective understanding of the current state of pain, and correcting any cognitive distortions about it39). To achieve this, it is important to provide accurate information and knowledge about pain, and to reduce anxiety related to pain during work.
Association of presenteeism with cognitive factors of pain in women workers
Low pain self-efficacy was significantly associated with presenteeism among women workers. However, there was no significant relationship between pain catastrophizing and presenteeism. Approximately 60% of the women participants in this study were in their 20s and 30s, and there were more women than men in informal employment. The child-rearing generation is typically defined as those between the ages of 20 and 4940). More than half of the female workers in this study belong to this group. Child-rearing can be mentally taxing, and it is important to reduce psychological stress, especially among women40). The study suggests that working while experiencing pain may add to the psychological stress among this generation of women workers. In such a scenario, low pain self-efficacy may lead to presenteeism, which is when employees come to work despite being unwell, due to decreased confidence and motivation. Therefore, it is expected that, in women workers, the adjustment of the working environment to their individual life stages will lead to improved confidence in their ability to work. In the acute phase of pain, presenteeism is related to women-specific symptoms and diseases, such as menstrual pain and premenstrual syndrome, in women workers25, 26, 41). In some women participants in this study, pain related to women-specific symptoms and illnesses may have been associated with presenteeism by lowering pain self-efficacy, which indicates the degree of confidence in the ability to perform daily activities and actions in the presence of pain. Women workers may prioritize confidence in handling pain over understanding the situation. Improving confidence while working with pain involves repeatedly achieving goals and accumulating successful experiences despite experiencing pain. This process involves easing action restrictions and encouraging motivation to act14, 18). The way to improve confidence and learn how to work in painful situations is by learning from one’s own experiences and from others who have worked with pain. Additionally, support from colleagues and supervisors at work can help reduce the physical and psychological burden associated with pain, thus enabling individuals to accumulate successful experiences and achieve their goals.
Suggestions for addressing cognitive factors of worker pain
Thus far, we have discussed gender differences in relation to pain catastrophizing, pain self-efficacy, and presenteeism. However, the relationship between these two cognitive factors of pain and presenteeism has been shown in previous studies. Therefore, we do not want to argue that it is sufficient to focus only on one of the cognitive factors of pain to counter presenteeism in gender. When considering measures to address employee presenteeism, it is important to understand these two cognitive factors related to pain. When considering presenteeism in a work environment biased toward one gender (e.g., a hospital facility with many women nurses), attention to gender differences in the association between perceived factors of pain and presenteeism may help establish more effective countermeasures.
In the future, Japan’s declining birth rate and aging population are expected to lead to a decrease in the economically productive population, and there are concerns about the extension of the retirement age system for workers and the aging of the workforce. This calls for companies to actively promote health management awareness among individual workers, including the younger generation, and to take measures to curb presenteeism. Generally, health care measures for those who work with chronic pain, such as low back pain and stiff shoulders, include taking analgesics for pain, adjusting the work environment, such as ensuring good work posture and sitting posture on a chair or at a desk, and stretching and exercises for stiff muscles in the lower back and shoulder areas. However, no company has assessed the content of the individual workers’ cognitive factors of pain or has taken individualized measures. This study suggests that, to reduce presenteeism related to pain that affects workers’ health, it is necessary to not only eliminate pain and promote physical activity but also consider measures by providing knowledge about the cognitive factors of pain, taking gender difference into account (e.g., pathophysiology of pain for men, living environment during pain for women). In addition to mental health care and prevention of lifestyle-related diseases, this study will contribute to the construction of health management measures that place even greater emphasis on individuality by understanding the status of cognitive factors for individual pain as health management for workers in companies.
Limitations
Limitation of this study is that we cannot refer to causal relationships due to the cross-sectional study design. Addition, selection bias in sampling exists because not all employees working for the participating companies were included in the study; in fact, only some employees participated, such as those who were interested in their own pain and working conditions. In addition, the statistical analysis did not take into account various factors such as gender-specific diseases and symptoms, social background including marital status, family structure, and household income, absence from work or leave taken due to health problems, history of current treatment, and psychosocial factors like mental stress in the workplace. It is possible that these factors can affect the correlation between cognitive factors of pain and presenteeism. In the future, it will be necessary to longitudinally observe the relationship between cognitive factors of pain and presenteeism over time after the experience of pain, and to examine the relationship between these factors and presenteeism while considering various social backgrounds.
Conflict of Interest
The authors have no conflicts of interest to declare regarding this study.
Acknowledgments
We would like to express our deepest gratitude to President Sugita and Mr. Sakurai, Secretary-General of the Healthcare and Welfare Environment Management Support Organization Saitama, for their cooperation in conducting this study.
References
- 1.Gray J. (2010) Presenteeism in the workplace: a review and research agenda. J Organ Behav 31, 519–42. [Google Scholar]
- 2.Nagata T, Mori K, Ohtani M, Nagata M, Kajiki S, Fujino Y, Matsuda S, Loeppke R, Loeppke R. (2018) Total health-related costs due to absenteeism, presenteeism, and medical and pharmaceutical expenses in Japanese employers. J Occup Environ Med 60, e273–80. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Fujino Y. (2018) Health management of workers with presenteeism is a new challenge in occupational health. J UOEH 40, 225–30. [DOI] [PubMed] [Google Scholar]
- 4.Allen D, Hines EW, Pazdernik V, Konecny LT, Breitenbach E. (2018) Four-year review of presenteeism data among employees of a large United States health care system: a retrospective prevalence study. Hum Resour Health 16, 59. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Lerner D, Adler DA, Rogers WH, Chang H, Lapitsky L, McLaughlin T, Reed J. (2010) Work performance of employees with depression: the impact of work stressors. Am J Health Promot 24, 205–13. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.Ravalier JM. (2018) The influence of work engagement in social workers in England. Occup Med (Lond) 68, 399–404. [DOI] [PubMed] [Google Scholar]
- 7.Sugano R, Ikegami K, Michii S, Ando H, Nozawa H, Imoto H, Shima A, Kawatsu Y, Fujino Y, Ogami A (2019) Musculoskeletal pain in Japanese workers and the relationship between labor productivity by presenteeism and chronic musculoskeletal pain: a cross-sectional study. Environ Occup Health Pract 1, 21–30. [Google Scholar]
- 8.Yokota J, Fukutani N, Nin K, Yamanaka H, Yasuda M, Tashiro Y, Matsushita T, Suzuki Y, Yokota I, Teramukai S, Aoyama T. (2019) Association of low back pain with presenteeism in hospital nursing staff. J Occup Health 61, 219–26. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9.Yamada K, Wakaizumi K, Fukai K, Iso H, Sobue T, Shibata M, Matsudaira K. (2017) [Study of chronic pain and its associated risk factors among Japanese industry workers: the Quality of Working Life Influenced by Chronic pain (QWLIC) study] Sangyo Eiseigaku Zasshi 59, 125–34(in Japanese). [DOI] [PubMed] [Google Scholar]
- 10.Yoshimoto T, Oka H, Fujii T, Nagata T, Matsudaira K. (2020) The economic burden of lost productivity due to presenteeism caused by health conditions among workers in Japan. J Occup Environ Med 62, 883–8. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 11.Raja SN, Carr DB, Cohen M, Finnerup NB, Flor H, Gibson S, Keefe FJ, Mogil JS, Ringkamp M, Sluka KA, Song XJ, Stevens B, Sullivan MD, Tutelman PR, Ushida T, Vader K. (2020) The revised International Association for the Study of Pain definition of pain: concepts, challenges, and compromises. Pain 161, 1976–82. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 12.Vlaeyen JWS, Linton SJ. (2000) Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art. Pain 85, 317–32. [DOI] [PubMed] [Google Scholar]
- 13.Adachi T, Nakae A, Maruo T, Shi K, Shibata M, Maeda L, Saitoh Y, Sasaki J. (2014) Validation of the Japanese version of the pain self-efficacy questionnaire in Japanese patients with chronic pain. Pain Med 15, 1405–17. [DOI] [PubMed] [Google Scholar]
- 14.Adachi T, Yamada K, Nishigami T, Sasaki J, Shibata M. (2015) [Effects of pain self-efficacy and other cognitive-emotional factors on health-related quality of life, and pain interference in Japanese chronic pain patients]. Manseitoutsu 34, 107–12(in Japanese). [Google Scholar]
- 15.Varela AJ, Van Asselt KW. (2022) The relationship between psychosocial factors and reported disability: the role of pain self-efficacy. BMC Musculoskelet Disord 23, 21. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 16.Mine Y, Fujino Y, Matsuda S. (2020) The interaction between pain intensity and pain self-efficacy in work functioning impairment: a cross-sectional study in Japanese construction workers. J Occup Environ Med 62, e149–53. [DOI] [PubMed] [Google Scholar]
- 17.Sullivan MJL .(2009) The Pain Catastrophizing Scale: user manual. 1–36, McGill University, Montreal. [Google Scholar]
- 18.Bandura A. (1977) Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev 84, 191–215. [DOI] [PubMed] [Google Scholar]
- 19.Van Damme S, Crombez G, Bijttebier P, Goubert L, Van Houdenhove B. (2002) A confirmatory factor analysis of the Pain Catastrophizing Scale: invariant factor structure across clinical and non-clinical populations. Pain 96, 319–24. [DOI] [PubMed] [Google Scholar]
- 20.Bonafé FSS, Marôco J, Campos JADB. (2018) Pain self-efficacy questionnaire and its use in samples with different pain duration time. Br J Pain 1, 9–33. [Google Scholar]
- 21.Tanaka C, Wakaizumi K, Takaoka S, Matsudaira K, Mimura M, Fujisawa D, Kosugi S. (2022) A cross-sectional study of the impact of pain severity on absenteeism and presenteeism among Japanese full-time workers. Pain Ther 11, 1179–93. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 22.Enck P, Klosterhalfen S. (2019) Does sex/gender play a role in placebo and nocebo effects? Conflicting evidence from clinical trials and experimental studies. Front Neurosci 13, 160. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 23.Pieretti S, Di Giannuario A, Di Giovannandrea R, Marzoli F, Piccaro G, Minosi P, Aloisi AM. (2016) Gender differences in pain and its relief. Ann Ist Super Sanita 52, 184–9. [DOI] [PubMed] [Google Scholar]
- 24.Bartley EJ, Fillingim RB. (2013) Sex differences in pain: a brief review of clinical and experimental findings. Br J Anaesth 111, 52–8. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 25.Watanabe M. (2020) [The presenteeism of workers with women’s disease and its factors]. Syakaidezaingakkai Gakkaishi 11, 98–108(in Japanese). [Google Scholar]
- 26.Schoep ME, Adang EMM, Maas JWM, De Bie B, Aarts JWM, Nieboer TE. (2019) Productivity loss due to menstruation-related symptoms: a nationwide cross-sectional survey among 32748 women. BMJ Open 9, e026186. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 27.Takura T, Ushida T, Kanchiku T, Ebata N, Fujii K, DiBonaventura M, Taguchi T. (2015) The societal burden of chronic pain in Japan: an internet survey. J Orthop Sci 20, 750–60. [DOI] [PubMed] [Google Scholar]
- 28.Sullivan MJL, Bishop SR, Pivik J. (1995) The pain catastrophizing scale: development and validation. Psychol Assess 7, 524–32. [Google Scholar]
- 29.Mastuoka H, Skano Y. (2007) [Assessment of cognitive aspect of pain: development, reliability, and validation of Japanese version of pain catastophizing scale]. Gakkaishi Shinshinigaku 47, 95–102 (in Japanese). [Google Scholar]
- 30.Nicholas MK. (2007) The pain self-efficacy questionnaire: taking pain into account. Eur J Pain 11, 153–63. [DOI] [PubMed] [Google Scholar]
- 31.Fujino Y, Uehara M, Izumi H, Nagata T, Muramatsu K, Kubo T, Oyama I, Matsuda S. (2015) Development and validity of a work functioning impairment scale based on the Rasch model among Japanese workers. J Occup Health 57, 521–31. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 32.Fujino Y, Shazuki S, Izumi H, Uehara M, Muramatsu K, Kubo T, Oyama I, Matsuda S. (2016) Prospective cohort study of work functioning impairment and subsequent absenteeism among Japanese workers. J Occup Environ Med 58, e264–7. [DOI] [PubMed] [Google Scholar]
- 33.Michishita R, Jiang Y, Ariyoshi D, Yoshida M, Moriyama H, Obata Y, Nagata M, Nagata T, Mori K, Yamato H. (2017) The introduction of an active rest program by workplace units improved the workplace vigor and presenteeism among workers: a randomized controlled trial. J Occup Environ Med 59, 1140–7. [DOI] [PubMed] [Google Scholar]
- 34.Nagata T, Fujino Y, Saito K, Uehara M, Oyama I, Izumi H, Kubo T. (2017) Diagnostic accuracy of the work functioning impairment scale (Wfun): a method to detect workers who have health problems affecting their work and to evaluate fitness for work. J Occup Environ Med 59, 557–62. [DOI] [PubMed] [Google Scholar]
- 35.Makishima M, Fujino Y, Kubo T, Izumi H, Uehara M, Oyama I, Matsuda S. (2018) Validity and responsiveness of the work functioning impairment scale (WFun) in workers with pain due to musculoskeletal disorders. J Occup Health 60, 156–62. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 36.Kageyama M, Tatsumi A, Fujino Y, Watai I. (2022) [Association between social jetlag and presenteeism in Japanese industry: a cross-sectional study]. Sangyo Eiseigaku Zasshi 64, 12–21(in Japanese). [DOI] [PubMed] [Google Scholar]
- 37.Ogino Y, Nemoto H, Inui K, Saito S, Kakigi R, Goto F. (2007) Inner experience of pain: imagination of pain while viewing images showing painful events forms subjective pain representation in human brain. Cereb Cortex 17, 1139–46. [DOI] [PubMed] [Google Scholar]
- 38.Luksyte A, Unsworth KL, Avery DR, Cordery JL, Seah J. (2023) Gender differences in the relationship between presenteeism and extra‐role behaviors. J Organ Behav 44, 957–72. [Google Scholar]
- 39.Harizuka N, Koga S. (2022) Investigation about the individuality and common point and functionality in the catastrophic worry. Bulletin of Center for Clinical Psychology and Human Development. Kyushu Univ 13, 9–15(in Japanese). [Google Scholar]
- 40.Japan Cabinet Office. White paper on national life 2005. http(s)://www5.cao.go.jp/seikatsu/whitepaper/h17/10_pdf/01_honpen/index.html. Accessed March 15, 2024.
- 41.Tanaka E, Momoeda M, Osuga Y, Rossi B, Nomoto K, Hayakawa M, Kokubo K, Wang EC. (2013) Burden of menstrual symptoms in Japanese women: results from a survey-based study. J Med Econ 16, 1255–66. [DOI] [PubMed] [Google Scholar]
