If surgery has been successful, aside from motivation, drug seeking and case building, if the patient does not recover, we should look for marital problems. That is the single greatest contributor to individuals languishing in care.
And those marital problems can run the gamut from infidelity of spouse to tension produced by being home all day with the children.
These problems are very infrequently disclosed to case managers or primary providers. The patient may feel that it is unrelated to their complaints or be embarrassed about the nature of what I occurring.
These problems rarely emerge solely because of injury; the injury merely provides as a catalyst for expression of longstanding tensions and/or incompatibility.
Whether the injured worker is male or female, there is a very similarly held belief that since pain (and often medication) blocks bedroom activities; they feel their spouse will leave them.
As we have discussed previously, financial collapse can be very rapid since there were few savings and major indebtedness.
While the husband bemoans having to find a new career, the wife and kids are burdened with him sleeping away the days, doing little to nothing around the house, and then being irritable when they arrive home.
Of equal importance is the lack of concern for hygiene, weight and keeping late hours due to having slept (or at least being sedentary) throughout the day.
While functional capacity exams are crucial, merely finding that there is _insufficient effort_ on these exams is insufficient. We need to know why the person perceives themselves as defeated and what, at home, contributes to this.