Psykisk hälsa/ohälsa är ett svårdefinierat begrepp som sätter fingret på ett av de största folkhälsoproblemen i vårt land, där depression är en av de vanligaste diagnoserna. Manualerna DSM-IV TR och ICD-10 används inom stora delar av sjukvården, världen över, i syfte att ge kunskap om lämpligast behandling till patienter med psykiska besvär. Denna studie syftar till att, genom en kvalitativ analys, undersöka vilka grunder som finns bakom de vanligast använda diagnosmanualerna och vilka kriterier som krävs för att uppfylla två vanligt förekommande diagnoser, PTSD och svår depression. Vidare syftar studier till att belysa eventuella likheter och olikheter mellan dessa diagnoser och vad det kan föra med sig. Såväl psykologisk forskning som klinisk praktik utgår idag mestadels från psykiatriska diagnoser, vilket kan ha såväl fördelar som nackdelar, men samtidigt diskuteras huruvida man istället ska lägga fokus på en annan mer underliggande nivå, nämligen processerna som sträcker sig över diagnosernas gränser. Fördelarna med ett transdiagnostiskt perspektiv är att det delvis kan ge en förklaring till den höga komorbiditet som finns i kliniska grupper och som skulle kunna iakttas även i de sjukdomsbilder som denna studie fokuserar på. Unified Protocol är en annan behandlingsmodell som tas upp i studien, vilken baseras på en betydande fenotypisk över-lappning mellan olika ångeststörningar hos patienter, där personer med subkliniska nivåer av symtom ändå kan ha en nedsatt funktionsnivå och ett subjektivt lidande, fastän de inte uppfyller alla de diagnostiska kriterierna för en specifik störning. Resultatet visar på möjligheten att se över diagnosgränser, för att öka chanserna för ett tillfrisknande hos patienten. Människans upplevelser av olika situationer den befinner sig i formas av personens egen uppfattning om sin förmåga, eller oförmåga, att påverka resultatet. Att uppleva sig ha mist kontroll över sitt eget liv kan i sig leda till såväl depression som suicidala tankar/-handlingar. Om symtomen för depression jämförs med kriterierna som står att finna under diagnosbilden “Posttraumatiskt stressyndrom” under kapitlet “ångestsyndrom”, kan många likheter konstateras. Slutsatsen blir att likheterna i symtombild skulle ge patienter med PTSD en behandlingsrekommendation som inte alls överensstämmer med de rekommenderade riktlinjer som är utformade för PTSD. Trots diagnosernas likheter rekommenderas olikartad behandling, och även olika förutsättningar för att fungera i kombination med förvärvsarbete påvisas. Vid så lika symtombilder, men ändå så skilda rekommenderade behandlingsplaner utifrån de olika diagnoserna, torde risken för en felaktig rehabiliteringsplan vara över-hängande. / Mental health/illness is complex to define and this highlight of the biggest public health problems in our country, in which depression is one of the most common diagnoses. The manuals DSM-IV TR and ICD-10 is used in much of health care, worldwide, in order to provide knowledge of appropriate treatment for patients with mental disorders. This study aims to, through a qualitative analysis, examine the grounds behind the most commonly used diagnostic manuals and the criteria required to meet two common diagnoses, PTSD and severe depression. Further studies aimed to highlight any similarities and differences between these diagnoses and what it can bring. Both psychological research and clinical practice today is based mostly from psychiatric diagnoses, which can have both advantages and disadvantages, but also discussed whether they should instead focus on another more underlying level, namely the processes that extend across the diagnostic boundaries. The advantages of a trans-diagnostic perspective are that it may partly explain the high co-morbidity found in clinical groups and that could be observed even in those syndromes which this study focuses on. Unified Protocol is a different treatment model that is entered in the study, which is based on a significant phenotypic overlap between anxiety disorders in patients, where individuals with subclinical levels of symptoms still can have a reduced level of functionality and a subjective suffering, although they do not meet all the diagnostic criteria for a specific disorder. The result shows at the opportunity to review the diagnostic boundaries, to increase the chances for a recovery of the patient. The human experiences of different situations it is in the form of personal self-perception of their ability, or inability, to influence the outcome. To experience they have lost control over his own life in itself can lead to both depression that suicidal thoughts / actions. If the symptoms of depression compared with criteria that are to be found during diagnostic image "Post-traumatic stress disorder" in the chapter "disorder" can be found many similarities. The discourse comes to that the similarities in symptoms would provide patients with PTSD, a treatment recommendation, which did not conform to the recommended guidelines that are designed for PTSD. Despite the diagnosis, the similarities are recommended disparate treatment, and also different conditions to work in conjunction with work shown. At this same symptom pictures, yet so different recommended treatment plans based on the different diagnoses, would risk a false rehabilitation plan to be imminent

Processkartläggning, som plattform för processbaserad verksamhetsutveckling, kan användas i hälso- och sjukvård för att kunna förstå en process och ge förutsättningar för förbättringar av den. Utgångspunkten var att det i litteraturen saknades en kartläggning av en vårdprocess som inkluderar sjukskrivningar, och sjukskrivningar ökar. Syftet var att förstå förutsättningarna för processbaserad verksamhetsutveckling gällande hälso- och sjukvårdens aktiviteter i primärvård för de patienter som söker vård vid förstämningssyndrom eller ångest/stress. Datainsamling gjordes i form av intervju samt processkartläggning av aktiviteter mellan sjukskrivning 1 och 2. Resultatet visade att berättelser med utgångspunkt i bra och dåliga erfarenheter av vårdprocessen kunde kopplas till framgångsfaktorer vad gäller förbättrad hälsa och återgång till arbete. De intervjuades roller, erfarenheter och syn på patientens behov gav upphov till olika förbättringsförslag gällande processen. Processkartläggningen visade på behov av en gemensam bild. Förslag till framtida processkartläggning gavs med utgångspunkt i resultatet. / Process mapping, as a prerequisite for process based organizational development, can be used in health care in order to understand the process and to provide possibilities of improving it. In the literature there was no mapping of the care process that includes sick leave, and sick leave increases. The purpose of the study was to understand the prerequisites for organizational development based on process mapping concerning primary health care activities for psychiatric diagnoses. Data collection was done by interviewing health professionals and by process mapping activities in the first period of sickness absence. The results showed that the stories based on good and bad experiences of the care process could be linked to success factors in terms of improved health and return to work. The informants different roles, experiences and perspective on the patient's needs gave rise to various suggestions for improvement of the process. Process mapping showed the need for a joint picture. Proposals based on the results, for future process mapping were given.

Σκοπός της διατριβής ήταν η διερεύνηση του φαινομένου της απουσίας (για λόγους υγείας) από την εργασία στον ιδιωτικό τομέα και ιδίως στη βαριά βιομηχανία, και τη πιθανή επίδραση στην ικανότητα εργασίας. Η παρούσα διδακτορική διατριβή στηρίχτηκε κυρίως στη μελέτη του αρχείου αναρρωτικών αδειών (μιας κοόρτης) εργαζομένων σε ένα από τα μεγαλύτερα ναυπηγεία της χώρας, καθώς και στις ετήσιες στατιστικές αναφορές του Ιδρύματος Κοινωνικών Ασφαλίσεων (ΙΚΑ) της τελευταίας 20ετίας. Τα χαμηλά επίπεδα απουσιασμού ασθενείας στον ιδιωτικό τομέα στην Ελλάδα επιβεβαιώθηκαν από τη μελέτη που έγινε στα πλαίσια αυτής της διατριβής, αν και τα αποτελέσματα υποδεικνύουν ότι ο απουσιασμός ασθενείας στην Ελλάδα είναι ελαφρώς μεγαλύτερος από ότι υποδείκνυαν οι πρόσφατες διεθνείς συγκριτικές μελέτες. Το ποσοστό απουσιασμού (Absenteeism rate) βρέθηκε περίπου 2.5%, από τα χαμηλότερα στην Ευρώπη. Παρόλα αυτά, επειδή περιλαμβάνει τον εργάσιμο χρόνο που διαφέρει από χώρα σε χώρα, δεν χρησιμοποιείται συχνά στις μελέτες αν και ίσως είναι ο πιο έγκυρος δείκτης απουσιασμού. Η μέση διάρκεια απουσίας για κάθε εργαζόμενο ανά έτος ήταν 5.8 ημέρες( μέγιστη τιμή 8 ημέρες προς το τέλος της περιόδου μελέτης) με ένα αντίστοιχο μέσο όρο που ξεπερνούσε κατά πολύ τις 10 ημέρες στην υπόλοιπη Ευρώπη. Ενδιαφέρον εύρημα αποτελεί το γεγονός ότι οι μικρής διάρκειας απουσίες (<4 ημέρες) αντιστοιχούσαν στο 25% της συνολικής διάρκειας των απουσιών, κάτι που μέχρι τώρα δεν μπορούσε να υπολογιστεί από τα εθνικά στατιστικά δεδομένα του ΙΚΑ. Κατά τη μελέτη των δεδομένων του ΙΚΑ τις δυο τελευταίες δεκαετίες, βρέθηκε μια κυματοειδής πορεία του απουσιασμού, επιδεικνύοντας πτωτική πορεία μέχρι τα τέλη τις δεκαετίας του 1990, σε συμφωνία με τις προηγούμενες μελέτες και εν συνεχεία μια ανοδική πορεία, αν και μέχρι το τέλος της περιόδου μελέτης τα επίπεδα παρέμειναν χαμηλότερα από τα αρχικά. Σίγουρα οι παρατηρήσεις αυτής της μελέτης χρήζουν περαιτέρω διερεύνησης, καθώς ο χαμηλός απουσιασμός μόνο μερικώς μπορεί να αποδοθεί στα χαμηλά επίπεδα αποζημίωσης μισθού σε περίπτωση αναρρωτικής άδειας ή τα υψηλά ποσοστά ανεργίας. Βασικός σκοπός πρέπει πάντα να είναι η διατήρηση και προώθηση της καλής υγείας των εργαζομένων, μέσω όσο το δυνατόν καλύτερων εργασιακών συνθηκών. Καθώς τόσο οι εργασιακές συνθήκες όσο και η υγεία των εργαζομένων είναι σε μια δυναμική κατάσταση, χρειάζονται εργαλεία παρακολούθησης. Η μέτρηση του απουσιασμού ασθενείας είναι ένας παράγοντας που πάντα θα πρέπει να εκτιμάται από τον ιατρό εργασίας και τον εργοδότη, χρησιμοποιώντας τους διάφορους δείκτες που έχουν καθιερωθεί. Σαν συμπληρωματικό εργαλείο παρακολούθησης προτείνεται η χρήση του Δείκτη Ικανότητας Εργασίας (Work Ability Index), που είναι ένα ερωτηματολόγιο, το οποίο σταθμίστηκε στα Ελληνικά και εκτιμά γενικά τη λειτουργική ικανότητα των εργαζομένων, όντας άμεσα συνδεδεμένο με τον απουσιασμό ασθενείας. Η ελληνική έκδοση του Δείκτη Ικανότητας Εργασίας έδειξε ικανοποιητικές ψυχομετρικές ιδιότητες και συνοχή, και μπορεί να αποτελέσει μια αξιόπιστη εναλλακτική επιλογή στα εργαλεία αξιολόγησης της ικανότητας εργασίας σε ατομικό και ομαδικό επίπεδο. Ο παράγοντας Bradford είναι ένας ακόμα δείκτης που η προγνωστική του δύναμη όσον άφορα το βραχυπρόθεσμο απουσιασμό φάνηκε σε αυτή τη μελέτη. Προτείνεται επίσης η χρήση και των δυο αυτών δεικτών με την μορφή ενός νέου δείκτη (Δείκτης Πρόβλεψης Πιθανής Απουσίας), για την ανίχνευση εργαζομένων και τομέων εργασίας με αυξημένη πιθανότητα απουσίας για λογούς υγείας τα αμέσως επόμενα χρόνια. Στα πλαίσια της στάθμισης έγινε επίσης φανερό το πρότυπο νοσηρότητας του πληθυσμού των ναυπηγείων, όπου κυριαρχούν οι μυοσκελετικές και αναπνευστικές παθήσεις μαζί με το τραύμα, ενώ τη μεγαλύτερη επίδραση στην ικανότητα εργασίας φαίνεται να έχουν οι καρδιαγγειακές και ψυχικές παθήσεις. Αναδείχτηκε επίσης η υποδιάγνωση των ψυχικών παθήσεων, που είναι ένα γενικότερο πρόβλημα στην Ελλάδα. Οι ραδιοτεχνίτες και οι φλογοχειριστές φαίνονται να εμφανίζουν τα μεγαλύτερα επίπεδα απουσιασμού. Οι παράγοντες που βρέθηκαν να συσχετίζονται θετικά με αυξημένα επίπεδα απουσιασμού είναι η μικρή ηλικία, οι χειρωνακτικές εργασίες, το χαμηλό επίπεδο εκπαίδευσης και η εργασιακή εμπειρία άνω των 3 ετών. Συμπερασματικά, χρειάζονται περαιτέρω μελέτες για να κατανοηθεί πλήρως ο απουσιασμός ασθενείας, σε όλους τους εργασιακούς τομείς και βεβαίως εκπαίδευση του ιατρικού προσωπικού στο θέμα της χορήγησης αναρρωτικών αδειών, όπου θα βοηθούσε η χρήση εργαλείων όπως αυτά που μελετήθηκαν σε αυτή τη διατριβή(πχ Disability Guidelines), και ήδη βρίσκουν εφαρμογή σε άλλες χώρες. / The aim of this study was to estimate the levels and analyse sickness absence in the private sector in Greece, using shipyard and national insurance data. Field data were collected in a cohort of shipyard employees in the period between 1999 and 2006. In addition, national sickness absenteeism data (compensated days) of employees insured at the Social Insurance Institute (IKA, the largest insurance scheme in Greece) were retrieved from the Institute’s annual statistical reports for the period 1987-2006. Low levels of sickness absence in the private sector in Greece have been confirmed by this study, although the findings show that sickness absence in Greece is slightly higher than what the recent international comparative studies indicate. The absenteeism rate was 2.5%, which is one of the lowest in Europe. Nevertheless, due to the fact that it involves working hours which differ from one country to another, it is not often used in the studies despite being the most valid indicator of absence. The average duration of absence for every employee per year was 5.8 days (maximum number was 8 days towards the end of the study). In Europe, the average number of days of sickness absence exceeded 10 days. An interesting finding is the fact that short period absences (<4 days) constituted 25% of the total duration of absences, which could not be calculated until now by the national statistical data of the Social Insurance Institute (IKA). While studying the data of IKA of the last two decades, a sinusoidal-like trend was recorded regarding absenteeism. Declining trend by the end of the 1990s was observed, in accordance with previous studies and then an increasing trend, although at the end of the study period the levels remained lower than those at the beginning. Further research is needed concerning the observations of this study since the low absenteeism levels can only be partially attributed to the low compensation rate in case of sick-leave or to the high levels of unemployment. The primary objective should always be health preservation and promotion of the employees by means of the best possible working conditions. As both working conditions and employees’ health are dynamic situations, monitoring tools are required. Sickness absence should always be monitored by the occupational health physician as well as the employer, using the various established tools. The use of Work Ability Index is recommended as an additional monitoring tool. It is a questionnaire, directly linked to sickness absence, which generally evaluates the employees’ functional ability. The Greek version of Work Ability Index displayed satisfactory psychometric properties and consistency thus constituting an appropriate option for evaluating work ability in both individual and population-based settings. The Bradford factor is another index whose prognostic strength concerning short-term absenteeism was evident in this study. The use of both these tools in the form of one new index (Sickness Absence Probability Factor) is also recommended in order to identify employees and work areas with an increased tendency for sickness absence. During the validation process, the morbidity pattern of the shipyard population also became obvious. Musculoskeletal, respiratory diseases as well as trauma are most prevalent, whereas cardiovascular and mental diseases seem to have the biggest impact on work ability. The underdiagnosis of mental diseases was also revealed, which is a general problem in Greece. Radiomen and flame-cutters seem to have the highest levels of absence, while the factors which were found to be positively linked to high levels of absenteeism are young age, manual labor, low educational level and working experience over 3 years. In conclusion, further research is necessary to fully describe and understand the phenomenon of sickness absence in various work fields. Medical staff training in the area of issuing sick-leave is essential and has already been implemented in other countries. Tools, like the ones studied in this dissertation should be utilized.

The aim of the thesis is to describe and analyse how a group of women experience that their every-day lives are affected during and after primary breast cancer treatment. The thesis is a consecutive, longitudinal study that takes an explorative qualitative approach. Seventy-one women younger than 60 years of age with primary breast cancer were consecutively included in the study. The women were interviewed four or five times over a period of 4 to 6 years from end of radiotherapy. The analyses of the interviews were inspired by grounded theory and narrative analysis.  The thesis encompasses four papers. Paper I focused on the women’s contact with health care. The results of this study indicate that it is crucial for patients in a vulnerable situation to be admitted into a supportive system – ‘admitted into a helping plan’ – that, more or less explicitly, displays a well-thought-out plan of care. This is a process built on individual relationships with members of the health-care staff, but it ends up in a relationship to health care as a helping system, a ‘safe haven’ to attach to. Study II explored the women’s ideas about what motivated and discouraged their return to work. The results illustrate that the meaning of work fluctuates over time and that the processes of returning to work are conditioned by the patients’ individual life situations. Returning to work was regarded as an important part of the healing process because of how it generated and structured the women’s everyday lives. Returning to work meant demonstrating well-being and normalcy after breast cancer. Study III examined how life was lived and valued during and after treatment for breast cancer compared to pre-cancer life. The analysis showed that being afflicted with breast cancer was evaluated from a context of the women’s former everyday lives and stressed that how the women experienced breast cancer was a matter of personal circumstances. Study IV focused on how the women experienced and dealt with their altered bodies. The results showed that the women followed three different body-mind trajectories that depended to a significant extent on the severity of side effects and bodily alterations that resulted from their treatments. Being afflicted by breast cancer implies vulnerability and losses, but it can also involve benefits and provide new perspectives on life. How the overall breast cancer experience is valued seems to be very much a matter of circumstances in everyday life. This thesis highlights circumstances that focus in particular on contacts with health care, the body, the work situation, and the family situation.

Studiens övergripande syfte är att belysa och gestalta det sociala stöd respektive sociala tryck personer sjukskrivna för utmattningsdepression anser sig uppleva från omgivningen, vad gäller både att vara sjukskriven och att återgå till arbete. Undersökningen genomfördes med hjälp av kvalitativ metod, och sex personer som var sjukskrivna för utmattningsdepression intervjuades individuellt. Resultatet visar att de sjukskrivna upplever en komplex blandning av både press och stöd i processen att ta sig tillbaka till arbetslivet. Stödet, oftast i form av förståelse och undvikande av press, upplevs främst från personer i individens nära omgivning, medan pressen att återgå till arbete oftast relateras till personer och grupper på längre avstånd. Störst press att återgå till arbetet upplevdes från den "samhälleliga" normen "att göra rätt för sig", men även omgivningens okunskap och brist på förståelse upplevdes som en press. / The overall aim in this essay is to highlight and describe the social support and social pressure, people on sick leave for burnout feel they experience by their environment, both in terms of being on sick leave and in terms of return to work. The survey was conducted using qualitative methodology, and six people being sick for burnout were interviexed individually. The result shows that people on sick leave for burnout are experiencing a complex mixture of both social pressure and social support in the process of returning to work. Social support, often in the form of understanding for the disease and avoidance of pressure, are mostly experienced by people in the individual's near environment, while the pressure usually is related to individuals and groups at longer distances. The strongest pressure to return to work was experienced from the "societal" norm "to do the right thing", but also lack of krowledge and lack of understanding were experienced as a pressure to return to work.

Diss. (sammanfattning) Linköping : Linköpings universitet, 2005. / Härtill 4 uppsatser.

This thesis studies how sick leave legitimacy is managed in interaction and develops an empirically driven conceptualization of ‘legitimacy work’. The thesis applies an ethnomethodological framework that draws on conversation analysis, discursive psychology, and membership categorization analysis. Naturally occurring interaction is examined in two settings: (1) multi-party meetings at the Swedish Social Insurance Agency, in which participants assess and discuss the ‘status’ of the sick leave and plan for work rehabilitation; (2) peer-based online text-in-interaction in a Swedish forum thread that gathers people on sick leave. The thesis shows how mental states, activities and alternative categories function as resources for legitimacy work. However, such invocations are no straight-forward matter, but impose additional contingencies. It is thus crucial how they are invoked. By detailed analyses of the interaction, with attention to aspects such as lexicality and delivery, the thesis identifies a range of discursive features that manage sick leave legitimacy. Deployed resources are also subtle enough to be deniable as legitimacy work, that is, they also manage the risk of an utterance being seen as invested or biased. While legitimate sick leave is a core concern for Swedish policy-making, administration, and public debate on sick leave, previous research has for the most part been explanatory in orientation, minding legitimacy rather than studying it in its own right. By providing detailed knowledge about the legitimacy work that people on long-term sick leave do as part of both institutional and mundane encounters, the thesis contributes not only new empirical knowledge, but a new kind of empirical knowledge, shedding light on how the complexities of sick leave play out in real-life situations. Traditional sociological approaches have to a significant extent treated legitimacy as an entity with beginnings and ends that in more or less direct ways relate to external norms and cognitive states, or that focus on institutions, authority or government. By contrast, the herein emerging concept ‘legitimacy work’ understands legitimacy as a locally contingent practicality – a collaborative categorially oriented accomplishment that is integral to the interactional situation.

The thesis is focused on the development of health insurance benefits under the social security system in the Czech Republic. Aiming to secure people for future social events, which may be predictable (age) or unpredictable (disability, funeral, sickness, widowhood, etc.) and prevent poverty or the worst consequences. This thesis briefly describes the system of social security. More specifically focuses on health insurance, health insurance benefits and their development. It also contains the characteristics of the selected business entity and cost analysis of selected companies of employing workers and their absence from work, which is associated with the payment of sickness benefits. Finally, it presents the identification of direct and indirect costs associated with health insurance benefits and their impact on the profit of the selected business entity. The conclusion describes the effect of the payment of health insurance benefits for profit companies, including negative and positive impacts.

Les risques psychosociaux (RPS) sont devenus en France une préoccupation majeure pour la société par leurs enjeux en termes de santé publique, de coûts pour les entreprises et les travailleurs. Les ministères du Travail et de la Santé se sont emparés de ces enjeux à la fin des années 2000 en suscitant enquêtes, collectes de données et travaux scientifiques. Malgré le développement de la connaissance sur les RPS et leurs conséquences, l’intégration de ces nouveaux risques dans les politiques publiques et managériales est encore très modeste.A travers une analyse économique, institutionnelle et empirique, l’objectif principal de cette thèse est de contribuer à une meilleure connaissance des conséquences de l’exposition aux RPS pour l’individu et pour l’entreprise, et d’analyser le rôle des instances de prévention actuelles dans la réduction des niveaux de RPS perçus et dans la préservation de la santé des travailleurs. Les différentes analyses empiriques réalisées révèlent que l’exposition des travailleurs aux RPS conduit à une dégradation de leur santé mentale, à davantage d’absence-maladie et de présentéisme. Il semble donc nécessaire de mettre en place des actions de prévention visant à limiter ces conséquences néfastes. Une analyse institutionnelle et économique du cadre de prévention français établit le rôle important du Comité d’Hygiène, de Sécurité et des Conditions de Travail (CHSCT) malgré les moyens d’action limités dont l’instance dispose. / In France, psychosocial risks (PSR) became a major concern for society by their stakes in termsof public health, costs for companies and workers. In the late 2000s, the Ministries of Labor and Health took up these challenges by initiating surveys, data collection and scientific works. Despite the development of knowledge about PSR and its consequences, the integration of these new risks into public and managerial policies is still very modest.Through an economic, institutional and empirical analysis, the main objective of this thesis is to contribute to a better knowledge of the consequences of PSR’ exposure for individual and for company, and to analyze the role of prevention authorities to reduce the perceived levels of PSR and preserving the workers’ health. The empirical analyzes carried out reveal that workers' exposure to PSR leads to a degradation of their mental health, more sick leave and presenteeism at work. It therefore seems necessary to put in place prevention measures to limit these harmful consequences. An institutional and economic analysis of the French prevention framework establishes the important role of the Health, Safety and Working Conditions Committee (CHSCT) in spite of the limited means of action available.

A lombalgia mecânica comum (LMC) representa um problema particularmente importante no ambiente ocupacional, muitas vezes associado a incapacidade, afastamento do trabalho e alto custo socioeconômico. O surgimento da neuroimagem funcional permitiu novos conhecimentos sobre a estrutura cerebral e a fisiologia da dor crônica. Embora os aspectos relacionados ao trabalho sejam importantes fatores de risco para a cronicidade, existem poucos estudos que abordam especificamente a fisiopatologia da LMC em indivíduos afastados do trabalho. A esse respeito, questionamos se um fator como a atenção, conhecida como um importante modulador da dor, poderia desempenhar um papel distintivo na modulação da dor nos indivíduos com LMC afastados do trabalho. Objetivos: comparar os correlatos neuronais entre indivíduos com lombalgia mecânica comum com afastamento do trabalho, com indivíduos lombálgicos sem afastamento. Métodos: Foram selecionados 74 indivíduos com LMC crônica, divididos em três grupos: indivíduos com LMC e afastamento do trabalho (LMC/A); indivíduos com LMC sem afastamento do trabalho (LMC) e indivíduos sem qualquer tipo de dor crônica e sem afastamento do trabalho (Controle). O estudo foi realizado no Hospital Israelita Albert Einstein (HIAE). A ressonância magnética funcional (RMf) foi utilizada durante o desempenho de dois paradigmas (dor e atenção). Resultados: Após a estimulação dolorosa, na comparação entre os grupos, verificamos diferença significativa na condição estimulação > repouso, sendo que o contraste LMC > LMC/A mostrou maior resposta hemodinâmica (efeito BOLD) no córtex cingulado anterior e giro frontal superior e médio direito (p < 0,001). No contraste controles > LMC/A, o grupo controle apresentou maior efeito BOLD em região do polo frontal e paracingulado (p = 0,002). Conclusão: Nosso estudo corrobora o conceito de que a presença de dor crônica está associada a uma alteração na plasticidade neuronal em áreas cerebrais que se estendem além das regiões somatossensoriais, para incluir áreas que processam emoções / Chronic low back pain (CLBP) is a particularly important problem in the occupational environment, often associated with incapacity, sick leave and high socioeconomic cost. The emergence of functional neuroimaging allowed new insights into the brain structure and physiology of chronic pain. Although work-related aspects are important risk factors for chronicity, there are few studies that specifically address the pathophysiology of CLBP in individuals with sick leave. In this regard, we questioned whether a factor such as the attention known as an important pain modulator could play a distinctive role in modulating pain in individuals with CLBP with sick leave. Objective The overall objective of this study is to compare the neuronal correlates between groups of individuals CLBP with or without sick leave. Methods We selected 74 individuals, divided into three groups: individuals with CLBP, functional incapacity and sick leave (CLBP_L); individuals with CLBP, functional disability without sick leave (CLBP_NL); individuals without any form of chronic pain and without sick leave (Control). Functional magnetic resonance imaging (fMRI) was used during the performance of two paradigms (pain and attention).Results After painful stimulation, a significant difference was observed in the stimulation > rest condition, while the CLBP > CLBP_L contrast showed a higher hemodynamic response in the anterior cingulate cortex and the right medium /superior frontal gyrus (p < 0.001) and in contrast controls > CLBP_L, the control group presented higher hemodynamic response in the frontal pole and paracingulate region (p = 0.002).Conclusions Our study corroborates the idea that the presence of chronic pain is associated with an alteration in neuronal plasticity involving brain areas linked to emotions and not just somatosensory areas