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As HR leaders work to keep remote employees healthy and engaged during the COVID-19 crisis, chronic back pain and mental health are two areas in particular where teams will need support.

Reduced access to exercise and physical therapy, combined with poor ergonomic setups on couches and at kitchen tables, may make matters worse for the 80% of people who experience back pain and millions of people living with mental health issues like anxiety and depression. That's because pain can worsen mental health symptoms, and vice versa. The two are closely linked: Chronic pain and depression occur together up to 50% of the time.

Even under normal circumstances, these conditions make it much more difficult to focus while working. Mental health and back pain are the two top contributors to presenteeism – when employees have clocked in, but are mentally checked out.

HR teams can support employees by offering accessible, reliable resources and wellness benefits. With the right support, remote employees coping with pain and mental health challenges can stay healthy and focused, and maintain a sense of normalcy during these challenging times.

Tip 1: Pass along resources on psychologically informed pain management skills that can help at home.

With social distancing restrictions in place, many people are avoiding going to the doctor or physical therapist for non-emergency care. That means employees need advice that they can use at home.

Lauren Szu-Tu, RN, MSN, certified health coach and manager of clinical services at Fern Health has some guidance for HR teams to share with employees on relaxation techniques and pain management. She's trained in pain neuroscience education, a method of educating patients about how pain works in the brain to help them to change their perception of pain.

She suggests sharing these relaxation techniques and pieces of advice with teams to support mental health, particularly for those living with chronic pain:

Watch out for catastrophizing. Anxiety can create unhelpful thought patterns in the brain related to pain. Catastrophizing, or imagining the worst, is one common pattern that research shows can lead to worse outcomes.

"Expecting pain to be terrible or to never go away can actually make your pain feel worse," says Szu-Tu. "If you believe that your pain can improve, your pain can go down and you can learn to do your normal activities without fear. It may take some time, but thought-work is really worth it."

To help, start by noticing situations that trigger negative thoughts. For example, sitting for a long period of time and feeling pain may lead you to think, "I'll never feel better." Try replacing negative thoughts with positive thoughts. For example, try thinking:

Stretching will help me feel better.
Taking a short walk will help me feel better.
This is temporary.

Notice if you're focusing completely on your pain. Hypervigilance is another common, anxious thought pattern related to pain. Especially when you're spending so much time at home and may not have as many distractions as usual, it can be hard to focus on something other than pain.

Research shows that focusing on pain can exacerbate how bad it feels. When an area of the brain becomes more preoccupied, it also becomes more sensitive. With time, heightened anticipation of pain can make even low-intensity sensations, such as being brushed against, feel painful. The mindfulness exercises, below, can help.

Try mindfulness breathing exercises. When we feel stressed or anxious, many of us tend to hunch up our shoulders or tense our back muscles. This is the body's way of preparing to escape – a response that probably was helpful in our caveman days. In the modern world, these stress responses can contribute to shoulder, neck, and back pain. Mindfulness exercises can help relax the muscles, reduce stress, and take your mind off your pain.

To start, find a comfortable place to sit, and set a timer for five minutes. Focus on your breathing: Take a deep breath in, pause, and exhale. Mentally count "one." Repeat your breath, and mentally count "two" and so on until you get to ten. Then, start over. If you lose focus, that's okay. Just direct your attention back to your breath. It's natural for thoughts to come up, too. Try to think of them as clouds passing over, then return to your breath.

Here's another simple breathing exercise that can help relax both your mind and muscles: Inhale for a count of four, and exhale for a count of six. While we often associate deep breathing with relaxation, inhaling breath is actually another way for the body to prepare to escape. Focusing on a longer exhale can be more relaxing.

Keep moving. For many employees, working from home means moving a lot less. But finding ways to fit aerobic exercise and stretching into your day can help with both pain and anxiety, research shows. Take advantage of your work-from-home arrangement but taking a short break to stretch out in a few simple yoga poses. A daily walk in the evening – while following the COVID-prevention rule of keeping six feet away from people you don't live with, of course – can make a difference, too. A healthy increase in your heart rate can stimulate the release of the body's natural chemicals that can help reduce stress.

Improve your sleep hygiene. Stress, anxiety, and pain symptoms can all interrupt a good night's sleep. More than twice as many people with chronic pain report that sleep problems interfere with their work, compared with those without pain.

During these challenging times, try adding a few healthy sleep habits to your routine to help improve your shut-eye. You don't have to try them all at once – just a pick a few to start with:

Turn electronics off 1 hour before bed.
Stick to a regular bedtime, even on weekends.
Turn down your thermostat at night, and make sure your bedroom is dark.
If anxious thoughts have been keeping you up, write down your worries in a notebook before bed.
Avoid caffeine at least 6 hours before bedtime
Avoid alcohol near bedtime – alcohol disturbs sleep.

Tip 2: Consider how wellness benefits can help

HR leaders can also take an active role in supporting employees with back pain and anxiety by offering a wellness benefit that can help from home.

When evaluating vendors, ensure that the program:

Addresses the psychological aspect of pain. Research shows that a psychologically-informed approach to back pain management is more effective than exercise therapy alone. Includes outside support. Health care is personal, and it's natural for people to feel leery about a treatment program that's purely digital. Look for solutions that include support from a real person, whether over the phone or through online messaging.
Focuses on personal goals. Participants are more likely to stick with a program if the goals they set resonate with them. Find a program that focuses not just on muscle strength or endurance, but on personal goals like being able to socialize more, or feel more focused at work.
Can easily be done from home. Avoid physical therapy programs that require some exercises to be completed outside or at a gym. Employees should be able to complete the program completely from home.

Tip 3: Share guidance on setting up an ergonomic workspace at home.

Your physical environment can also impact your mental health. Poor ergonomics in non-ideal setups can exacerbate pain symptoms, and increased pain can worsen stress, anxiety, and feelings of depression. One simple way to help remote employees reduce back pain is to offer ergonomic tips on how to improve their home workspace.

HR teams can share these tips to help employees set up workspaces that are both safe and comfortable. When setting up for the workday, employees can follow this checklist for better ergonomics:

Align your elbows and wrists, with your elbows bent at 90 degrees. If you're sitting on the couch and need to raise your computer, try putting a pillow in your lap.
Keep your back straight. Sit in a straight line starting from your lower back, up through the top of your head. Relax your shoulders down your back. Make sure your pelvis isn't rotating forward – this creates a curve in your lower back.
Support your lower back. If you're slouching on the couch, try arranging pillows behind your lower back for added support. You can do the same in a chair by rolling up a towel and placing it behind your lower back.
Position the top of your computer screen at eye level. Stack your laptop on top of a heavy book to raise it up at the table, or put a pillow in your lap on the couch.
Create your own standing desk. Get a small change of scenery and try working from a different room. Stand up at your kitchen counter or a high dresser to create your own "standing desk" and stretch out your back.

Pain symptoms, especially when they're worsened by stress and anxiety, can make it even more difficult to focus in a challenging environment. Helpful advice and wellness resources can go a long way toward creating a sense of safety and normalcy for remote workers, especially those living with pain and mental health conditions.

Nancy Ryerson is a health care writer with a passion for employee benefits and engagement. She is senior marketing manager at Fern Health, a digital health company that provides virtual musculoskeletal pain programs to employers.

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Stress, anxiety and chronic back pain: 3 ways employers can help

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