When pain changes how construction workers cope

A sore knee after years of kneeling. A shoulder aches after lifting materials all day, and back pain that you can’t seem to shake.

For many construction workers, pain can feel like it’s a part of the job. Construction is physically demanding, with repeated lifting, bending, kneeling, climbing, and other strenuous activities that can put significant stress on the body.

But pain doesn’t always remain a physical problem. When an injury or musculoskeletal symptoms persist, pain can affect sleep, mood, job-site performance, and overall quality of life. For some workers, it can influence how they cope with stress and pain, including whether they turn to medication or other substances.

The physical toll of construction work

Musculoskeletal symptoms are among the most common health concerns reported by construction workers.

Research has identified musculoskeletal symptoms across multiple areas of the body among construction workers, including the knee, shoulder, wrist, neck, ankle and foot, elbow, back, and hip or thigh.

Reported symptom rates include:

• Knee: 37.2%
• Shoulder: 32.4%
• Wrist: 30.4%
• Neck: 24.4%
• Ankle/foot: 24.0%
• Elbow: 20.3%
• Upper back: 19.8%
• Hip/thigh: 15.1%
• Lower back: 1.1%

It’s important to distinguish musculoskeletal symptoms from chronic pain. Not every ache, injury, or episode of musculoskeletal pain becomes chronic. Some symptoms resolve as the body heals. Others may recur or persist, particularly when workers experience repeated injuries or ongoing physical strain.

When pain becomes more than a physical concern

A construction injury doesn’t always end when the physical injury heals. For some workers, pain can continue or return over time.

That persistent pain can affect much more than the injured body part.

Acute pain vs. chronic pain

Everyone experiences pain at some point. Acute pain typically comes on suddenly and is often connected to a specific event, such as an injury, surgery, or short-term illness. It generally improves as the underlying condition heals.

Chronic pain lasts longer, typically more than three months, and can continue even after the original injury or condition has healed. The CDC’s Clinical Practice Guideline for Prescribing Opioids for Pain defines chronic pain as pain lasting longer than three months. It recognizes its potential effects on physical functioning, mental health, and quality of life.

For construction workers, recurring pain can be especially challenging when physical strength and mobility are essential to doing the job.

Why behavioral health belongs in the pain conversation

Pain and behavioral health are not separate issues. For some workers, they can become closely connected.

A worker experiencing persistent pain may also be dealing with poor sleep, anxiety about missing work, financial pressure, depression, or concerns about being able to continue doing a physically demanding job. These challenges can influence how someone manages pain and copes with stress.

How persistent pain can affect mental health

Pain doesn’t stay in one part of the body. When it becomes persistent, it can affect how a person sleeps, works, interacts with others, and manages everyday stress.

For a construction worker, those effects can have very real consequences. Pain may make it harder to get a good night’s sleep, keep up physically on the job, spend time with family, or enjoy activities outside of work.

There can also be pressure to keep working despite the pain. An injury may mean missed hours, lost income, concerns about job security, or worries about supporting a family. Those pressures can add emotional stress to an already difficult physical situation.

The National Institute of Neurological Disorders and Stroke (NINDS) notes that chronic pain can affect physical and emotional well-being and can occur alongside mental health and sleep problems.

The connection between pain and depression

The relationship between chronic pain and depression can go both ways. Research has found a significant overlap between the two conditions, with one review estimating that 30% to 45% of people with chronic pain also experience depression. The review also describes a bidirectional relationship: depression can increase vulnerability to chronic pain, while chronic pain can increase the risk of depression.

This doesn’t mean that experiencing chronic pain automatically causes depression. Instead, it highlights why mental health can be an important part of understanding and treating persistent pain.

When pain changes how workers cope

Pain management isn’t always limited to medical treatment. People may develop their own strategies to get through a painful day.

Some coping strategies may be helpful, while others can create additional health risks over time.

Prescription opioids and pain management

Prescription opioids can play an important role in treating certain types of acute pain. At the same time, opioid exposure carries risks, particularly when use continues or becomes difficult to control.

Research has found a strong connection between musculoskeletal conditions and prescription opioid use among construction workers. One study found that construction workers with musculoskeletal symptoms were approximately three times as likely to use prescription opioids as those without these conditions.

These findings highlight the importance of comprehensive pain management, early treatment of injuries, and access to appropriate medical and behavioral health support.

Other substances workers may use to manage pain

Prescription opioids aren’t the only substances some construction workers report using when pain becomes difficult to manage.

Emerging research among construction workers has identified alcohol, cannabis, and kratom among the substances workers report using as pain-management strategies. A recent study of construction workers examined a range of approaches workers use to manage pain, including traditional treatments and substances.

These findings are important to understand through a behavioral health lens. What begins as an attempt to cope can become problematic when substance use starts affecting health, relationships, work, or daily functioning.

A healthier approach to pain and recovery

Supporting construction workers means looking at the whole person, not just the injury, prescription, or substance.

By combining injury prevention with behavioral health education, early intervention, and access to appropriate resources, employers can help create a workplace where asking for help is seen as a strength.

Rosecrance Resilience offers one pathway for construction organizations that want to make behavioral health part of a healthier, more resilient workforce.