Back Pain in the Workplace

Low back pain is a very expensive problem; the cost in the U.S. per year is estimated to be $50 billion. Furthermore, low back pain (LBP) in the clinical setting is a complex problem—some patients get well quickly, while some develop chronic disability.

The medical literature has recently seen a large number of studies that address the complexities of LBP, and the following are a few of the most pertinent.

The Comfortable Workplace
This editorial¹ sums up the problem of back pain in our society: “In spite of 50 years of concerted effort to diminish task demand, the incidence of compensable back injuries has not wavered.”

The author continues by showing that the relationship between LBP and work demand may not be the most important factor in the etiology of back pain: “…biomechanical factors account for so little of the prevalence, let alone incidence, of compensable back ‘injuries’ that their influence can not even be discerned in most studies.”

This editorial offers a new direction in the prevention of back pain—one that acknowledges that the workplace social environment may play a larger role than workplace physical demands:

“The solution to the conundrum of backache in the workplace is straightforward. There must be a national mandate to provide workplaces that are comfortable when we are well and accommodating when we are ill. Comfortable means that no individual should be expected to perform any task against his or her will, including any physical task that seems to the worker to be more demanding than the worker is comfortable meeting at that time. Assistive devices, mutual assistance, and mutual understanding should be at hand. Management must be valued for valuing the human resource that is the worker. Medicine must learn or relearn its place as wise counsel. Any physician who sits in judgment of a worker with a back ‘injury’ is no longer behaving as a physician. Ergonomics must turn from the quest to prevent back ‘injuries’ to the quest for enhancing the ability of a person with a backache to cope. All of us must cry out for empathy whenever another human being is having difficulty maintaining self-respect in a work setting that values the worker so little that even a backache is not accommodated.”

Predicting Back Pain Recurrence
In this study², researchers surveyed a group of 1,412 adults who were currently employed and who were free from current back pain. The survey measured social class, levels of stress, and psychosocial factors (e.g., finances, job satisfaction, work relationships). These subjects were then monitored for new cases of back pain during the following 12 months.

At the baseline evaluation, issues such as “perceived inadequacy of income,” job dissatisfaction, and lower social class were modestly related to a history of back pain. At one year follow-up, however, these issues were very important in determining new cases of back pain. In fact, those subjects who perceived their income as being too low were 3.6 times more likely to have a new case of back pain. Those subjects in the lowest social classes were 4.8 times more likely to have a new case of back pain. “The associations with work dissatisfaction and perceived adequacy of income were not explained by general psychologic distress or social status.”

The authors conclude:

“These results show that the attitude of employees toward their work influences both the reporting of new LBP episodes and consulting behavior. This could be a specific reflection of the more general associations between psychologic factors and somatic symptoms, including musculoskeletal pain. Most people who experience LBP cope with this symptom without turning to the primary care practitioner. However, when this occurs, it is important that the health professional recognize such psychosocial factors as important influences contributing to the occurrence of new episodes of pain in the low back region.”

Predicting Delayed Return to Work
This study³ examined 162 workers who reported an episode of lost-work back pain; all subjects were evaluated within one week of their injury for a variety of physical, social, and psychological measures. The object of the study was to determine what factors were useful at predicting long-term disability.

“The results of this study indicate that abnormal heel-walk, perceptions of disability and vibration on the job are predictors of delayed return to work within a week of onset of nonspecific low back pain…”

“Perception of functional disability was a strong predictor of subsequent work days lost. Some non-physical factors that may affect these perceptions include erroneous beliefs about functional limitations when suffering from low back pain, psychological distress resulting in a general ‘negative affectivity’ of response, and fear of movement.”

“Any and all of these factors may be alleviated by clear and accurate information about the favorable course of low back pain and recommendations for the early care provided at the first encounter with a patient.”

1. Hadler NM. Back pain in the workplace: what you lift or how you lift matters far less than whether you lift or when. Spine 1997;22(9):935-940.
2. Papageorgiou AC, Macfarlane GJ, Thomas E, et al. Psychosocial factors in the workplace—Do they predict new episodes of low back pain? Spine 1997;22(9):1137-1142.
3. Nordin M, Skovron ML, Hiebert R, et al. Early predictors of delayed return to work in patients with low back pain. Journal of Musculoskeletal Pain 1997;5(2):5-23.

 

 

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