Physician prescribes work as relief for low back pain

Low back pain is the most common cause of job-related injuries and accounts for the majority of workers' comp claims and costs. But the vast majority of cases are benign and will get better regardless of the treatment provided.

By approaching low back pain as a condition rather than an injury, the workers' comp system could save unnecessary aggravation for workers and employers, as well as untold thousands of dollars. An approach using evidence-based medicine, proactive measures from employers and an active recovery role by employees may be the answer.

"We follow a biopsychosocial model," said Dr. John Anderson, senior vice president of medical operations for Concentra Health Services. "The approach is a combination of sports medicine as well as taking into consideration the psychosocial influences that might affect the outcome."

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Sports medicine approach. Traditional medicine typically suggests aggressive, invasive and costly treatment with only marginal outcomes. "The patient will be evaluated and told to go home, rest and follow up with his doctor," Anderson said "They go home, lie down on the couch, take meds, and watch TV -- further deconditioning themselves and detaching themselves from their social support structures."

Sports medicine takes a completely different approach. "The intervention is timely, the advice is encouraging and supportive -- to return to normal activities as soon as possible," Anderson said. "We try to get them to stay at work in some capacity that will be manageable for them."

Influencing factors. Part of that process involves identifying and addressing the psychosocial factors. "As a physician we need to be aware of those issues influencing a patient's willingness and ability to return to work," Anderson said. "The doctor must be astute enough to pick up on cues, sometimes from the patient or his supervisor. It's a team of people that have to get these patients back on the road to recovery."

Work site assessments should be included with questions about the employee's satisfaction with his job, supervisor, type of work, shift, and potential downsizing. There may also be personal issues.

"It doesn't have to be negative," he said. "It can be good things causing them to reevaluate their ability to go to work. A multitude of factors -- some that have nothing to do with the workplace and many that do -- could influence their mind-set."

Armed with the psychosocial information and using the sports medicine approach, Anderson said the next step is setting up the injured worker with appropriate treatment that often includes physical therapy.

"We make every effort to get patients into programs designed specifically for them to retain their level of conditioning and retain and improve their mobility and range of motion with appropriate exercises to reduce the spasms or irritability they have," he said. "Therapists spend a great deal of time educating these patients and reinforcing that the condition is benign; they may have some discomfort, but they're not worsening their progress."

It's important for patients with low back pain to understand that while their pain is real, it is not life threatening or a harbinger of long-term disability or chronic pain. The therapists progressively increase the physical capacity of the injured worker with the goal of getting them back to preinjury status.

The concept is based on a team approach. In addition to the injured worker, the therapists work with physicians and employers.

"They ask, 'What are their functional demands? How far do they have to walk? How many pounds must they lift?'" he said. "When we know that it's easier to get them back to that level and they can get back to the job without the risk of reinjuring themselves."

Read more at the WorkersComp Forum homepage.

November 22, 2010

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