UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Occupational low back pain: Evaluation

Author
Michael Erdil, MD, FACOEM
Section Editor
Steven J Atlas, MD, MPH
Deputy Editor
Lee Park, MD, MPH

INTRODUCTION

Back pain in working individuals is a common presenting complaint in primary care settings. Many occupations have been anecdotally linked to certain musculoskeletal disorders, such as "policeman's heel" or "deliveryman's back." For some pain disorders, such as carpal tunnel syndrome, the relationship of the condition to specific patterns of work is better established [1]. For other disorders, however, the relationship between the work environment and the patient's symptoms, though clearly perceived by the patient to be causative, may be less certain.

Determining whether a patient's low back pain is a consequence of his or her occupational activity, and how best to treat symptoms to maximize functionality and potential for a return to full employment capacity, can be challenging. Many physicians, including those practicing in primary care settings where back pain is most often seen, lack training and confidence in addressing workplace issues.

This topic will address evaluation of work-related low back pain. Treatment of work-related low back pain is discussed separately. (See "Occupational low back pain: Treatment".) The evaluation of low back pain in the general setting is also discussed separately. (See "Evaluation of low back pain in adults".)

THE INJURY MODEL

The injury model of an occupational disorder proposes that specific work activities are the cause of the patient's pain. The injury model for low back pain, implicating a causal connection with specific work activities, is complex and controversial [2-4]. Multiple factors and lines of evidence challenge this model, including:

Low back pain is a ubiquitous complaint, with particularly high prevalence among people in their working years [5,6].

               

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Nov 2016. | This topic last updated: Thu Mar 07 00:00:00 GMT 2013.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
References
Top
  1. Palmer KT, Harris EC, Coggon D. Carpal tunnel syndrome and its relation to occupation: a systematic literature review. Occup Med (Lond) 2007; 57:57.
  2. Melhorn JM, Ackerman WE. uides to the Evaluation of Disease and Injury Causation, American Medical Association, Chicago 2008.
  3. Panel on Musculoskeletal Disorders and the Workplace, Commission on Behavioral and Social Sciences and Education, National Research Council. Musculoskeletal Disorders and the Workplace: Low Back and Upper Extremities. National Academy Press, Washington, DC 2001. Available at: http://www.nap.edu/catalog.php?record_id=10032 (Accessed on November 30, 2011).
  4. UK Industrial Injuries Advisory Council. Position Paper 18. Back and Neck Pain, 2007. Available at: www.iiac.org.uk/pdf/reports/IIAC_Pospaper.pdf (Accessed on February 20, 2008).
  5. Speed C. Low back pain. BMJ 2004; 328:1119.
  6. Koes BW, van Tulder MW, Thomas S. Diagnosis and treatment of low back pain. BMJ 2006; 332:1430.
  7. Airaksinen O, Brox JI, Cedraschi C, et al. Chapter 4. European guidelines for the management of chronic nonspecific low back pain. Eur Spine J 2006; 15 Suppl 2:S192.
  8. Waddell G. The Back Pain Revolution, 2nd ed, Churchill Livingstone, New York 2004.
  9. Andersson GB. Epidemiological features of chronic low-back pain. Lancet 1999; 354:581.
  10. Pengel LH, Herbert RD, Maher CG, Refshauge KM. Acute low back pain: systematic review of its prognosis. BMJ 2003; 327:323.
  11. Frank JW, Brooker AS, DeMaio SE, et al. Disability resulting from occupational low back pain. Part II: What do we know about secondary prevention? A review of the scientific evidence on prevention after disability begins. Spine (Phila Pa 1976) 1996; 21:2918.
  12. Love T, Crampton P, Salmond C, Dowell A. Patterns of medical practice variation: variability in referral for back pain by New Zealand general practitioners. N Z Med J 2005; 118:U1381.
  13. Loisel P, Abenhaim L, Durand P, et al. A population-based, randomized clinical trial on back pain management. Spine (Phila Pa 1976) 1997; 22:2911.
  14. Shaw WS, Robertson MM, McLellan RK, et al. A controlled case study of supervisor training to optimize response to injury in the food processing industry. Work 2006; 26:107.
  15. Anema JR, Steenstra IA, Bongers PM, et al. Multidisciplinary rehabilitation for subacute low back pain: graded activity or workplace intervention or both? A randomized controlled trial. Spine (Phila Pa 1976) 2007; 32:291.
  16. Williams CA. An international comparison of workers' compensation (Huebner international series on risk, insurance, and economic security), Springer, Boston 1991.
  17. International Labour Office (ILO). Workers Compensation Systems. Encyclopaedia of Occupational Health and Safety. Available at: www.ilocis.org (Accessed on August 30, 2008).
  18. LaDou J, Rodriguez-Guzman J. Worker's Compensation. In: Occupational & Environmental Medicine, LaDou J (Ed), McGraw-Hill Medical, New York 2006.
  19. Hussey S, Hoddinott P, Wilson P, et al. Sickness certification system in the United Kingdom: qualitative study of views of general practitioners in Scotland. BMJ 2004; 328:88.
  20. Russell G, Brown JB, Stewart M. Managing injured workers: family physicians' experiences. Can Fam Physician 2005; 51:78.
  21. Shaw W, Hong QN, Pransky G, Loisel P. A literature review describing the role of return-to-work coordinators in trial programs and interventions designed to prevent workplace disability. J Occup Rehabil 2008; 18:2.
  22. Gourlay DL, Heit HA, Almahrezi A. Universal precautions in pain medicine: a rational approach to the treatment of chronic pain. Pain Med 2005; 6:107.
  23. Dworkin RH, Turk DC, Wyrwich KW, et al. Interpreting the clinical importance of treatment outcomes in chronic pain clinical trials: IMMPACT recommendations. J Pain 2008; 9:105.
  24. Glass LS, Harris JS, Blais BR, et al. Occupational Medicine Practice Guidelines: Evaluation and Management of Common Health Problems and Functional Recovery of Workers, 2nd ed, OEM Press, Beverly Farms, MA 2003.
  25. Stanos SP, McLean J, Rader L. Physical medicine rehabilitation approach to pain. Med Clin North Am 2007; 91:57.
  26. Vingård E, Alfredsson L, Hagberg M, et al. To what extent do current and past physical and psychosocial occupational factors explain care-seeking for low back pain in a working population? Results from the Musculoskeletal Intervention Center-Norrtälje Study. Spine (Phila Pa 1976) 2000; 25:493.
  27. Shaw WS, Pransky G, Patterson W, Winters T. Early disability risk factors for low back pain assessed at outpatient occupational health clinics. Spine (Phila Pa 1976) 2005; 30:572.
  28. Krause N, Dasinger LK, Deegan LJ, et al. Psychosocial job factors and return-to-work after compensated low back injury: a disability phase-specific analysis. Am J Ind Med 2001; 40:374.
  29. Mielenz TJ, Garrett JM, Carey TS. Association of psychosocial work characteristics with low back pain outcomes. Spine (Phila Pa 1976) 2008; 33:1270.
  30. Chou R, Shekelle P. Will this patient develop persistent disabling low back pain? JAMA 2010; 303:1295.
  31. Costa-Black KM, Loisel P, Anema JR, Pransky G. Back pain and work. Best Pract Res Clin Rheumatol 2010; 24:227.
  32. Corporation, NZAC New Zealand Acute Low Back Pain Guide, incorporating the Guide to Assessing Psychosocial Yellow Flags in Acute Low Back Pain. Available at www.acc.co.nz/PRD_EXT_CSMP/groups/external_ip/documents/internet/wcm002131.pdf. (Cited 2008 August 30, 2008).
  33. Institute for Clinical Systems Improvement Guideline for Adult Low Back Pain (rev 2006). Available at www.icsi.org/low_back_pain/adult_low_back_pain_8.html. (Accessed February 20, 2008).
  34. Chou R, Qaseem A, Snow V, et al. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med 2007; 147:478.
  35. Kendall, NAS, Linton, SJ, Main, CJ. Guide to Assessing Psychosocial Yellow Flags in Acute Low Back Pain: Risk Factors for Long Term Disability and Workloss. Accident and Rehabilitation and Compensation Insurance Corporation of New Zealand and the National Health Committee. New Zealand 1997.
  36. Abásolo L, Blanco M, Bachiller J, et al. A health system program to reduce work disability related to musculoskeletal disorders. Ann Intern Med 2005; 143:404.
  37. Shaw WS, Linton SJ, Pransky G. Reducing sickness absence from work due to low back pain: how well do intervention strategies match modifiable risk factors? J Occup Rehabil 2006; 16:591.
  38. Turner JA, Franklin G, Fulton-Kehoe D, et al. Worker recovery expectations and fear-avoidance predict work disability in a population-based workers' compensation back pain sample. Spine (Phila Pa 1976) 2006; 31:682.
  39. Dionne CE, Dunn KM, Croft PR, et al. A consensus approach toward the standardization of back pain definitions for use in prevalence studies. Spine (Phila Pa 1976) 2008; 33:95.
  40. Bombardier C. Outcome assessments in the evaluation of treatment of spinal disorders: summary and general recommendations. Spine (Phila Pa 1976) 2000; 25:3100.
  41. Cone, J, LaDou, J. Chapter 2 The Occupational Medical History. In: Current Occupational & Environmental Medicine, 4th ed, LaDou, J, McGraw-Hill Medical, New York 2006.
  42. Rom, WN, Markowitz, S. Environmental and Occupational Medicine, 4th ed, Lippincott Williams & Wilkins, Philadelphia, PA 2006.
  43. Rosenstock, L, Cullen, M, Brodkin, C, Redlich, C. Textbook of Clinical Occupational and Environmental Medicine, 2nd ed, Saunders, Philadelphia, PA, London 2004.
  44. Agency for Toxic Substances and Disease Registry. Case studies in environmental medicine, Taking an Exposure History. Available at www.atsdr.cdc.gov/csem/exphistory/ehcover_page.html. (Accessed February 20, 2008).
  45. Lurie JD. What diagnostic tests are useful for low back pain? Best Pract Res Clin Rheumatol 2005; 19:557.
  46. Waddell G, McCulloch JA, Kummel E, Venner RM. Nonorganic physical signs in low-back pain. Spine (Phila Pa 1976) 1980; 5:117.
  47. Armstrong, T. Chapter 3e Workplace Adaptation. In: Musculoskeletal Disorders in the Workplace: Principles and Practice, 2nd ed, Nordin, M, Pope, MH, Andersson, G (Eds), Philadelphia, Mosby Elsevier 2007.