Occupational low back pain: Treatment
- Michael Erdil, MD, FACOEM
Michael Erdil, MD, FACOEM
- Assistant Clinical Professor of Medicine
- Division of Occupational Medicine
- University of Connecticut School of Medicine
Back pain is a common presenting complaint in primary care, and frequently affects individuals in their working years .
Treatment for low back pain primarily focuses on relieving pain and improving function. A common assumption has been that a medical intervention that improves pain and function will facilitate return to work and prevent disability. However, considerable evidence demonstrates that effective treatments for pain and function are not necessarily associated with favorable work and disability outcomes . As a result, multiple treatments have been developed with the specific intent to improve work return, productivity, and satisfaction, and minimize disability.
This discussion focuses on treatment aspects unique to patients with occupational low back pain. The evaluation of patients for occupational low back pain is discussed separately (see "Occupational low back pain: Evaluation"). Treatment for acute, subacute, and chronic nonspecific low back pain is also presented separately. (See "Treatment of acute low back pain" and "Subacute and chronic low back pain: Nonsurgical interventional treatment" and "Subacute and chronic low back pain: Pharmacologic and noninterventional treatment" and "Subacute and chronic low back pain: Surgical treatment".)
ROLE OF PRIMARY CARE
Treatments that focus on work-related low back pain often are designed for implementation by clinicians who specialize in back conditions or occupational health. This does not imply that the primary care physician's only responsibility is to refer a patient for appropriate evaluation and treatment.
Frequently, the primary care physician does not have resource information about specific occupational programs. Inquiring about workplace interventions and programs through the patient's disability insurer may be helpful.
- Hart LG, Deyo RA, Cherkin DC. Physician office visits for low back pain. Frequency, clinical evaluation, and treatment patterns from a U.S. national survey. Spine (Phila Pa 1976) 1995; 20:11.
- Pransky G, Shaw W. Return to work-from research to practice. J Occup Environ Med 2007; 49:249.
- 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.
- Russell G, Brown JB, Stewart M. Managing injured workers: family physicians' experiences. Can Fam Physician 2005; 51:78.
- 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.
- Costa-Black KM, Loisel P, Anema JR, Pransky G. Back pain and work. Best Pract Res Clin Rheumatol 2010; 24:227.
- Palmer KT, Cox RA, Brown I. Fitness for Work: The Medical Aspects, 4th ed, Oxford University Press, New York 2007.
- Webster BS, Verma SK, Gatchel RJ. Relationship between early opioid prescribing for acute occupational low back pain and disability duration, medical costs, subsequent surgery and late opioid use. Spine (Phila Pa 1976) 2007; 32:2127.
- AMA Council on Scientfic Affairs. Physician Guidelines for Return to Work after Injury or Illness - Report 12 (A-04) 2004. Available at: www.ama-assn.org/ama/pub/category/13609.html (Accessed on August 30, 2008).
- The physician's role in helping patients return to work after an illness or injury. Canadian Medical Association. CMAJ 1997; 156:680A.
- Du Bois M, Donceel P. Guiding low back claimants to work: a randomized controlled trial. Spine (Phila Pa 1976) 2012; 37:1425.
- Colledge A, Holmes E, Pack R, et al. Management of Occupational Low Back Injuries. In: Low Back Syndromes: Integrated Clinical Management, Morris CE (Ed), McGraw-Hill Medical, New York 2005.
- Schultz IZ, Stowell AW, Feuerstein M, Gatchel RJ. Models of return to work for musculoskeletal disorders. J Occup Rehabil 2007; 17:327.
- Waddell G. The Scientific and Conceptual Basis of Incapacity Benefits, The Stationary Office, London 2005.
- Hall H, McIntosh G, Melles T, et al. Effect of discharge recommendations on outcome. Spine (Phila Pa 1976) 1994; 19:2033.
- Staal JB, Hlobil H, Twisk JW, et al. Graded activity for low back pain in occupational health care: a randomized, controlled trial. Ann Intern Med 2004; 140:77.
- Garcy P, Mayer T, Gatchel RJ. Recurrent or new injury outcomes after return to work in chronic disabling spinal disorders. Tertiary prevention efficacy of functional restoration treatment. Spine (Phila Pa 1976) 1996; 21:952.
- Waters TR, Baron SL, Piacitelli LA, et al. Evaluation of the revised NIOSH lifting equation. A cross-sectional epidemiologic study. Spine (Phila Pa 1976) 1999; 24:386.
- Holmström EB, Lindell J, Moritz U. Low back and neck/shoulder pain in construction workers: occupational workload and psychosocial risk factors. Part 1: Relationship to low back pain. Spine (Phila Pa 1976) 1992; 17:663.
- Hiebert R, Skovron ML, Nordin M, Crane M. Work restrictions and outcome of nonspecific low back pain. Spine (Phila Pa 1976) 2003; 28:722.
- Gross DP, Battié MC. Functional capacity evaluation performance does not predict sustained return to work in claimants with chronic back pain. J Occup Rehabil 2005; 15:285.
- 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).
- Bernard BP, Putz-Anderson V, National Institute for Occupational Safety and Health. Musculoskeletal Disorders and Workplace Factors: A Critical Review of Epidemiologic Evidence for Work-Related Musculoskeletal Disorders of the Neck, Upper Extremity, and Low Back. National Technical Information Service distributor; US Department of Health and Human Services, 1997.
- Wedderkopp N, Leboeuf-Yde C. Preventing back pain. BMJ 2008; 336:398.
- Coggon D. Occupational medicine at a turning point. Occup Environ Med 2005; 62:281.
- Talmage JB, Melhorn JM. A Physician's Guide to Return to Work, AMA Press, Chicago 2005.
- Slovic P. The Perception of Risk, Earthscan Ltd, London 2000.
- Nguyen TH, Randolph DC. Nonspecific low back pain and return to work. Am Fam Physician 2007; 76:1497.
- What is ergonomics? Available at: www.cdc.gov/od/ohs/Ergonomics/ergodef.htm (Accessed on August 31, 2008).
- Chou R, Shekelle P. Will this patient develop persistent disabling low back pain? JAMA 2010; 303:1295.
- Waddell G. The Back Pain Revolution, Churchill Livingston, Edinburgh 2004.
- Linton SJ, van Tulder MW. Preventive interventions for back and neck pain problems: what is the evidence? Spine (Phila Pa 1976) 2001; 26:778.
- Hignett S. Intervention strategies to reduce musculoskeletal injuries associated with handling patients: a systematic review. Occup Environ Med 2003; 60:E6.
- IJzelenberg H, Meerding WJ, Burdorf A. Effectiveness of a back pain prevention program: a cluster randomized controlled trial in an occupational setting. Spine (Phila Pa 1976) 2007; 32:711.
- Anema JR, Cuelenaere B, van der Beek AJ, et al. The effectiveness of ergonomic interventions on return-to-work after low back pain; a prospective two year cohort study in six countries on low back pain patients sicklisted for 3-4 months. Occup Environ Med 2004; 61:289.
- 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.
- Feuerstein M. Workstyle: it's probably time we address both biomechanical and biobehavioral approaches? Pain 2007; 132:3.
- Hignett S, Wilson JR, Morris W. Finding ergonomic solutions--participatory approaches. Occup Med (Lond) 2005; 55:200.
- van Duijvenbode IC, Jellema P, van Poppel MN, van Tulder MW. Lumbar supports for prevention and treatment of low back pain. Cochrane Database Syst Rev 2008; :CD001823.
- Workplace use of back belts: Review and recommendations. NIOSH Publication No. 1994-122. Available at: www.cdc.gov/NIOSH/94-122.html (Accessed on August 31, 2008).
- Forssell MZ. The Swedish Back School. Physiotherapy 1980; 66:112.
- Heymans MW, van Tulder MW, Esmail R, et al. Back schools for non-specific low-back pain. Cochrane Database Syst Rev 2004; :CD000261.
- Elders LA, van der Beek AJ, Burdorf A. Return to work after sickness absence due to back disorders--a systematic review on intervention strategies. Int Arch Occup Environ Health 2000; 73:339.
- Maier-Riehle B, Härter M. The effects of back schools--a meta-analysis. Int J Rehabil Res 2001; 24:199.
- Heymans MW, de Vet HC, Bongers PM, et al. The effectiveness of high-intensity versus low-intensity back schools in an occupational setting: a pragmatic randomized controlled trial. Spine (Phila Pa 1976) 2006; 31:1075.
- Martimo KP, Verbeek J, Karppinen J, et al. Effect of training and lifting equipment for preventing back pain in lifting and handling: systematic review. BMJ 2008; 336:429.
- Schonstein E, Kenny DT, Keating J, Koes BW. Work conditioning, work hardening and functional restoration for workers with back and neck pain. Cochrane Database Syst Rev 2003; :CD001822.
- Roche-Leboucher G, Petit-Lemanac'h A, Bontoux L, et al. Multidisciplinary intensive functional restoration versus outpatient active physiotherapy in chronic low back pain: a randomized controlled trial. Spine (Phila Pa 1976) 2011; 36:2235.
- Harris I, Mulford J, Solomon M, et al. Association between compensation status and outcome after surgery: a meta-analysis. JAMA 2005; 293:1644.
- Atlas SJ, Chang Y, Keller RB, et al. The impact of disability compensation on long-term treatment outcomes of patients with sciatica due to a lumbar disc herniation. Spine (Phila Pa 1976) 2006; 31:3061.
- Gibson JN, Waddell G. Surgery for degenerative lumbar spondylosis: updated Cochrane Review. Spine (Phila Pa 1976) 2005; 30:2312.
- Fritzell P, Hägg O, Wessberg P, et al. 2001 Volvo Award Winner in Clinical Studies: Lumbar fusion versus nonsurgical treatment for chronic low back pain: a multicenter randomized controlled trial from the Swedish Lumbar Spine Study Group. Spine (Phila Pa 1976) 2001; 26:2521.
- Brox JI, Sørensen R, Friis A, et al. Randomized clinical trial of lumbar instrumented fusion and cognitive intervention and exercises in patients with chronic low back pain and disc degeneration. Spine (Phila Pa 1976) 2003; 28:1913.
- Pengel LH, Herbert RD, Maher CG, Refshauge KM. Acute low back pain: systematic review of its prognosis. BMJ 2003; 327:323.
- Hagen KB, Thune O. Work incapacity from low back pain in the general population. Spine (Phila Pa 1976) 1998; 23:2091.
- Letz G, Christian JH, Tierman SN. Disability Prevention and Management. In: Current Occupational and Environmental Medicine, LaDou J (Ed), McGraw-Hill, New York 2007.
- Biering-Sørensen F, Bendix AF. Working off low back pain. Lancet 2000; 355:1929.
- ROLE OF PRIMARY CARE
- PHARMACOLOGICAL TREATMENT
- SPECIFIC OCCUPATIONAL INTERVENTIONS
- Return to work advice
- Exercise therapy
- Work restriction
- Ergonomic intervention
- Lumbar supports
- Back schools and other educational interventions
- Functional restoration or work hardening programs
- Multidisciplinary rehabilitation
- SURGICAL TREATMENT
- SUMMARY AND RECOMMENDATIONS