Acute low back pain will afflict more than 80 percent of the working population in the United States. It will cause more than 20 percent of the industrial work force to incur days away from work. The impact on the health care system for the diagnosis and treatment of the disorder is enormous. From $8 billion to $20 billion is spent each year in medical costs and lost wages. The good news is that most sufferers of low back pain will recover in 2-7 weeks with or without treatment and will suffer no long-term effects. In spite of this, insurance claims for health care and workers' compensation have risen at an alarming rate (Jones, 1997).
Throughout industry, musculoskeletal disorders consume a large portion of medical claims. A worker's back is 4-5 more times likely after an initial episode to be injured again. Back injury accounts for 20-25 percent of all claims and cost 30-40 percent of all claims. In Ohio, for example, one out of five workers file a claim associated with back injury. Cost for claims in Ohio is over $1 billion (Ohio Bureau of Worker's Compensation).
Episodes of work-related back pain result in days off and days away from work, thus adding to the cost. Medical management and treatment for acute low back pain is varied and made even more complicated by the lack of consensus of providers about the most effective method of diagnosis and treatment of the disorder (Jones, 1997).
The causes of acute low back pain are seldom identifiable. Terms such as myofascial pain, lumbar strain and sciatica are all components of back pain. Less frequent causes of low back pain, known as the "Red Flags," include Cauda Equina, infection, fractures and tumors. Episodes of improper lifting, poor posture and alignment, degenerative wear and tear, spinal abnormalities, sudden twisting, a slipped disc, sitting and poor physical condition may be attributable to acute episodes of low back pain.
Treatment for low back pain is varied and often complicated. Health care providers may utilize a variety of treatments in the management of acute low back pain. To resolve some of the complexities of this issue, the Agency for Health Care Policy and Research (AHCPR) identified the following facts and guidelines:
- About 90 percent of patients with acute, uncomplicated low back pain spontaneously recover activity tolerance within one month.
- Bedrest is no longer recommended.
- Stretching exercises should begin as early as possible.
- AHCPR guidelines suggest that in absence of red flags or spinal nerve involvement, MRI and Cat scanning be postponed.
Over the counter Tylenol, ibuprofen and aspirin have proven more effective than prescriptive medications. Light exercise, such as swimming, walking, and hiking, are excellent rehabilitation activities. The AHCPR guidelines recommend that back exercises begin within two weeks of injury. Bedrest, back belts and corsets are no longer advocated in the treatment of acute low back pain. At 30 days with no improvement, a CT scan or MRI scan may be considered with a previous negative exam (Jones, 1997).
What Can Employers Do?
Though low back pain is pervasive, industry managers can do much to control the cost of the disorder. Many employers provide restricted duty programs -- work hardening programs which offer reconditioning and accommodate injured workers in a less physically demanding job. The ultimate resolution is to educate the work force on the prevention and current treatment guidelines for low back pain.
Ideally, employers should contact the health care provider to inform them that an employee need not always be taken off work for acute low back pain. Restricted duty programs become invaluable as they keep the injured employee working and demonstrates concern by management for the health of the employee. Managers and injured workers need to talk so that special needs can be accommodated. For example, the employee may have to walk on the hour, or have an ice pack available. Job placement in a less physically demanding area may be an option. Reporting of new symptoms by the employee should be encouraged to prevent any further injury.
Employers should review the OSHA log, production records, absenteeism and job turnover rates to identify trends as to how and where back injuries are occurring. Job site analysis will identify environmental hazards which can be corrected through an ergonomic approach. Lift aids and engineering controls can be implemented to reduce the potential for back injury ( Ohio Bureau of Worker's Compensation, Safety & Hygiene Division).
Low back pain is a complex and multifaceted problem. More attention should be placed on work site and equipment design. The health and safety professional can increase awareness and recognition among employees and management.
Education is an effective component in back pain prevention and treatment. Back pain occurs more often in people who consider their occupation to be physically hard and in those who believe their work to be stressful to the spine or who are dissatisfied with their work (Barker, Burton & Zieve, 1999).
In conclusion, it is important to assist the employee to work toward wellness. Back injury prevention and treatment demand the employee's cooperation. Education regarding the risk factors of low back pain are important. Risk factors include obesity, smoking, and alcohol use. The employee should be given information about back care to maintain wellness after the acute episode. Back schools can help by teaching employees about stretching, exercise and proper lifting techniques.
References
Barker, L., Burton, J. & Zieve, P. (1999). Principles of Ambulatory Medicine. Baltimore: Williams & Wilkins.
Jones, A. (1997). Primary care management of acute low back pain. The Nurse Practitioner, 22.
Ohio Bureau of Worker's Compensation, Division of Safety and Hygiene.
Heidi Buckley, RN, BSN, is a graduate student with Otterbein College in Westerville, Ohio and currently working toward a master's degree and nurse practitioner certification. She has been working in occupational health for the past 5 years at manufacturing and research sites in Ohio.