Preventing disability from work-related low-back pain

Abstract DESPITE THE PUBLICATION IN THE MID-1990S of comprehensive practice guidelines for the management of acute low-back pain, both in the United States and elsewhere, this ubiquitous health problem,continues to be,the main,cause of workers’ com- pensation claims in much,of the Western world. This paper represents a synthesis of the intervention studies published in the last 4 years and is based on a new,ap- proach,to categorizing ,these studies that emphasizes ,the stage or phase ,of back pain at the time of intervention,and the site or agent,of the,intervention. Current thinking suggests that medical management,in the first 3‐4 weeks after the onset of pain should be generally,conservative. Several studies of rather heterogeneous,in- terventions focusing on return to work and implemented,in the subacute stage (3‐4 to12 weeks,after the onset of pain) have shown,important reductions in time lost from work,(by 30% to 50%). There is substantial evidence,indicating that employ- ers who ,promptly ,offer appropriately modified ,duties can reduce ,time lost per episode of back pain by at least 30%, with frequent spin-off effects on the inci- dence of new back-pain claims as well. Finally, newer studies of guidelines-based approaches,to back,pain in the workplace,suggest that a combination,of all these approaches, in a coordinated workplace-linkedcare system, can achieve a reduc- tion of 50% in time lost due to back pain, at no extra cost and, in some settings, with significant savings. Résumé EN DÉPIT DE LA PUBLICATION, AU MILIEU DES ANNÉES 90, de guides de pratique détaillés