OCCUPATIONAL BACK PAIN - AN UNHELPFUL POLEMIC

In most industrialized countries, disability and work absence due to o ccupational back pain have risen steadily in recent decades. Conventio nal views of the causes of this slow epidemic tend to fall into one of the following three areas. (i) the clinical pathology view, which att ributes the level of pain and disability to either the severity of the initial injury or to psychosomatic conditions; (ii) the biomechanical exposures view, which attributes the problem to hazardous and prevent able conditions of work. and (iii) the perverse incentives view, which suggests that reporting and disability are influenced by a combinatio n of work dissatisfaction and accessible disability benefits. This pap er reviews, from an epidemiologic perspective, the specific methodolog ical hurdles faced during investigations of the etiology of occupation al back pain. It is argued that methodological issues have contributed to the perpetuation of the three distinct but incomplete views of the problem. New research directions are suggested and a broader interdis ciplinary perspective is proposed to help resolve the existing polemic .