PREVENTING DISABILITY FROM WORK-RELATED LOW-BACK-PAIN - NEW EVIDENCE GIVES NEW HOPE - IF WE CAN JUST GET ALL THE PLAYERS ONSIDE

DESPITE THE PUBLICATION IN THE MID-1990s of comprehensive practice gui delines for the management of acute low-back pain, both in the United States and elsewhere, this ubiquitous health problem continues to be t he main cause of workers' compensation claims in much of the Western w orld. This paper represents a synthesis of the intervention studies pu blished in the last 4 years and is based on a new approach to categori zing these studies that emphasizes the stage or phase of back pain at the time of intervention and the site or agent of the intervention. Cu rrent thinking suggests that medical management in the first 3-4 weeks after the onset of pain should be generally conservative. Several stu dies of rather heterogeneous interventions focusing on return to work and implemented in the subacute stage (3-4 to 12 weeks after the onset of pain) have shown important reductions in time lost from work (by 3 0% to 50%). There is substantial evidence indicating that employers wh o promptly offer appropriately modified duties can reduce time lost pe r episode of back pain by at least 30%, with frequent spin-off effects on the incidence of new back-pain claims as well. Finally, newer stud ies of guidelines-based approaches to back pain in the workplace sugge st that a combination of all these approaches, in a coordinated workpl ace-linked care system, can achieve a reduction of 50% in time lost du e to back pain, at no extra cost and, in some settings, with significa nt savings.