Clinical management and the duration of disability for work-related low back pain

Clinical practice guidelines recommend a conservative approach to managemen t of acute low back pain (LBP). The present study sought to determine wheth er health care utilization and the physician's initial managetment of work- related LBP were associated with disability duration. Clinical management i nformation was obtained for Bg randomly selected, workers' compensation cla imants with acute, uncomplicated, disabling work-related LBP. Length of dis ability tons based on indemnity (wage replacement) payments. Disability was significantly associated With increased utilization of specialty referrals (P = 0.013) and provider visits (P < 0.001), use of magnetic resonance ima ging (P 0.003), and use of opioids for more than 7 days (P = 0013). Effects of early diagnostic imaging (first 30 days of care) on length of disabilit y were observed (P = 0.001). Patients whose treatment course did not involv e Extended opioid use and early diagnostic testing were 3.78 tines more lik ely (95% confidence interval, 1.6 to 8.9) to have gone off disability statu s by the end of the study. The nature of the association between these init ial clinical management aspects and LBP disability duration merits further exploration.