Should you stay at home or continue working with back pain?

 $28 million. That’s the annual productivity loss due to lost work days from back pain.¹ Year after year, low-back pain is consistently among the top six most expensive health problems.² Clinical guidelines now suggest that if possible, patients remain active and working through back-pain treatment. Yet many practitioners still recommend that patients stay at home.

A new study published in the journal Pain evaluated beliefs among a sample of 337 chiropractors, osteopaths, and physiotherapists in the UK.³ Most practitioners believed that work could aggravate back pain and 80% of practitioners said they recommended work absence at least sometimes.

Researchers noted that recommending a patient take time off work may make them more anxious and create fear of movement. Other studies have shown that fear of movement can actually worsen pain and disability in patients with low-back pain.⁴ When recommending breaks from work, most practitioners do tell patients to be active even in their work absence. Even still, it’s important to be not immediately opt for work absence.

The vast majority of doctors in the study also had not contacted employers or visited the work site directly,  typically because they did not feel it was their role and sometimes because patients specifically asked them not to for fear of stigmatization. This is unfortunate since researchers pointed out that “integrated care at work” involving an ergonomic intervention has “shown promising results.”

Although most practitioners did not visit the workplace or contact employers, 83% said they did assign exercises that could be incorporated into patients’ work routines. This may be a sign that practitioners are on the right track. Further cooperation among practitioners, patients, and employers could reduce costs, work absence, and disability.  A combination of exercises and modified work activities is likely more beneficial for patients than work absence.

References

1. Maetzel A, Li L. “The economic burden of low back pain: a review of studies published between 1996 and 2001.” Best Practice and Research Clinical Rheumatology 2002;16(1):23-30. Quoted in Pincus, Greenwood, and McHarg (2011).
2. Lamb SE, Hansen Z, Lall R, Castelnuovo E, Withers EJ, Nichols V, Potter R, Underwood MR. Group cognitive behavioural treatment for low-back pain in primary care: a randomised controlled trial and cost-effectiveness analysis. Lancet 2010;375(9718):916-923. Quoted in Pincus, Greenwood, and McHarg (2011).
3. Pincus, Tamar, Leona Greenwood, and Emma McHarg. “Advising people with back pain to take time off work: A survey examining the role of private musculoskeletal practitioners in the UK.” Pain. 2011; 152 (12): 281-8.
4. For instance: Vlaeyen JWS, Seelen HAM, Peters M, et al. “Fear of movement/(re)injury and muscular reactivity in chronic low back pain patients: an experimental investigation.” Pain. 82. 1999;297-304. A