Treatment and outcomes in occupational low back pain: A practice evaluation and comparison with national and international guidelines

Low back pain (LBP) is the sin gle larg est musculoskeletal injury inthe working pop u la tion, and the sec ond most com mon reason for vis its to pri mary care physicians. D e spite its frequency, thepathologic diagnosis is un certain in 85% of cases. Out comes, particularly in work related LBP vary widely as does treat ment. Numerous guidelines have been re cently promulgated to speed treatment, improve out comes and minimize cost. This study follows 709 workers with low back pain. Methods: Seven hun dred and nine se rial low back pain pa tients werefol lowed through two years. Their charts were au dited for diag nos tics, ther a peutics, refer rals and out comes. The dif fer ingfacets of clinical treatment paradigms are compared with out comes. Results: Out of five cat e go ries, al most half of back in juries re sulted from heavy lift ing alone. Out of 709 pa tients, 1.4% eventu ally re quired sur gery. Only 10 pa tients were clin i cally dis abled at the end of the study pe riod al though a total of 30 did not re turnto work for a va ri ety of reasons. Al most 39% of pa tients re ceived back X-rays, and 10% re ceived MRIs of the lower back. Ninety-three per cent re ceived NSAIDs as part of their treat ment, and 34% nar cot ics. Nei ther NSAIDs nor mus cle re lax-ants cor re lated with prob a bil ity of re turnto work. The me diantreat ment inter val wasseven days, with the ma jor ity of pa tients (551/709) re turned to reg u lar work withintwo weeks of thefirst of ficevisit. Pro longed duration of treat ment and sur gery cor re lated with lit i ga tion. Conclusions: De spite popular clinical mythology, thevast majority of occupationally acquired low back pain pa tients do re turnto work in a timely fash ion.