Helping Patients Return to Work Following Acute Back Pain

In recent years, a number of studies have been done to understand return to work outcomes following an incident leading to acute low back pain. LBP is a leading cause of workplace absenteeism in the United States and all industrialized countries, costing billions in workers’ compensation, loss of productivity and patient anxiety. Studies show, physicians play a key role in a patient’s return to work.

According to a 2012 study by Canada’s Institute for Work & Health, the main potentially modifiable factors impacting patients return to work are:

• Recovery expectations
• Interactions with healthcare providers (care provided, area of specialty)
• Self-reported pain and functional limitations
• Presence of radiating pain
• Work factors such as the physical demands of the job and job satisfaction

The study noted that if doctors are aware of the above factors, they might be able to better screen patients and try to more closely guide patients who are at risk for long-term disability.

Cleveland Clinic pain specialist Teresa Dews, MD, understands these study results. She says, “It’s almost never just about the pain. There are many subconscious things impacting a patient’s response to his or her work-related back pain.”

Patient screening

Dr. Dews stresses the importance of doing a thorough assessment of low back pain patients. In addition to understanding the pain-causing incident, her assessment includes getting a full history of the patient to understand their medical history, past surgeries, family history (related to pain), social history (including work details) and the medications they take. She then does a physical exam to get a sense the patient’s body mechanics as well as the neurological and musculoskeletal systems. She then evaluates imaging tests as necessary such as X-ray, CT scan or MRI; additional tests may also include lab work if there is the possibility of a deeper issue.

“It takes time and observation to make a proper assessment, but it leads to the best outcomes,” she says. She notes that when it is work-related, sometimes the urgency to get back to work may mean moving things along faster.

She has many tools at her disposal to help patients with acute low back pain, including nerve blocks and injections. And she often prescribes non-narcotic medications and physical therapy for these patients. These injections and medications are meant to help facilitate what patients can do in physical therapy. “The pain is the barrier,” she says. “If we take the edge of the pain away, patients can get through physical therapy and the pain can improve and heal with time.”

Another 2012 study at the University of Rochester Medical Center, found that when patients did not receive a referral for pain treatment in a timely fashion following a work-related incident, going to a pain treatment center (or spine clinic) did not yield improvements in functional outcomes.

“This tells us we should not delay in beginning treatment for pain,” says Dr. Dews. “It shows the importance of seeking treatment for back pain right away [following a work incident] in order to have the best outcome.”

The Work & Health study revealed that initial screening questions with these patients should include asking what their expectations are for returning to work. The study concluded that knowing this can help physicians to identify the patients who are at high risk for a long absence from work “and, therefore, in need of extra attention to help them recover and return to work more quickly.”

“Each patient is an individual and we have to take time to listen and ask the right questions,” says Dr. Dews. “There is an art to it.”

Of course, some patients who have a severe injury may never be able to return to work depending on their age, medical issues or the nature of the job. But, says Dr. Dews, getting to know your patients can make all the difference in helping to relieve their pain and get them back to work.