Send letter to journal:
Re: Comments on article by Hoogendorn

Dear Editor

In a recent interesting study published in your journal, Hoogendoor et al.[1] determined that high physical work load and job dissatisfaction increase the risk of sickness absence due to low back pain. I would like to focus on the job satisfaction variable.

It is to be noted that the above study was performed in a prospective fashion with employed workers who had no recent history of low back pain injury. As such, I would like to familiarize the readership with a series of studies performed with chronic low back pain (CLBP) patients treated in a pain facility. The results of the studies described below resonate with Hoogendoor's results[1] and point to the importance of perceived job stress and job dissatisfaction and their importance to job function.

In a series of four papers, Fishbain and colleagues have attempted to determine if pre-injury job satisfaction impacts on "intent" to return to work to the pre-injury job after pain facility treatment. In the first report, Fishbain et al[2] demonstrated that chronic pain patients not intending to return to work after pain facility treatment were more likely to complain of job dissatisfaction. In the second report from this group, Rosomoff et al.[3] demonstrated that an association between non-intent to return to work after pain facility treatment and pre-injury job dissatisfaction was similarly found across Workers' Compensation and non- Workers' Compensation chronic pain patients. In the third report, Fishbain et al.[4] looked at actual return to work after pain facility treatment in relation to these variables. They found that actual return to work was predicted at one month "by intent", perceived job stress and job like (job dissatisfaction plus other variables). At 36 months, return to work was predicted by "intent" and by perceived job stress plus other variables. In the final study, Fishbain et al.[5] attempted to predict "intent" to return to work after pain facility treatment in relation to actual return to work. "Intent" was predicted by perceived pre-injury job stress plus other variables. In addition, those chronic pain patients who intended to return and did not, were predicted by whether there was a job to go back to. Also chronic pain patients not intending to go back to work to the pre-injury job initially, but doing so later, were predicted by having a job to go back.

Overall, this series of studies points to a strong relationship between pre-injury work variables such as job dissatisfaction and "intent" to return to that job after treatment. In addition, these studies indirectly support the findings of Hoogendoor et al.[1] It seems that in trying to understand the low back pain injury and recovery process, it is important to take into account work related perceptions such as those of perceived job dissatisfaction and job stress.

References

(1) Hoogendoorn WE, Bongers PM, de Vet HCW, Ariens GAM, van Mechelen, Bouter LM. High physical work load and low job satisfaction increases the risk of sickness absence due to low back pain: results of a prospective cohort study. Occup Environ Med 2002;59:323-328.

(2) Fishbain DA, Rosomoff HL, Cutler R et al. Do chronic pain patients' perceptions about their preinjury jobs determine their intent to return to the same type of job post-pain facility treatment? Clin J Pain 1995;11:267 -278.

(3) Rosomoff HL, Fishbain DA, Cutler R et al. Do chronic pain patients' perceptions about their pre-injury jobs differ as a function of worker compensation and non-worker compensation status? Clin J Pain 1997;12:297- 306.

(4) Fishbain DA, Cutler R, Rosomoff HL, Khalil T, Steele-Rosomoff R. Impact of chronic pain patients' job perception variables on actual return to work. Clin J Pain 1997;13(3):197-205.

(5) Fishbain D, Cutler B, Rosomoff HL, et al. The prediction of chronic pain patient "intent", and "discrepancy with non-intent" for return to work post pain facility treatment. Clin J Pain 1999;15:141-150.