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Sickness absence due to low back pain
  1. D A Fishbain
  1. University of Miami Medical School, Florida, USA; d.fishbain{at}miami.edu

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    In a recent interesting study published in your journal, Hoogendoorn and colleagues1 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 familiarise 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 Hoogendoorn and colleagues’ results1 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 and colleagues2 showed 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 and colleagues3 showed 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 and colleagues4 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 and colleagues5 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. Furthermore, 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 to.

    Overall, this series of studies points to a strong relation 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 Hoogendoorn and colleagues.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.

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