Study design: A prospective observational cohort was recruited from 208 randomly selected North Carolina practices.
Objective: To compare the course of compensation claimants with gainfully employed patients not so insured from the time when they first sought care for acute back pain.
Summary of background data: The human and financial cost attributable to disabling chronic low back pain identified by worker's compensation programs continues to escalate. We explored the antecedents to this phenomenon.
Method: Consecutive patients with acute low back pain were interviewed by telephone within 1 week of first seeking care and in follow-up calls after 2, 4, 8, 12, and 24 weeks to monitor functional and work status.
Results: Of the 1633 patients enrolled, 505 were insured by workers' compensation. These were compared with 861 who had been employed on any job for pay within 3 months of the onset of their backache but whose care was not so underwritten. Those with compensable back pain were more likely to categorize their tasks as physically demanding and had taken more time off work in the month before the baseline interview (P = 0.02). Recovery of the sense of wellness they enjoyed before this episode of back pain was delayed (Cox Model: Hazard Ratio = 0.822; P < 0.001; confidence interval: 0.733, 0.923), but recovery of function or return to work was not. This delay was independent of type of health care and perception of task demand and beyond that which could be ascribed to the quality of back pain.
Conclusion: Each of these associations is a reproach to the fashion in which workers' compensation insurance for regional back pain serves the ethic that is its raison d'être.