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• Comments on article by Andersen et al
  David Fishbain
  Published on: 2 March 2004

• Published on: 2 March 2004

  Comments on article by Andersen et al

  • David Fishbain, Professor of Psychiatry, Neurosurgery and Anesthesiology

  Dear Editor

  In a recent interesting research report published in your journal, Andersen et al. [1] performed a 4-year prospective COHORT study with yearly assessments trying to develop variables that could predict the development of new onset neck/shoulder pain. They determined that repetitive movements of the shoulder/arm, jobs with high demands and low control were variables which were all independently a...

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  Dear Editor

  In a recent interesting research report published in your journal, Andersen et al. [1] performed a 4-year prospective COHORT study with yearly assessments trying to develop variables that could predict the development of new onset neck/shoulder pain. They determined that repetitive movements of the shoulder/arm, jobs with high demands and low control were variables which were all independently associated with development of neck/shoulder pain.

  It is to be noted that Nahit et al.[2] have also previously noted an association between high job demands and low job control and development of musculoskeletal pain. Nahit et al.[2] also noted that those who perceived their work as stressful most of the time, were more likely to report pain.[2] From another standpoint, Fishbain et al. [3,5,6] and Rosomoff et al. [4] have examined if pre-injury job satisfaction impacts on “intent” to return to work after pain facility treatment. In the first reports Fishbain et al. [3] 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. [4] 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 reports, Fishbain et al. [5] 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. [6] 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 Nahit et al.[2]

  It seems that in trying to understand the low back pain injury/neck 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. It is likely that some of the patients identified in Anderson’s et al. study [1] as developing neck/shoulder pain would have gone on to develop chronic pain. It is also likely that a significant percentage of the patients developing chronic pain would have perceived their pre-injury job as stressful. Thus, rehabilitation efforts with these patients would have been difficult at best. As such, there is communality between Anderson’s et al. findings [1] and that of Fishbain [3,5,6] and colleagues.[4] As pointed out by Anderson et al. [1] workplace interventions should be geared toward preventing the development of chronic pain.

  References

  1. Andersen JH, Kaergaard A, Mikkelsen S, Jensen UF, Frost P, Bonde JP, Fallentin N, Thomsen JF. Risk factors in the onsets of neck/shoulder pain in a prospective study of workers in industrial and service companies. Occup J Env. Med 2003;60(9):649-5.

  2. Nahit ES, Pritchard CM, Cherry NM et al. The influence of work related psychosocial factors and psychological distress on regional musculoskeletal pain: a study of newly employed workers. J Rheumatology 2001;28:6:1378-1384.

  3. 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.

  4. Rosomoff HL, Fishbain DA, Cutler R et al. Do chronic pain patients’ perceptions about their preinjury jobs differ as a function of worker compensation and non-worker compensation status? Clin J Pain 1997;12:2997- 306.

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

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

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  Conflict of Interest:
  None declared.

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