Work-related low back pain: secondary intervention

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Abstract

A review of the literature indicates that non-specific low back pain is basically an age-related disorder that is affected by differences in occupation, genetics and personal behavior. The cause of low back pain is unknown in most cases, and most of the treatments in routine use are ineffective. There is no evidence that low back pain has decreased in recent years. Consequently, there are a growing number of investigators who believe that efforts at preventing low back pain are futile; that low back pain is an unavoidable consequence of life that will afflict two thirds of the adult population at some point in their lives. These investigators believe that programs aimed at reducing low back disability are likely to be more effective and less costly. Only a small percentage of people with low back pain become disabled, but this small percentage consumes most of the cost. The literature pertaining to the reduction of low back disability is reviewed and discussed. It is concluded that low back disability can be reduced, and that management (not the health care provider) has the primary responsibility for reducing disability.

Section snippets

Nature of low back pain

Scientific evidence indicates that non-specific low back pain is basically an age-related disorder that is affected by differences in occupation, genetics, and personal behavior.

Diagnosis and treatment of low back pain

About 85% of people with low back pain cannot be given a precise diagnosis [21], [64]. The most accurate diagnosis for these people is idiopathic low back pain or non-specific low back pain. The common diagnosis of strain or sprain has never been anatomically or histologically characterized [21]. Bulging discs have little or no association with low back pain [39]. A herniated disc can be diagnosed in only about 4% of patients, and spinal stenosis in about 3% [21]. Herniated discs occur in

Secondary intervention

There is no evidence that low back pain has decreased in recent years [12]. Consequently, there are a growing number of investigators who believe that efforts at preventing low back pain are futile; that low back pain is an unavoidable consequence of life that will afflict most people at some point in their lives [26], [27], [72], [76], [79]. These investigators believe that programs aimed at reducing low back disability are likely to be much more effective and less costly. As Frymoyer and

Risk factors for low back disability

Disability risk factors refer to the increased risk of disability after the onset of pain, and the increased duration of disability. The major risk factors for low back disability are shown below.

Reducing low back disability

Although low back pain may not be preventable at the present time, the good news is that we know how to reduce the disability from low back pain. There is sufficient evidence in the literature to suggest an approach consisting of the following components.

Conclusion

At the present time, the prevention and treatment of low back pain has not been very successful. The bottom line is that we can not really prevent low back pain—primarily because we can not control aging, we can not control genetics, and we can not control personal behavior. However, we can control the job; and because we can control the job, we can reduce the disability from low back pain—and it is the disability that is the primary problem for industry.

Much of the responsibility for reducing

Dr. Snook is a Lecturer on Ergonomics in the Department of Environmental Health at the Harvard School of Public Health in Boston, Massachusetts. He has been a member of the Harvard faculty since 1974. In 1997, he retired as Assistant Vice President, Ergonomics Laboratories, at the Liberty Mutual Research Center in Hopkinton, Massachusetts. Dr. Snook spent 35 years at Liberty Mutual conducting research on low back pain, manual materials handling, cumulative trauma disorders, heat stress,

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    Dr. Snook is a Lecturer on Ergonomics in the Department of Environmental Health at the Harvard School of Public Health in Boston, Massachusetts. He has been a member of the Harvard faculty since 1974. In 1997, he retired as Assistant Vice President, Ergonomics Laboratories, at the Liberty Mutual Research Center in Hopkinton, Massachusetts. Dr. Snook spent 35 years at Liberty Mutual conducting research on low back pain, manual materials handling, cumulative trauma disorders, heat stress, fatigue, machine guarding, stairway design, and personal protective equipment. Prior to joining Liberty Mutual in 1962, Dr. Snook spent six years as a member of the professional staff of Dunlap and Associates in Stamford, Connecticut, where he participated in the human factors design and evaluation of military missile systems, control systems, and weather observing and forecasting systems.

    Dr. Snook earned a B.A. degree from Hartwick College, an M.A. from Fordham University, and a Ph.D. from Tufts University. He is a Certified Professional Ergonomist (CPE), a Fellow of the Human Factors and Ergonomics Society, and a Fellow of the Ergonomics Society (UK).

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