ABC of Work Related Disorders: BACK PAIN

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Abstract
The number of working days lost due to back problems has increased dramatically in recent years. Over 80 million days a year are now lost due to registered disability,1 but the total estimate, including short spells, is probably in the order of 150 million. This is some four times the figure for 20 years ago. This increase does not reflect an increased incidence of back problems, which has changed little over the period, but rather increased disability associated with episodes of back pain. Much of the increase in disability is probably due to an altered reaction to the problem, with increases in sick certification and state benefit perhaps reflecting patients' and doctors' expectations, concerns by employers, and social and medicolegal pressures. Changes in sickness and invalidity benefit for back pain since 1955 (from report of Clinical Standards Advisory Group1 The costs of back pain are huge. Current estimates suggest the global cost to our economy is about £6bn a year.1 Improved management and better outcomes would lead to major financial, as well as medical, benefits. The problem affects workers of all ages. It usually starts between the late teens and the 40s, with the peak prevalence in 45-60 year olds and little difference between the sexes. There is an increased prevalence of back disability in people performing heavy manual work, smokers, and those in social classes IV and V. Clearly, these factors interact in many patients. It is often difficult to determine whether heavy manual work has caused or aggravated a back problem or whether a worker cannot do the job because of back pain. Obesity and tallness are also associated with back problems. Postural abnormalities, however, do not predict back problems, except possibly gross discrepancies in leg length Psychological factors are important. Psychological distress in a …