Recent Article takes a survey of concerns of low back pain patients sent for rehab. The results are no surprise.
J Occup Rehabil. 2010 Apr 7. [Epub ahead of print]
What Concerns Workers with Low Back Pain? Findings of a Qualitative Study of Patients Referred for Rehabilitation.
Coole C, Drummond A, Watson PJ, Radford K. abstract here
1) Justification of their pains at work – not surprising when routine imaging, in straight back pain, rarely points to the source of problems. Facet blocks and discograms might, but one orthopod I talked to felt they weren’t reliable enough to bother with. My take on that, is they couldn’t be bothered because there is no money in it and it would be too much trouble trying to figure out what results meant.
2) Future work ability – workers are fed this jargon about “don’t worry about reinjury – it doesn’t happen”. The only two settings I was able to get a feel for this was in 2 realms- military parachutists, and nurses. Answer is, yes it does happen; and the work capacity is affected.
3) Coping with flares – with opioid phobia out there, it is likely the patient is under-medicated. Flare scenarios could be a real issue.
4) Reluctance to use medications – opioids have a ceiling effect and only take 20-50% of pain away. Trying to push the dose only increases side effects. Only 1/2 of people will find opioids tolerable or effective.
5) Concerns about sickness records – I’ve had to deal with too many employers that only want their workers back when they are 100%. I doubt the boss works at 100%… Yet, be sick often, and employers seem to find a way to get rid of you. Just wait for an excuse.
Comment – sorry to be so cynical, but this side of the situation is not explained to people in rehab.