Bad Backs and Workers Comp: First, Do No Harm

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The American College of Physicians (ACP) has issued new guidelines for the treatment of back pain. After seeing far too many cases of "failed back syndrome" involving injured workers whose surgeries led to permanent total disability, this is welcome news.
The recommendations address an adult patient population with acute, subacute or chronic low back pain (been there, done that). The guidelines begin with an important and underreported observation: most patients with low back pain improve over time regardless of treatment. 

The American College of Physicians (ACP) has issued new guidelines for the treatment of back pain. After seeing far too many cases of “failed back syndrome” involving injured workers whose surgeries led to permanent total disability, this is welcome news.

The recommendations address an adult patient population with acute, subacute or chronic low back pain (been there, done that). The guidelines begin with an important and underreported observation: most patients with low back pain improve over time regardless of treatment. As a result, the first recommendation focuses on minimal medications (nonsteroidal anti-inflammatory drugs or muscle relaxants) and non-invasive treatments, including the use of heating packs, massage, acupuncture and spinal manipulation (chiropractic).

For patients with more chronic low back pain, the recommendations read like a New Age catalog, including a focus on exercise, acupuncture, mindfulness-based stress reduction, tai chi, yoga, biofeedback and cognitive behavioral therapy. All this in addition to the above treatment modalities.

The third recommendation kicks in where the first two options do not provide lasting relief. Here we find a tiered approach to pharmacology, with opioids as a last resort, only if the potential benefits outweigh the risks, and only after a discussion with the patient and his/her family of risks and potential benefits.

Because the recommendations are all non-invasive, surgery is not addressed. Needless to add, there are situations where surgery is both necessary and prudent, but only where none of the non-invasive approaches are effective.

For lower back pain, the best advice appears to be staying as active as you can, treating as conservatively as you can, for as long as you can, and living in the reasonable hope that time will eventually heal your wounds.

Jon Coppelman
Senior Workers Compensation Consultant

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