Should we treat back pain as a preventable disease?

Colin Alert

Barbados

Should we treat back pain as a ‘preventable disease’?.
Dr. C. V. Alert.
Family Physician.
April 2011

Low back pain is a major health problem among populations in western industrialized countries and a major cause of medical expenses, absenteeism, and disablement.[1,2]. Barbados has no specific immunity in this regard.

For some time now, the National Insurance Scheme (NIS) has been noting that the single largest medical condition that causes the scheme to pay out worker’s compensation (millions of dollars annually) is back pain; funds paid out to back pain sufferers have accounted for a little more than 50% of all the funds that are paid out annually.

In speeches about health, our ‘Health Decision Makers’ often make a strong case for ‘Prevention’, usually when the chronic non-communicable diseases are being considered, and perhaps more so in recent times at the worldwide recession forces us/them to realize that it can’t be ‘business as usual’ when it comes to health economics.

Is there scope then, for preventing back pain? Apart for personal health benefits, the NIS statistics strongly suggest that as a country there could be economic benefits as well.

There are of course some occupations, particularly in the ‘blue-collar’ workforce, that are more prone to back pain. Although my working years at the hospital are long behind me, I can still remember individual members of the nursing staff, and the orderlies, for whom lifting was an integral part of their everyday activities, complaining of back pain, or going off on prolonged sick leave with back pain. I had the good fortune of working alongside a local physiotherapist a few years ago as we organized a ‘back pain’ seminar for those young men and women who loaded our many suitcases into airplanes, some massive, some small, but all with limited cargo spaces. Many of these aircraft-loaders suffered back pain from time to time, in which their cramped working environment was a contributor.

Participants at the seminar were taught, and had to demonstrate, good posture, correct lifting techniques, exercises that strengthened the core muscles, aerobic conditioning, and exercises for general fitness. They all paid glowing tributes after the two day seminar.

A ‘back pain’ seminar will not stop all cases of back pain, but has the potential of significantly reducing the number of individuals who experience work-limiting back pain; and to reduce the severity of symptoms, and the work-hours lost, in those who do go on to have back problems.

Many individuals within our workforce work in manufacturing and in construction, and fall in this category. If we are going to be serious about prevention, then the physical therapists must be approached to implement the preventive programs that these workers need.

Thus ‘back pain prevention’ has particular significance in places where there may be a large group of persons at risk of developing the condition, where the condition is costly, and where rehabilitation is difficult and generally prolonged. All these apply here.

Targeting segments of the workforce in this way has traditionally been considered ‘occupational medicine’, and prevention in occupational medicine normally means wearing the appropriate safety equipment. Adopting ‘back pain prevention’ strategies allows an important interaction between prevention and occupational medicine, and redefines the boundaries of preventive medicine.

Thus our ‘Health Decision Makers’ may do well to consider the many conditions that have a negative impact on the health of the people they serve. In remembering that ‘an ounce of prevention is better (and cheaper) than a pound of cure’, specific preventive efforts directed towards back pain in our manual laborers has the potential for significant benefit.

References:

1. Deyo RA, Cherkin D, Conrad D, et al. Cost, controversy, crisis: low back pain and the health of the public. Annual Rev Public Health 1991; 12:141–56.
2. Van Tulder MW, Koes BW, Bouter LM. A cost-of-illness study of back pain in the Netherlands. Pain 1995; 62:233–40.