In western societies back pain disability
is growing at staggering rates. It is the greatest industrial
health problem in the United States today. It accounts
for 31% of all workers' compensation claims. As many
as eight million Americans are disabled partially or
permanently each year from back pain, and it is the
most frequent cause of limitation of activities in those
under 45 years old. Nearly 18% of the population will
have back pain in any given year and 10% to 15% will
have some work disability connected to it. In one recent
decade, the incidents of disabling back pain increased
fourteen times that of the general population.
Fortunately, 90% of the people
will recover within three months. But, almost 80% of
all the costs of back pain treatment are absorbed by
the remaining 10% - and those costs are enormous! With
an average cost per claim approaching twenty-four thousand
dollars, the total cost for lost productivity, workers'
compensation benefits, and medical care is estimated
by some to be more than fifty billion dollars per year.
In short, we see that back pain
disability is a major health problem that is growing
in frequency. Intuitively, this suggests that physical
disease alone is not responsible. Confounding the problem,
or, perhaps indirectly explaining it, are acknowledged
observations that in the majority of cases of chronic
back pain, a specific cause is not known or cannot be
accurately diagnosed! This is in spite of all our extensive
and costly diagnostic methods. What often remains are
vague labels such as lumbar strain, back sprain, lumbago,
or idiopathic back pain. Patients frequently go from
one physician to another, expose themselves to various
diverse treatment methods, often undergo one or more
surgeries and frequently allow practitioners on the
fringes of medicine to offer their own brand of snake
oil. Traditional treatment methods that are so successful
in 90% of acute back pain are often an abysmal failure
in chronic back pain.
There is a critical difference
between having back pain and being disabled from it.
Chronic back pain disability is associated with personal
subjective factors which are not easily quantifiable
and which may or may not be related to the insult that
marked the onset of back pain. These chronic conditions
must be addressed as a medical and psychosocial phenomenon.
No one psychosocial factor has been established as the
prototype for them.
Disability can spring from secondary
psychosocial factors which merely complicate an injury
or from primary ones unrelated to the injury and which
generate and maintain the disability. These can include
depression, pain prone personality types, other adverse
life events, job dissatisfaction, negative conditioning,
and compensation and litigation reinforcers. The motivation
of the injured person to recover is the most important
component in rehabilitation. That motivation can only
be understood in light of all psychosocial variables.
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