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Psychosocial risks for low back pain: are these related to work?
  1. DAVID A FISHBAIN
  1. University of Miami School of Medicine, University of Miami Comprehensive Pain and Rehabilitation Center, USA

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    In an interesting prospective study, Papageorgiouet al,1 reported that in a low back pain free population dissatisfaction with work status doubled the risk of reporting a new low back pain episode in the employed and non-employed. This is an interesting finding that adds to the literature on the importance of worker job perceptions to the development of low back pain episodes. In this report, however, Papageorgiou et al 1 neglected to discuss previous research on the importance of pre-injury job perceptions to chronic low back pain patients' intent to return to work after treatment.

    In a series of four papers, Fishbain and colleagues have attempted to determine if pre-injury job satisfaction impacts on “intent” to return to work to the pre-injury job after pain facility treatment. In the first report Fishbain et al 2 demonstrated that chronic pain patients not intending to return to work after pain facility treatment were more likely to complain of job dissatisfaction. In the second report from this group, Rosomoff et al 3demonstrated that an association between non-intent to return to work after pain facility treatment and pre-injury job dissatisfaction was similarly found across Workers' Compensation and non-Workers' Compensation chronic pain patients. In the third report, Fishbainet al 4 looked at actual return to work after pain facility treatment in relation to these variables. They found that actual return to work was predicted at one month “by intent”, perceived job stress and job like (job dissatisfaction) plus other variables. At 36 months, return to work was predicted by “intent” and by perceived job stress plus other variables. In the final study, Fishbain et al 5attempted to predict “intent” to return after pain facility treatment in relation to actual return to work. “Intent” was predicted by perceived pre-injury job stress plus other variables. In addition, those chronic pain patients who intended to return and did not were predicted by whether there was a job to go back to. Also chronic pain patients not intending to go back to work at the pre-injury job, but doing so, were predicted by having a job to go back. Overall, this series of studies points to a strong relation between pre-injury work variables such as job dissatisfaction and “intent” to return to that job after treatment. In addition, these studies indirectly support the findings of Papageorgiouet al.1 It seems that in trying to understand the low back pain injury and recovery process, it is important to take into account work related perceptions such as those of perceived job dissatisfaction and job stress.

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