Volume 180 - Issue 10
Management of chronic low back pain
Author: David S Elder
Med J Aust 2004; 180 (10): 542-544. || doi: 10.5694/j.1326-5377.2004.tb06069.x
Published online: 17 May 2004
Published online: 17 May 2004
David S Elder
Occupational Physician, 517 St Kilda Road, Melbourne, VIC 3004. delderATbigpond.net.au
To the Editor: In Bogduk’s review of the management of low back pain,1 he cited several international guidelines but did not address the effect of returning the patient to work. Disappointingly, return to work was mentioned only as an outcome of multidisciplinary therapy, with no mention at all of a planned and purposeful return to work in the suggested approach. This is surprising, given the literature available2,3 and the significant adverse effects of being out of work.4
Further, the algorithm in Box 3 (general practice management of chronic low back pain) appears to have a never-ending loop: I am cautious of the adverse effects that the reductionist model can have,5 and it appears possible in this algorithm to be forever stuck in the investigative loop. An additional pathway from this loop to intensive therapy would allow progression in some cases.
The inclusion of a return to work in management of low back pain has been extensively analysed in the Australian setting and shown to significantly reduce disability.6 This advice should be included in any clinical update on management of low back pain.
References
- Bogduk N. Management of chronic low back pain. Med J Aust 2004; 180: 79-83. CHDEIIJH
- Victorian WorkCover Authority. Guidelines for the management of employees with compensable low back pain. Melbourne: Victorian Workcover Authority, 1996. CHDBIADH
- Waddell G. The back pain revolution. Edinburgh: Churchill Livingstone, 1998. CHDIEAGE
- Gerdtham UG, Johannesson M. A note on the effect of unemployment on mortality. J Health Econ 2003; 22: 505-518. CHDGDFBG
- Ober KP. Uncle Remus and the cascade effect in clinical medicine. Brer Rabbit kicks the tar-baby. Am J Med 1987; 82: 1009-1013. i1083061
- Buchbinder R, Jolley D, Wyatt M. 2001 Volvo award winner in clinical studies. Effects of a media campaign on back pain beliefs and its potential influence on management of low back pain in general practice. Spine 2001; 26: 2535-2542. i1083063