Contributed Column

The Company Doctor

by Andrew J. Haig, M.D.

Back pain: What’s a boss to do?

Back pain will disable you and almost every one of your employees for over two weeks sometime during the working years. Some will have recurrent episodes and surgery, and even become chronically disabled: depressed, out of shape, out of work, and stuck on drugs.

A little knowledge can help keep your valuable team out of trouble and on the job.

Screen new employees: Predictors of back pain disability are psychological and social, so your skill at finding and keeping motivated, well-balanced employees is more important than the medical facts. Still, a person who physically can’t do the job is going to get injured, so a post-offer job-function test is useful. It pays to retest and recondition employees returning from pregnancy or illness leave, too.

Prevent injury: Forget it. The prevalence of back pain is surprisingly similar among office workers, farmers, hunter-gatherer tribes, and foundry workers. You can’t prevent it.

Prevent disability: Disability from pain comes when workers are afraid; can’t cope; are angry; misinformed by doctors, lawyers, and others; or whose employers mismanage their recovery. Education is critical. Encourage people to keep active, stretch out painful cramps, use ice, and wait patiently because pain will almost certainly get better. That’s no fun, but the right thing to do.

Many treatments can lower the pain level in the short term, but the only one proven to have a long-term effect is my Norwegian buddy Aage Indahl’s “Aage Talk.” In his award-winning study, half of the patients received the usual care of physical therapy. To the other half, Aage respected the pain and suffering, but also cracked one-liners like, “Back pain? You should go to bed. But take someone with you because you might as well have sex while waiting to get better.” His goal was to show that pain is not dangerous, it almost always gets better, and moving naturally instead of protecting yourself is the best treatment.

So discuss return-to-work plans with the employee. Hard-line bosses who provide no gradual return to work are bucking for big losses. Ask for ideas about how the employee can return to light, limited, or full work.

Doctors are legally in charge of release to duty. But a lot of doctors don’t have the time, motivation, or skill to do this. As an employer the best thing you can do is to engage the doctor and keep the worker in the loop. Doctors can’t tell you about patients without written consent, but you can still talk to them. Leave a message saying you care about the employee and are happy to discuss job accommodations.

Prevent medical misadventure: Emergency departments are busy with real emergencies. With no chance to follow up on their decisions, and huge legal pressures, they’re likely to order tests, drugs, and work restrictions that won’t help. Back pain is rarely an emergency unless there is big trauma, the worker can’t feel or move muscles, or there are other medical problems like cancer or infection. Barring these, X-rays are almost useless. Expensive MRI’s and CT scans are misleading in the first weeks. So without danger signs, a next-day visit to a primary care physician is preferable to a midnight trip to the emergency room.

Chiropractic, osteopathic, and physical therapies have been shown to help in the short term. Experts I respect in these fields tell me that treatment should take less than a month. If not, it might be time for a second opinion: perhaps a physiatrist — an M.D. specializing in physical medicine and rehabilitation and trained to make difficult diagnoses, judge past therapies, and evaluate psychological and social factors. A study we published showed a 30 percent drop in back operations when a physiatrist’s second opinion was required. •

Andrew Haig, M.D., is active emeritus professor of physical medicine and rehabilitation in the University of Michigan’s School of Medicine and Michigan’s Ross School of Business. His clinical practice and healthcare and management group, Haig et al., Consulting, are in Williston: (802) 857-5671.

Index of Contributed Columns

For information on submitting a contributed column see here.