CMSA Today - Issue 8, 2014 - (Page 12)
Chronic Pain Conditions
Injured Workers with Low Back Pain
BY JANET S. COULTER, RN, MSN, MS, CCM
ver 1.5 billion people have chronic pain conditions in the world today. The Institute of
Medicine of the National Academies estimates that 100 million people in the United
States suffer from chronic pain. This is more than the combined number of Americans
with diabetes, heart disease, and cancer. According to National Institute of Health statistics, the
most frequent complaints about chronic pain include low back pain (LBP), severe headaches or
migraines, and neck pain. Additionally, the Centers for Disease Control found that 51.5 percent
of adults reported a chronic musculoskeletal condition, which is twice the rate of chronic heart
or respiratory conditions. LBP is the world's most debilitating condition and is an increasingly
prevalent and costly issue in the United States. Furthermore, nearly 80 percent of the general
population will experience LBP at some point in their lives, meaning four out of five people will
have intermittent recurrent back pain. In the United States, direct and indirect costs to treat
LBP have been estimated to be $90 billion annually. This has increased steadily over the last
few decades, mainly due to the high economic cost of injured workers who are off work for
more than six months.
The third most common reason Americans
seek medical attention is musculoskeletal
conditions. A U.S. Department of Health study
showed that managing musculoskeletal sprain
or strain injuries - including lost wages -
costs an average of $850 billion annually,
making it the largest workers' compensation
expense. For employers, the economic strain
is very significant. Of all claims under workers'
compensation, 80 percent are musculoskeletal
sprain or strain injuries with low back injury
consuming more than 33 percent of every
workers' compensation dollar. According
to the U.S. Department of Labor, back pain
causes more than 314 million bed days and
187 million lost work days a year. Furthermore,
LBP is the biggest cause of work absenteeism.
The total annual costs of LBP in the United
States - including lost wages and reduced
productivity - is more than $100 billion.
Additionally, employers lose 5.9 hours of
productivity per week from those suffering
from musculoskeletal pain who continue to
be on the job. Musculoskeletal injury is clearly
a primary threat to employers' risk programs.
Although LBP is extremely common, in 85
percent of cases, it is next to impossible to
say why a person is experiencing back pain.
Symptoms and severity vary greatly, mainly
due to the intricate structure of interconnected
and overlapping tendons, muscles, and soft
Issue 8 * 2014
tissues with highly sensitive nerves and nerve
roots traveling from the lower back to the
legs and feet.
Back injuries often occur sporadically
rather than all at once. Ninety percent
of back pain is uncomplicated and can
be part of the normal aging process.
Additionally, there are several possible
causes for LBP. Most cases of LBP can be
linked to muscle strain, injury, overuse, or
a specific diagnosis or condition such as
herniated disc or degenerative disc disease.
Furthermore, LBP can be caused by the same
vascular mechanism that causes angina.
Atherosclerosis can obstruct branching
arteries of the abdominal aorta including the
four paired lumbar arteries and the middle
sacral artery that feed the lumbar spine.
This diminished blood flow could result
in various back problems. Other causes of
LBP include: sacroiliac joint dysfunction,
spinal tumors, fibromyalgia, piriformis
syndrome, lumbar herniated disc, lumbar
spinal stenosis, degenerative disc disease,
and osteoarthritis isthmic spondylolisthesis.
Smoking and high serum cholesterol levels
have consistent associations with disc
disease and LBP. Adults under 60 years old
are more likely to experience LBP from the
disc space itself or from back muscle strain
or soft tissue strain. Adults over 60 years
old are more likely to have pain related to
joint degeneration or a compression fracture.
Most episodes of LBP are self-limiting and
the injured worker heals within one to three
weeks. Out of these cases, 50 percent of injured
workers will experience relief within two weeks,
while 90 percent will experience relief within
three months. Sometimes doing nothing can
be as or more effective than treating the injury
with conventional treatments.
Treatment is usually based on the specific
training of the health care provider. For
example, pain management physicians use
injection therapy; chiropractor physicians
employ manipulation; physical therapists apply
general exercises; and surgeons recommend
surgery. The first step in determining
treatment is to determine a diagnosis followed
by implementation of the most effective care
strategies delivered by the correct provider
type. Self care is very important as well as
reinjury-prevention interventions. However,
treatment can also be ineffective and costly.
About 80 percent of all workers' compensation
dollars are allocated to musculosketal injuries.
These costs are impacted by inappropriate and
over-utilization of services that lengthen the
duration of the claim and increase medical costs
and time away from work. This can eventually
lead to disability and a negative outcome.
IMPROVING RETURN TO
Case management of the injured worker
with LBP can be challenging. Case managers
can positively impact the outcome of these
injuries and facilitate an early, successful
return to work (RTW); however, there are many
variables that influence outcomes. The case
manager must first enlist active participation
of the injured worker and employer. Other case
management interventions that can improve
RTW outcomes for injured workers with LBP
are managing costs, implementing employer
Table of Contents for the Digital Edition of CMSA Today - Issue 8, 2014
Workers’ Compensation Case Management: Up Close & Personal
CMSA Corporate Partners
The Impact of the Aging Workforce
Inside the Mind of a Traumatic Brain Injury Case Manager
Index of Advertisers
CMSA Today - Issue 8, 2014