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MUSCULOSKELETAL PAIN = LEADING CAUSE OF EARLY PENSIONS

Textbook of Pain, 1998, “Prevention of Disability due to Chronic Musculoskeletal Pain,” written by Steven James Linton:

The above-mentioned chapter in the Textbook of Pain, “examines procedures designed for use in health-care settings to prevent disability due to musculoskeletal pain.”

The following statement is made:

“Because musculoskeletal pain is a major source of suffering, health care, and utilization of compensation, there is a definite need for prevention.  However, prevention is not an easy task because disability is related to a developmental process in which multidimensional factors operate over time to produce significant lifestyle changes.  Research on risk factors indicates that although medical and workplace factors are obvious, psychosocial variables are central to the transition from acute to chronic pain.  The early identification of ‘at-risk’ patients is a key to allocating resources and initiating secondary prevention.”

“Unfortunately, we do not yet understand the exact mechanisms that produce musculoskeletal pain.”

ACUTE PAIN

“Acute pain – Pain which is generally defined as pain up to about three weeks is characterized by temporary decreases in activity, reliance on medication, and help-seeking.  It is accompanied by psychological distress; for example, fear, anxiety and worry, in addition to beliefs that pain is controllable through medical and active coping…The patient may have organic findings as well as muscle spasms.

SUBACUTE PAIN

“Subacute pain – Pain which is considered to be between 3 and 12 weeks.  Patients may exhibit altering patterns of increasing and decreasing activity, and withdraw or become reliant on medication.”

PERSISTENT OR CHRONIC PAIN

“Persistent or chronic pain – Pain which is defined as more than 3 months’ duration, activities may have decreased sharply. . .The pain becomes more constant although patients may experience ‘good’ and ‘bad’ periods.”

RECURRENT MUSCULOSKELETAL PAIN

“Musculoskeletal pain is usually recurrent in nature.  While most episodes of back pain remit rather quickly and most people return to work within 6 weeks, (Reid, et al., 1997), the majority of sufferers will experience several episodes of pain during the course of a year, (Frymoyer, 1992; Nachemson, 1992; VonKorff, 1994; Linton & Hallden, 1997).”

50 % OF ACUTE BACK PAIN SUFFERERS HAVE PAIN 6 – 12 MONTHS LATER

“More than 50 percent of patients with acute back pain will experience another episode within a year (Nachemson, 1992), and prospective studies indicate that almost half will still have significant problems 6 – 12 months later, (Philips & Grant, 1991; VonKorff, 1994; Linton & Hallden, 1997).”

MUSCULOSKELETAL PAIN = LEADING CAUSE OF EARLY PENSIONS

“Firstly, a large number of people suffer from musculoskeletal pain, making it a leading health-care problem even though only a minority develop persistent dysfunction.  Musculoskeletal pain is a leading cause of health-care visits, particularly in primary care,  sick absenteeism, and early pensions, (Frymoyer, 1992; Nachemson, 1992; Skovron, 1992).  However, several studies indicate that over 90 percent of those off work with an acute episode of back pain will return within 3 months, (Waddell, 1996;  Reid, et al., 1997).”

“Secondly, as shown above, musculoskeletal pain is recurrent in nature even though most patients return to work rather quickly after an acute episode.  Although acute sufferers usually feel better and return to work within a few weeks, this does not mean that they have recovered fully or permanently.”

“Thirdly, while up to 85 percent of the population will suffer from musculoskeletal pain, only a small number will account for most of the costs, (Nachemson, 1992; Skovron, 1992; Waddell, 1996).  In general, less than 10 percent of the sufferers may consume up to 75 percent of the resources, (VonKorff, 1994; Reid, et al., 1997).  Thus preventing disability and high-cost cases may result in large economic savings, so that these people constitute a special target for prevention programs.”

MUSCULOSKELETAL PAIN IN SWEDEN & THE NETHERLANDS

“Further, most of the money at this time is spent on compensation, while relatively little is spent on treatment, and almost nothing is invested in prevention.  In Sweden, about 85 percent of the total resources for musculoskeletal pain are spent on compensation as compared to 15 percent for all treatments and drugs, a figure which has remained fairly constant over a 15-year period, (Linton, 1998).”

“Similarly, in The Netherlands, a recent study of all costs due to back pain showed that 93 percent involved compensation and only 7 percent involved treatment, (Van Tulder, et al., 1995).”

PREVENTION NEEDS RESOURCES

“Consequently, until prevention is granted more resources, programs need to be relatively cheap; and this suggests incorporating them into existing practice routines.”

ERGONOMIC RISK FACTORS TO PREVENT

“A host of ergonomic factors, for example, lifting, heavy work, twisting, bending, manual handling, and repetitive work have been found to be associated with musculoskeletal pain, (Pope, et al., 1991; Skovron, 1992).”

“A recent review of some 60 studies revealed a relationship between musculoskeletal pain problems and job demands, control, monotonous work, time pressure, and perceived workload, (Bongers, et al., 1993).”

“If the problem does not remit within 2 – 4 weeks, a formal screening procedure is suggested.”