Dr Charles Sears, GP and member of the back pain guidelines working group, Faculty of Occupational Medicine
The Faculty of Occupational Medicine has recently launched new guidelines1 for the management of low back pain at work. These are evidence based, and designed to complement the RCGP guidelines.2 They are aimed at the management of back pain in the workforce, but do not only relate to pain that comes on at work.
Since the advent of the Clinical Standards Advisory Group Guidelines3 and the subsequent RCGP Guidelines, awareness of the basic principles of management of simple back pain has increased.
Although there is no hard evidence of the widespread application of these guidelines, the exponential rise in people claiming state benefits for back pain has shown signs of improvement. This may, however, also reflect changes in the regulations regarding claims.
Some of the recommendations that GPs and therapists alike have found difficult in the RCGP guidelines relate to getting people back to work quickly. In order to minimise the disability caused by back pain, the message from the RCGP guidelines is that it is necessary to impress on patients:
|Avoid time off work if possible|
|If you need to be off work, try to stay active|
|Get back to work as soon as you can|
|Do not wait to be pain free before you go back to work.|
It may be possible to persuade patients that return to work is a good thing, but frequently it is the workplace (and often hospital trusts are the worst offenders) that is reluctant to facilitate this early return.
The new guidelines are aimed at occupational health professionals, employers and employees. They not only clarify the benefits of early return to work, but also encourage a supportive role from the employers, staying in touch with employees while they are off work, and enabling them to return to modified activities. The recommendation that return to work need not depend on being pain free is reinforced.
The guidelines may help to clarify matters for employers taking on new employees.The advice is that a history of back pain should not generally be a reason for refusing employment; however, there are naturally certain jobs that are not compatible with a history of back pain.
The lack of evidence for any valid methods of pre-placement screening is highlighted, and also the lack of evidence for the protective value of lumbar supports.
Employers are encouraged to:
|Get in touch with their employee as soon as possible, and remain in contact until he/she returns, offering to provide help if necessary|
|Arrange a meeting to discuss how the employee's job could be adapted temporarily to help with return to full activities|
|Ask for consent to speak to the GP to discuss how he/she might help with plans for return to work.|
If the absence lasts more than 4 weeks it is recommended that employers:
|Find out if the NHS can provide a rehabilitation programme locally; if not it may be possible for them to make arrangements with their employers' liability or private medical insurer|
|Liaise with the rehabilitation team to find out the best ways of supporting a return to work.|
The full evidence review behind the guidelines is available from the Faculty of Occupational Medicine (6 St Andrew's Place, London NW1 4LB) for £15 or from their website at http://www.facoccmed.ac.uk
- Waddell C, Burton AK. Occupational Health Guidelines for the Management of Low Back Pain at Work – Evidence Review. London: Faculty of Occupational Medicine, 2000.
- Clinical Guidelines for the Management of Acute Low Back Pain. London: RCGP, 1999.
- Back Pain. Report of a Clinical Standards Advisory Group committee on back pain. London: HMSO, 1994.
- The Back Book. London: The Stationery Office, 1996. (ISBN 011 702 0788)
- Burton AK, Waddell G, Tillotson KM. Spine 1999: 24: 2484-91.