Research Associate Professor Markus Melloh, an orthopaedic surgeon and rheumatologist with the Western Australian Institute for Medical Research (WAIMR) and The University of Western Australia, found that a third of people studied with niggling non-specific back pain went on to develop everyday back pain that severely affected their career and social lives.
Although the workers required extended sick leave and went to their doctors complaining of pain, only a few had suffered a physical change such as a slipped disc. Anatomical tests showed no reasons for their ongoing daily problems with pain.
“Everybody has occasional lower back or neck pain but we are concerned about people with continuous non-specific pain for weeks at a time, which has significant socio-economic and personal costs,” Associate Professor Melloh said.
Researchers found that patients who continued to show “maladaptive cognitions” such as fear and helplessness about their condition, movement avoidance and magnification of its seriousness were most likely to develop a persistent condition.
“Attitude in the workplace and positive thinking have a huge impact on lower back pain,” Associate Professor Melloh said. “If an employee has the option to participate in change in their workplace or have some say in their job design, they can regain a positive attitude and the condition may correct itself.
“Having somebody to listen and show emotional support at work is a strong protective factor.”
A total of 315 patients who went to their GP with their first episode of non-specific back pain were interviewed at that time and followed up at three, six and 12 weeks, and six months. The assessment included questions about their attitude. By the end of the study, 169 people were still participating in the research and about a third of them – 64 patients – were classed as having a persistent condition.
Some reported worse pain after six months, which was not what doctors would usually expect.
“Once people stay at home on sick leave, it gets harder to go back to work and the pain gets worse,” Associate Professor Melloh said. “It’s a vicious circle that needs to be broken. The research shows that if patients feel helpless and are convinced that any movement will land them in a wheelchair, they are making their condition worse.”
Associate Professor Melloh said the study focused only on lower back pain because its incidence was higher than neck pain. However, neck pain was now increasing and may also be linked to a resigned attitude at work.
“Therapies to address the way patients think about their condition should be considered as early extra treatment for lower back pain for people who appear to be at risk of developing a persistent condition,” he said.
Associate Professor Melloh will present his research at a Spine Society of Australia meeting in Sydney on Friday April 27. He is also due to speak at a European Orthopaedic Associations’ meeting in Berlin, a SpineWeek congress in Amsterdam and a World Forum for Spine Research in Helsinki.