Efforts to curb back problems through preemployment screening, safety measures, and educational programs have had little effect on this most expensive musculoskeletal malady. Present knowledge raises doubts about the possibility of preventing back pain. However, recent scientific investigations indicate that chronic back pain disability, which accounts for 80% of the costs for back problems, can be prevented. In Gothenburg, Sweden, the collective use of proven treatment methods during the acute stage of back symptoms markedly reduced the period of time patients were disabled from back problems. Effective early intervention centers around: (1) teaching patients about back care, including how to control symptoms through improved body mechanics; (2) applying these educational principles, specifically to the patient's livelihood; (3) avoiding the debilitation that results from overusing bed rest and medication; (4) recommendations to increase cardiovascular fitness; and (5) the judicious use of orthopedic surgery. This approach targets the few patients who tend to be disabled the longest, suffer the most, and become the most costly to society.
From the University of Washington, Department of Orthopaedics, Seattle, Washington.