To the Editor:
Back pain is a leading cause of job-related disability among US employers, contributing to productivity loss for businesses.1–4 Medical care and lost productivity add to the cost of every product and service, which is adverse in the current global market. Treatment of back pain often involves narcotic pain medications that have known associated risks.5 Integrative medicine (IM) includes the use of evidence-based complementary and alternative therapies within the context of conventional medicine. IM approaches to back pain include acupuncture and mind-body interventions to manage stress, which are safe and have been demonstrated to benefit pain conditions.6,7
We sought to evaluate the effect of an IM intervention on acute, work-related low-back pain in a pilot study at the Ford Motor Company assembly plant in Louisville, Kentucky. The study design called for a total of 50 eligible employees with acute low-back pain to be randomized to either usual medical care or an IM program along with usual care (UC). Unfortunately, we were unable to complete the study because of scheduled layoffs and variability in the operating schedule at the Ford plant during difficult economic times. Nonetheless, nearly half of the designated sample size were recruited and followed through the 6-week intervention and 12-week follow-up. We report here on the results of those participants.
Ford assembly plant workers presenting with acute low-back pain were diagnosed by the Ford health clinic physician and given a medical treatment plan. After diagnosis and informed consent, eligible participants were randomized to one of two groups. Those in the UC group followed the medical plan only. Those randomized to IM followed the medical plan, in addition to being offered 10 acupuncture treatments over 6 weeks and given materials for a mind-body program to manage back pain8 and HealthyroadsTM CD9 to practice at home. All participants were interviewed at 6 and 12 weeks for study outcomes.
Outcomes included the 1) Roland Morris Disability Questionnaire, which is specific to back pain-related disability, 2) Stanford Presenteeism Scale, which measures effect of a person's current medical condition on his job performance, 3) SF12 questionnaire, which measures physical and mental well-being, and 4) type and number of medications over time.
Twenty-four participants were enrolled and randomized, 11 to IM and 13 to UC. Of these 24 participants, 22 (92%) and 19 (79%) completed the 6- and 12-week assessments, respectively, with no difference between groups in attrition. In the IM group, the median number of acupuncture treatments delivered was 9 or 1.5 per week on average. The mind-body program and HealthyroadsTM CD were practiced with a median of 12 times over 6 weeks or twice per week on average. Results at 6 and 12 weeks indicate that there was no difference between the IM and UC groups in the Roland Morris Disability Questionnaire, Stanford Presenteeism Scale, or SF12. A subanalysis did indicate that the ASH MindBody/Relaxation CDs were the one component of the intervention which was associated with a significant increase in meditation practice and a small but statistically significant improvement in four of the outcome measures including these previously cited three measures. At the end of the intervention, the intake of prescription pain medications was 58% lower in the IM than the UC group (P = 0.04).
In difficult economic times, conducting a research study in an automotive assembly plant proved challenging because of periods of production shutdown and employee layoffs. Nonetheless, there was full cooperation by the Ford Motor Company in support of this research. Participants were highly compliant with the research protocol, suggesting that an intervention of this nature is acceptable to assembly plant workers. There was insufficient sample size to adequately estimate the effect of the IM intervention on disability or absenteeism. Nevertheless, a significant reduction in prescription pain medication intake was observed, associated with the IM intervention. This suggests a potential economic benefit to the company and health and safety advantage to the workers. To investigate further, a larger clinical trial should be conducted once stability is returned to the economic environment.
Elizabeth Kimbrough, PhD, MPH
Lixing Lao, PhD
Brian Berman, MD
Center for Integrative Medicine
University of Maryland School of Medicine
Kenneth R. Pelletier, PhD, MD (hc)
University of Arizona School of Medicine
University of California (UCSF) School of Medicine
San Francisco, Calif
Walter J. Talamonti, MD, MPH, FACOEM
Ford Motor Company World Headquarters
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8. Pelletier KR. Managing Back and Neck Pain—CD and Workbook
. San Diego, CA: American Specialty Health. 2009.
9. American Specialty Health, San Diego, CA; 2009. Available at: www.healthyroads.com
. Accessed February 17, 2010.