According to the Department of Labor, low back pain accounts for one-third of all occupational mesculoskekletal injuries and illnesses resulting in work disability. A recent article in the Journal of Occupational and Environmental Medicine, December 2015, states that two thirds of low back pain cases return to work within 1 month, but a substantial number (17%) experience work disability for 1 to 6 months, and 7% for 6 months or longer. The article goes on to examine the length of disability and medical costs with regard to various states’ workers’ compensation policies. While the study may have some interest for those concerned with various states’ laws on medical provider choice, it has less to offer readers most interested in treatment of low back pain with length of work disability or medical costs.
Most injured workers want to know what will “fix” them, and how quickly they can be pain-free and return to normal work and activities of daily living. While injured workers in Nevada can ask for a change of doctors within the first 90 days of their claim under NRS 616C.090, most are unaware of this right and continue treating at the clinic required by their employer for a work-related injury.
Unfortunately, many of the clinic physicians who treat any low back claims throughout the day take very little time to explain the anatomy of the back and what treatment options are ordinarily available depending on the severity of the symptoms and how long the symptoms persist. A lumbar spine strain or strain from overexertion on the job or trauma can cause an excruciating spasm where the injured worker can barely move. If the initial treating physician spends less than a minute with the patient and doesn’t acknowledge the pain, the patient has no confidence in the diagnosis or a treatment plan that takes the worker off work for only three days before he is required to return to the clinic. (Workers comp. clinic doctors know that if an injured worker is off work for 5 days in a row or within a 20-day time period, they are entitled to be paid workers’ compensation lost time benefits.)
Treatment consisting of anti-inflammatories, medication for muscle spasm, and six visits of physical therapy may be a totally appropriate treatment plan by the clinic doctor. However, if the attitude of the prescribing doctor is not caring, the healing process can be affected by the patient’s feeling that the doctor is more concerned with cost containment on the claim than adequate treatment. It is bad enough experiencing low back pain that prevents someone from working, but to be treated disrespectfully by a doctor who questions your motivation to return to work adds insult to injury.
Chronic low back pain can be difficult to treat, with no magic fix. Treatment usually consists of medication, physical therapy, epidural injections when indicated, and back surgery when supported by abnormal findings that are consistent with an abnormal clinical exam. If an injured worker is not a surgical candidate, it doesn’t mean that there isn’t significant chronic pain or disability. Having a caring doctor who takes the time to provide a detailed analysis of your injury and an individual treatment plan can make a tremendous difference.