Of the 131 million days of sickness absence in the UK (according to the Office for National Statistics), 31 million were for back and neck pain - more than any other reason given. It’s also a health problem with long-term consequences, as around 3-10% of cases of low back pain become chronic and around 62% of people are still experiencing the pain after a year.
GPs check for the serious physical health issues, a fracture, infection, or inflammation. But once they’ve been ruled out all we can do is prescribe painkillers, talk about physio and provide a sick note.
Business owners need to be thinking again about whether they can just accept a sick note for what might appear to be ongoing and unresolvable back pain. It’s not a case of browbeating absentees, but taking a more active approach that helps both the employee and the organisation get to the root cause of problems.
1. We’ve learnt from research that the physical pain isn’t the root of the problem. The psychology - people's attitudes to themselves, their back pain and health in general - play a significant role in conditions like chronic back pain, and identifying issues of anxiety and/or depression are critical in terms of providing the right kind of help and allowing people to return to work.
2. Find out more about the background. Some employers are starting to use the ‘Orebro Musculoskeletal Pain’ questionnaire (named after the town in Sweden where the tool was developed). Questions explore individual attitudes and feelings about levels of pain experienced, its effect on their ability to work, experiences of anxiety or depression and any impact on sleeping. It’s been shown to be effective in predicting future issues and which employees are most likely to be long-term absent.
3. The data from this kind of questionnaire is a basis for referring employees to other forms of support that tackle the underlying root causes - often through Cognitive Behavioural Therapy (encouraging more positive attitudes and therefore a better ability to cope with the types of pain associated with MSDs).
4. Don’t just rely on physical therapy. One research study looked at the impact of a number of programmes offering a combination of physical therapy (exercise supervised by a physical therapist) along with psychological therapy (counselling or Cognitive Behavioural Therapy). The progress of chronic back pain sufferers was tracked over at least a year, showing that including a psychological element of treatment was more likely to lead to a better recovery than exercise alone. There's also good evidence from a programme undertaken in New South Wales in Australia under its Work Cover initiative which saw successful results in terms of helping speed up recovery times and help more people back to work.
5. Look beyond the traditional route of physiotherapy and the benefits of osteopathy, acupuncture and chiropractics. They might appear ‘gimmicky’ on the surface compared with physio, but there is solid evidence it works, and often more effectively.
The more we can break out of the standard routines of treatment and understand the whole picture, the closer we'll come to helping people stay in work, avoiding what can become a vicious circle of physical and mental illness, and make sizeable cost-savings for employers.
By Dr Nick Summerton, GP and Medical Director at Bluecrest Wellness