Managing the worker with a fresh episode of low-back pain
The Faculty’s review stresses the importance of following current clinical management guidelines. Several such evidence-based guidelines now exist; from these the Faculty selected the model of the UK Royal College of General Practitioners (RCGP) to align occupational health practice with that of primary care. (A comparison with other guidelines is offered in the following sections.)
A central component of the guidelines is advice to continue ordinary activities of daily living as normally as possible ‘despite the pain’. Many trials indicate that this approach can give equivalent or faster symptomatic recovery from symptoms, and leads to shorter periods of work loss, fewer occurrences, and less sickness absence over the following year than advice to rest until completely pain free.
This advice is captured in a user-friendly way in The Back Book,22 an evidence-based booklet developed in conjunction with the RCGP clinical guidelines (Box 11.4). This is a valuable handout to patients.
Box 11.4 Extracts from The Back Book which aims to promote self-coping in sufferers through positive evidence-based messages
? . . . back pain need not cripple you unless you let it!
Causes of back pain:
- ? . . . it is surprisingly difficult to damage your spine.
- ? . . . back pain is usually not due to anything serious.
Rest vs. active exercise:
- ? . . . bed rest is bad for backs.
- ? . . . exercise is good for you-use it or lose it.
Copers suffer less [than avoiders] at the time and they are healthier in the long run. To be a coper and prevent unnecessary suffering:
- ? Live life as normally as possible . . .
- ? Keep up daily activities . . .
- ? Try to stay fit . . .
- ? Start gradually and do a little more each day . . .
- ? Either stay at work or go back to work as soon as possible . . .
- ? Be patient . . .
- ? Don’t worry . . .
- ? Don’t listen to other people’s horror stories . . .
- ? Don’t get gloomy on down days . . .
Extracts reproduced from Kim Burton et al. The Back Book © Crown Copyright 2002, available from