From the Guidelines
For patients with back pain, work restrictions should be minimized and a gradual return to normal activities encouraged whenever possible, as prolonged work restrictions can worsen outcomes by promoting deconditioning, fear-avoidance behaviors, and delayed recovery. I recommend limiting heavy lifting (typically under 15-20 pounds), avoiding repetitive bending or twisting, and allowing for position changes every 30-60 minutes. These restrictions should be time-limited, usually 1-2 weeks, with a clear plan for progressive return to full duties. Medications like acetaminophen (500-1000mg every 6 hours) or NSAIDs such as ibuprofen (400-600mg every 6-8 hours) can help manage pain during this transition, as supported by the American College of Physicians and the American Pain Society guidelines 1.
Some key considerations for managing back pain and work restrictions include:
- Providing patients with evidence-based information on low back pain, including its expected course and effective self-care options 1
- Encouraging patients to remain active and providing information about effective self-care options, such as self-care education books and heat application 1
- Considering the use of medications with proven benefits, such as acetaminophen or NSAIDs, in conjunction with back care information and self-care 1
- Referring patients to specialist input for further evaluation and management if necessary, particularly for those with severe or progressive neurologic deficits or suspected serious underlying conditions 1
It's also important to note that the evidence is insufficient to guide specific recommendations about the utility of modified work for facilitating return to work 1. However, brief individualized educational interventions and self-care education books can be effective in reducing sick leave and improving outcomes for patients with back pain 1.
Overall, the goal of managing back pain and work restrictions should be to promote a gradual return to normal activities, minimize work restrictions, and provide patients with the necessary tools and support to manage their condition effectively, as recommended by the British Pain Society's spinal care pathway 1.
From the Research
Back Pain and Work Restrictions
- Back pain is a common issue that affects work ability, with patients often receiving little or no work-focused guidance and support from GPs and other clinicians 2.
- A qualitative study found that patients with back pain had concerns about their ability to work, future job security, and the impact of back pain on their work capacity 3.
- The study also found that patients felt the need to justify their condition with a medical diagnosis and evidence, and were concerned about how back pain was viewed by their employers and co-workers 3.
- Return to work, if safe, is beneficial for recovery and well-being, and physicians may need to actively communicate with employers and others to achieve safe and sustained return to work 4.
- A clinical perspective on chronic low back pain suggests that assessing treatment effectiveness should consider multiple domains, including physical, psychological, social, and health-related quality-of-life measures, in addition to pain intensity 5.
Work-Related Help and Advice
- Patients with back pain often receive sickness certification as the main method of managing work problems, but may not receive assistance with temporary modifications or work-focused guidance and support 2.
- Clinicians and employers may need to address the concerns and needs of patients with back pain, including providing reassuring messages about activity and facilitating the return to work process 4.
- A biopsychosocial model of pain management may be useful in addressing the multidimensional nature of chronic low back pain, including physical, psychological, and social factors 5.
Implications for Work Restrictions
- Work restrictions may be necessary for patients with back pain, but should be implemented in a way that supports return to work and minimizes the risk of long-term disability 4.
- Clinicians and employers should consider the individual needs and circumstances of patients with back pain, and provide support and guidance to enable them to continue working safely and effectively 2, 3, 4.