Could an understanding boss help your bad back?

BMJ Group News

What do we know already?

Most people suffer from back pain at some point, and while many people recover, between 10 and 25 percent of people with low back pain have long periods where they're unable to work.

Treatments for back pain include painkillers, exercise, and physiotherapy. An important goal of treatment is to help someone get back to normal, as well as reducing pain. Researchers have been looking at a treatment programme where people's workplaces were modified to accommodate their bad back, and activity levels were built up over time.

What does the new study say?

The trial included 134 people aged between 18 and 65, all with back pain that had lasted at least three months. Half the people carried on seeing their usual doctor or physiotherapist. The other half went through a more intensive treatment programme, with changes to their workplace to help them adapt, occupational therapy, and physiotherapy that emphasised gradually returning to normal.

People who took part in the workplace programme were able to go back to work after three months on average. People who only had usual care faced an average of seven months' disability.

About 4 in 10 people in the workplace programme took drugs for their back pain in the year after the programme, compared with 6 in 10 people who didn't get the extra treatment.

How reliable are the findings?

The main problem with the study is that the people taking part in the workplace programme got far more treatment and attention than the comparison group, who just carried on with their previous treatment. All this attention might lead to a kind of placebo response.

People seem to do better when they're closely studied, regardless of what specifically is done to them. It might be that extra contact with health professionals helped to motivate people, or that people seeing a physiotherapist regularly didn't want to let them down by not being ready to work. It's difficult to separate these effects from benefits that might have been down to the treatment itself.

Where does the study come from?

Most of the researchers are based in the Netherlands. Their study was published by the BMJ (British Medical Journal), which is published by the British Medical Association. Funding came from several sources, including the VU University Medical Center and the Dutch Health Insurance Executive Council.

What does this mean for me?

The treatment people received included several different components. We already know that physiotherapy is useful, as are programmes like this one that combine several types of care. In terms of staying active and getting on with your life, there are obvious benefits to having changes made at work to help you adapt. However, it's hard to say just how important changes in the workplace are, as the study didn't look at this approach in isolation.
The study only looked at unexplained back pain, so the results might not apply to you if you've had back surgery, or if you have a bad back because of arthritis or some other cause.

What should I do now?

We know that the most important thing to do if you have a bad back is to stay active. Resting in bed can make you get stiff, weaken your muscles, and slow your recovery.
There are treatments your doctor can prescribe for back pain, but no one approach works for everyone. If your back pain has lasted a long time, be prepared to try a few different treatments.