As both a patient and student of the back injury treatment industry, I have used this blog to discuss what I believe to be major impediments to recovery.
These include surgery, which, particulary for a diagnosis of “regional back pain”, is over-prescribed, rarely helps more than conservative treatment and in some cases makes the problem worse.
The psyche of the patient also hinders recovery, in my opinion, because patients “catastrophize” their injuries, leading them to protect them and furthering the cycle of pain and disability. I would add stress into this category as well, because I believe mind-body connection advocates who conclude that internalizing pscychological pain can cause physical pain, particularly in the lower and upper back.
Finally, I would say inactivity obviously hampers recovery, as does being overweight and excessive reliance on pain medications.
Dr. Nortin Hadler, in his fascinating book, Stabbed in the Back: Confronting Back Pain in an Overtreated Society, adds a counterintuitive item to the list: the worker’s compensation system. While he credits the indemnity program – used in the U.S. and other countries under different names – for successly reintegrating victims of traumatic work injuries back into the workforce, he holds it up as an abject failure when it comes to back injuries.
That’s because the status of those unfortunate enough to injure their backs at work immediately shifts from patient to claimant, Hadler observes. This designation can send patients on a years-long search to determine the degree of their injury – a journey that can lead to sometimes unnecessary surgeries because “refusal of treatment taints the claimant with innuendo that he or she does not really want to get well and return to work.”
“If you have to prove you are ill, you can’t get well,” Hadler writes. “Being challenged naturally causes anyone to focus on his or her symptoms, to recall the waxing more than the waning of symptoms, to be less inventive in circumventing activities that might aggravate them, and to consider any coincidental regional musculoskeletal disorder as yet another setback.”
This self-defeating, litigious downward spiral is creating legions of back pain sufferers stuck in a horrible limbo – unable to work and unable to heal, Hadler writes. And it’s an extremely expensive conundrum, as well.
While 80 percent of U.S. workers compensation claims are related to tramatic injuries such as dismemberment, Hadler writes, 80 percent of medical and indemnity payouts relate to the other 20 percent – claims that involve “regional musculoskeletal disorders, regional low back “injury” in particular,” he adds.