Get rid of workers’ compensation for back pain, a respected South Australian back surgeon has suggested, and patients and the broad community will benefit.

"I am beginning to feel, after so many years practising in this difficult field, that we may be all better off,” Dr Orso Osti told a public forum on back pain in the workplace.

Everyone, that is, except for rehabilitation providers, lawyers, doctors and insurers, who according to Dr Osti, “prosper on...people’s long-term misery”.

The problem begins when patients first talk to their doctor about their back pain. Serious injuries to the spine are very rare: for most people, back pain is a result of the natural ageing process, and doctors are usually unable to pinpoint a specific problem.

According to Dr Osti, the onus then falls on the patient, to prove that there really is something wrong with them, which in turn diminishes their capacity to cope with back pain effectively.

If, however, as Dr Osti says, the problems begin in the doctor’s surgery, how will getting rid of compensation for back pain solve the problem?

While we know that people who claim compensation have worse health outcomes for a whole range of injuries, including back pain, we also know that the advice people are given about managing their back pain is not always evidence-based, and may in fact intensify and prolong pain.

Dr Kevin Purse, former director of SA WorkCover and now with the Hawke Research Institute at UniSA, described Dr Osti's suggestion as an "appalling prescription".

 "They shouldn't be penalised for being injured," he said, but acknowledged that there may be a need to reform the system.

Dr Aage Indahl, a Norwegian back pain specialist, says that the increase in chronic back pain observed in many highly developed countries is likely a result of “the way we’ve been treating people.”

Dr Indahl identifies two things that delay recovery from back pain: failing to understand the causes of back pain, and “protecting” the back, by tensing muscles and limiting movement.

“It’s very important to know that the spine is very strong, and very difficult to harm. Back pain usually comes from the muscles that support the spine, and is usually caused by minor problems. Worrying about back pain doesn’t help get rid of it, and nor does tensing up. Many people find that by moving lightly around, and not being afraid, pain becomes less and less of a problem. When you have a positive attitude, and move around enough to have good circulation in your muscles, you free Nature up to do its job, and fix the problem.”

Not all doctors are clued into the best-practice treatment for common back pain, and in South Australia where Dr Osti is based, Dr Mary Wyatt has observed treating practitioners pushing their patients in the opposite direction.     

“In South Australia, workers are often declared fit to work, but have limitations placed on them that make return to work extremely unlikely. For example, a worker might be told that they can only work two hours a day, for three days a week. The employer and the worker might both think that returning for three two hour stints is a waste of time; so an opportunity to remain active and engaged with normal life is lost.”

Rather than getting rid of workers’ compensation for back pain, how about reforming the workers’ comp system, and improving the standard of advice given by treating practioners to people suffering from back pain, so that both promote recovery?

It can be done. Dr Indahl’s research has included the assessment of a back pain education program, in which patients with back pain who had been off work for 8-12 weeks were divided into a control group and a treatment group. The control group continued with their “normal care', which consisted of seeing their local doctor and continuing any other treatment (e.g. physiotherapy) they were having. The treatment group continued with normal care (as did the control group), but with the addition of attending a specialist clinic.

Patients attended the clinic on two occasions, and both times were given information about their back pain. They were reassured that the back pain was unlikely to be a serious problem, and informed that severe back pain was best thought of as inadequate circulation in the muscles and that neither the pain nor the resulting muscle spasms indicated a serious long term problem.

They were also advised to continue doing normal activities, and avoid being too careful of their back.

The results?

People who attended the back pain education clinic:

• Had 50% less days absent from work;
• Were twice as likely to return to work;
• Were half as likely to have a long term disability; and
• Had 50% less disability when followed up five years later.

Dr Osti’s remarks are taken from this article, posted on Adelaide Now.