Chapter

The Physician as Disability Advisor for Back Pain Patients

James Rainville, Glenn S. Pransky, Sarah Gibson and Pradeep Suri

in From Acute to Chronic Back Pain

Published on behalf of Oxford University Press

Published in print January 2012 | ISBN: 9780199558902
Published online November 2012 | e-ISBN: 9780191753343 | DOI: http://dx.doi.org/10.1093/med/9780199558902.003.0110
The Physician as Disability Advisor for Back Pain Patients

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When attending to patients with musculoskeletal complaints, physicians are required to give advice about the appropriate level of activities and work for the condition under treatment. Evidence suggests that this advice varies greatly between physicians. This variation results from multiple factors. From the perspective of physicians, differences in medical knowledge, attitudes and beliefs, negotiation abilities, and professionalism surrounding the doctor–patient relationship can all influence their recommendation. Patient, employer, and societal factors may also influence these recommendations.

Prolonged work avoidance has no identified therapeutic benefit and significant adverse effects on social well-being. Although some physicians recognize the impact of poor recommendations, most efforts to persuade physicians to discourage patients from sustained work absence have been unsuccessful. This may be in part due to an incomplete understanding by physicians of the processes whereby back pain-related disability becomes chronic (Guzman et al. 2002). Regardless, efforts to harmonize physicians’ recommendations to promote full return to activity or work despite chronic musculoskeletal pain seem warranted. One-dimensional interventions such as physician education or implementation of evidence-based guidelines have had limited effect on disability recommendations. Based on the available evidence, significant changes in physician recommendations will require educating both physicians and patients, along with altering societal expectations about back pain and work (Aylward and Waddell 2002). Successful multidimensional efforts have included educational material to enhance physicians’ knowledge combined with effective community-based efforts to influence patients’ functional expectations before they enter the physicians’ office. During the medical encounter, physicians should be motivated to address the issues where there is disagreement about disability, consistent with the standards of high quality doctor-patient communication. Accepting the input, and understanding the needs of employers and governmental organizations can aid the physician in providing appropriate medical input for these entities.

Thus, future research should concentrate on interventions that can change the attitudes and actions of key players in the disablement process, within the context of a particular sociopolitical environment. Even in the setting of expectations for prolonged disability, interventions that address all of the most significant factors underlying extended LBP-related work absence could be successful (Loisel et al. 2003). Our future challenge will be to generalize these findings in a way that will enable physicians, patients and employers to accept early, rapid, and safe return to activity and/or work as an expected outcome.

Chapter.  7965 words. 

Subjects: Neuroscience ; Pain Medicine

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