Recommendations for management of uncomplicated back pain in the workers' compensation system: a focus on functional restoration.

OBJECTIVE

To present recommendations for conservative strategies to improve the management of uncomplicated back pain and to evaluate the financial crisis currently facing the workers' compensation system due in part to rapidly rising medical costs.

BACKGROUND

Medical costs in the workers' compensation system have risen at an alarming rate placing a tremendous burden on the cost of doing business in the United States. Historically, treatment for back pain in the United States has been a pathology-based approach; the literature supports a functional restorative approach for clinical efficacy and cost effectiveness.

DESIGN

Narrative overview of the literature.

METHODS

Computerized databases were searched for relevant literature in the English language from the years 1994-2004, including: Alternative Health Watch; Cochrane Database of Systematic Reviews; Pre-CINAHL; CINAHL; MEDLINE; AgeLine; SPORT Discus. A narrative synthesis of the literature was written from retrieved articles.

DISCUSSION

A history and overview of the workers' compensation system is presented. Concerns regarding rising medical costs and recommendations for strategies to improve cost and quality of care with an emphasis on ergonomic and functional restoration recommendations are made.

CONCLUSION

A percentage of costs in the workers' compensation system go towards treating uncomplicated back pain; recurrences and chronicity of back pain are key contributors to these costs, which are currently increasing. Ergonomic advice plays a key role in helping the patient with musculoskeletal injuries heal faster and prevent costly flare-ups. Conservative care, which includes chiropractic manipulation, ergonomic recommendations, and exercise rehabilitation with an emphasis on coordination and endurance training, is supported by the literature as a possible method of cost containment.