The role of the primary care physician in reducing work absenteeism and costs due to back pain.

In many cases, the primary physician may best serve his or her patient's interests by encouraging an early return to work and avoidance of adversarial proceedings. Though data are fragmentary, it seems likely that these goals will be promoted by reassuring patients about the good prognosis of acute back pain and by avoiding alarming terminology (e.g., "injury," "ruptured disc"). Patients have a great need for explanation of their symptoms, but this can usually be met by brief, clear explanations from the physician and need not require extensive diagnostic testing. In most cases, a parsimonious diagnostic approach is appropriate, and this may reinforce the message that the illness is not serious and should be self-limited. For patients without neurologic deficits, very brief if any bed rest is necessary, and an early (if gradual) return to work is usually feasible. Many faddish treatments are widely promoted but rarely tested in a rigorous way. Anti-inflammatory drugs and intervention with adverse lifestyles (sedentariness, smoking, and obesity) provide important therapeutic and preventive opportunities.