Diagnoses and treatment options in occupational low-back pain

Job modification is often effective for prevention of LBP, but employee selection is generally risky, unreliable, and (increasingly) illegal. For acute care, excellent results are obtained with a simple, well-organized protocol. A trial of additional interventions is usually not productive. In rehabilitation, the challenge is to choose interventions at the most cost-effective time and identify local programs which have proven effectiveness. Case-closure issues such as medical end-result, impairment rating, and permanent job restrictions continue to be poorly supported by scientific literature. They are often best resolved by consensus of the patient, physician, and employer. We look forward to more reliable predictors of long-term outcome. An old adage says, "If there are dozens of treatments for a disease, probably none of them is effective." In recent years we have advanced from dozens of equally acceptable treatments to a few well-documented ones, as outlined in the Quebec study. Such an approach is very effective in changing the course of back pain. However, there are still many unproven treatments in common use. Perhaps some will prove useful. In adding interventions to a simple, effective protocol, one must be aware of the true risks and benefits.