The Management of Back Pain at Work AOHNP (UK) Symposium 13th May 2004 - PowerPoint PPT Presentation

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The Management of Back Pain at Work AOHNP (UK) Symposium 13th May 2004

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Management of physical and emotional stress/strain. Use of leisure centre facilities e.g. gym, badminton, squash, tennis ... Physiotherapy. Rehabilitation ... – PowerPoint PPT presentation

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Title: The Management of Back Pain at Work AOHNP (UK) Symposium 13th May 2004


1
The Management of Back Pain at WorkAOHNP
(UK) Symposium13th May 2004
  • Carol Coole
  • Occupational Therapist
  • NOTTINGHAM BACK TEAM

2
Nottingham Back Team
  • GP referrals back pain gt 6 weeks
  • Biopsychosocial assessment
  • Group treatment
  • Interdisciplinary team
  • Community based treatment
  • Cognitive-behavioural model

3
Main treatment elements
  • Paced activity
  • Graded exercise
  • Relaxation training
  • Medication advice
  • Goal focused treatment
  • Management of physical and emotional
    stress/strain
  • Use of leisure centre facilities e.g. gym,
    badminton, squash, tennis
  • Additional individual treatments as required
  • Occupational advice group

4
The Problem with Back Pain
  • If not well managed - costly to
  • Employers and business
  • Government
  • The individual physical health
  • work financial security
  • hobbies leisure
  • friends family
  • mental health

5
Understanding Pain
  • 1965 Gate Control Theory of Pain
  • 1979 International Association for the Study
    of Pain-
  • Pain is an unpleasant sensory and
    emotional experience, associated with actual or
    potential tissue damage, or described in terms
    of such damage
  • Pain is a mental, not a physical state
  • All pain is real to the sufferer, whether or not
    a cause can be found
  • The intensity of pain does not equate to the
    severity of the injury

6
Understanding Pain (cont.)
  • Subjective and unique
  • Fear of the pain may be as potent as the pain
    itself
  • The nervous system becomes oversensitive pain
    continues after healing
  • It can be modified by our thoughts, feelings and
    beliefs
  • Can lead to disability if poorly managed

7
Clinical Guidelines
  • 1994 Clinical Standards Advisory Group report
  • leading to
  • 1999 Royal College of General Practitioners
    Guidelines
  • Diagnostic triage (LBP is a diagnosis)
  • (consider differential diagnoses)
  • - Simple backache (common, recurrent)
  • - Nerve root problem (often resolves lt5)
  • - Possible serious spinal pathology (red flags)
    lt2
  • Routine Xrays/scans not advised for mechanical
    LBP
  • Assess for psychosocial risk factors (yellow
    flags)
  • Advise regular pain medication

8
Clinical Guidelines (cont.)
  • Advise early progressive return to normal
    activity even if with some pain
  • Refer on if not improving
  • Manipulation
  • Physiotherapy
  • Rehabilitation
  • Provide written information e.g. The Back Book
    to support advice given

9
2000 Occupational Health Guidelines
  • Evidence-based recommendations developed by the
    Faculty of Occupational Medicine
  • Pre-placement assessment of the worker with back
    pain
  • Prevention of back pain
  • Assessment of the worker with back pain
  • Managing the worker with back pain in work
  • Managing the worker off sick due to back pain

10
Obstacles to recovery 1 Red Flags
  • Possible serious spinal pathology e.g. tumour,
    fracture, infection
  • A clinical decision based on the following
  • Age of onset
  • Thoracic pain
  • PMH of cancer, steroid use, HIV
  • Significant recent trauma
  • Non-mechanical pain
  • Systemically unwell
  • Widespread neurological deficits
  • NB Immediate referral for cauda equina syndrome

11
Obstacles to recovery 2 Yellow Flags
  • Psychosocial factors which may lead to disability
    e.g.
  • A belief that back pain is harmful or severely
    disabling
  • A belief that avoidance of activity, or reduced
    activity levels will help recovery
  • A tendency to low mood and withdrawal from social
    interaction
  • An expectation that passive treatment(s) will
    bring about recovery

12
Obstacles to recovery 3
  • Physiological factors e.g.
  • De-conditioning muscle weakness, joint stiffness
  • Shortened scar tissue
  • Activity Cycling
  • Learnt pain

13
Obstacles to recovery 4
  • Occupational psychosocial factors (individual
    perceptions) e.g.
  • High job demands/low control
  • Time pressures/monotony
  • Low job satisfaction
  • Lack of supervisor/social support
  • A belief that the job is harmful to the back

14
Obstacles to recovery 5
  • Organisational occupational factors e.g.
  • Sickness policies
  • Occupational health management
  • Management style/culture
  • Working conditions
  • Organisational size and structure
  • Physical job demands

15
Workplace interventions
  • Aim to prevent disability (prevention of back
    pain is difficult)
  • Educate all workforce in back pain management
  • Help to stay at work/early return to work
  • Ensure policies and procedures reflect
    occupational health guidelines
  • Optimise take-up of existing NHS services for
    acute and non-acute back pain
  • (cont.)

16
Workplace interventions (cont.)
  • Buy-in private treatment(s) or provide in-house
    treatment (in accordance with clinical
    guidelines)
  • Provide information/advice/screening clinics for
    employees
  • - Reassure (triage?) but take back pain
    seriously
  • - Advise to remain active but pace activity
    (home and
  • work)
  • - Advise regular use of pain medication
  • - Refer for further assessment/treatment if
    required
  • Provide the Back Book to support advice given
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