Abstract

This chapter has sought to address three aspects of back pain: the size of the problem, risk factors and preventive measures. In relation to each aspect the epidemiological approach, with particular reference to sociological and environmental factors, has been shown to have a useful role in clarifying what is on the whole a woolly clinical field. Furthermore, the problems of back pain present a challenge to clinicians from the many different specialties, including rheumatologists, orthopaedic surgeons, gynaecologists and psychiatrists, as well as those practising in more general fields as physicians and surgeons. In the face of such diversity of skills it is unlikely that a consensus will be reached without resorting to basic epidemiological principles. Back pain is among the most important cause of absence from work and long-term disability in Britain. Not only is there a formidable cost in terms of lost earnings, but those affected make heavy demands on the medical services and social security. The extent to which occupational hazards contribute to the aetiology by accelerating the onset of degenerative changes in the musculoskeletal system is difficult to assess. More studies need to be made, particularly among those who retire prematurely, change their jobs or stay off work for long periods. Cohort studies carried out prospectively are costly in manpower and time but it is only by such measures that light may be shed on factors about the workers, their low back pain and the tasks required by particular jobs which could affect prognosis. Primary prevention by controlling the weight and bulk of material being handled and also the posture adopted at work could be a possible starting point in preventing low back pain. Here again, more work needs to be done to establish which tasks and methods of performance are particularly hazardous. As far as secondary prevention or the early identification of those at risk is concerned, the low specificity and sensitivity of screening tests cast doubt over their effectiveness at the present time. There remain, therefore, many patients requiring rehabilitation, and this problem seems unlikely to decrease. Closer liaison needs to be established between health authorities and industry--possibly by such methods as attaching Disablement Resettlement Officers to hospital and appointing specialists in rehabilitation whose responsibility is not restricted to hospital-based patients.(ABSTRACT TRUNCATED AT 400 WORDS)

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