Important takeaways from recent guidance on back pain

Low back pain

A recent study: The Timing of Physical Therapy for Low Back Pain: Does It Matter in Workers' Compensation? by the Workers Compensation Research Institute (WCRI) found that early initiation of PT for workers with low back pain injuries leads to lower utilization and costs of medical services, as well as shorter duration of temporary disability. On average, the number of temporary disability weeks per claim was 58 percent longer for those with PT initiated more than 30 days postinjury and 24 percent longer for those with PT starting 15 to 30 days postinjury, compared with claims with PT within three days postinjury.

Also, workers whose PT treatment started more than 30 days postinjury were 46 and 47 percent more likely to receive opioid prescriptions and MRI, respectively, compared with those who had PT treatment initiated within three days of injury. The differences between PT after 30 days postinjury and PT within three days postinjury were 29 percent for pain management injections and 89 percent for low back surgeries.

Non-low back pain

In recently released clinical guidelines, the American College of Physicians and the American Academy of Family Physicians cite research showing that topical NSAIDs are among the "most effective for pain reduction, physical function, treatment satisfaction, and symptom relief, and were not associated with any significant harms" for treating acute pain from non-low-back musculoskeletal injuries. The groups are recommending topical nonsteroidal anti-inflammatory drugs, with or without menthol gel, as a non-opioid "first-line therapy" and note that opioids, including tramadol, shouldn't be used "except in cases of severe injury or intolerance of first-line therapies."

Takeaway: Back injuries are the leading cause of all musculoskeletal claims, which are the leading cause of all workers' compensation claims. A paradigm shift in the diagnosis and treatment of back pain has convincingly shown that alternatives to invasive procedures and opioids provide effective treatment and lead to shorter durations of disability and lower medical costs. Partnering with an occupational medicine provider will ensure an effective treatment plan for your injured workers.