Copy of OSHA Trade Release

Copy of the April 30, 2018 OSHA Trade Relase re: Tracking of Workplace Injuries and Illnesses electronically. For more info go to OSHA.gov.

Trade Release

Department of Labor, United States of America

U.S. Department of Labor
Occupational Safety and Health Administration
Office of Communications
Washington, D.C.
www.osha.gov

For Immediate Release
April 30, 2018
Contact: Office of Communications
Phone: 202-693-1999

U.S. Department of Labor Fixes Error Dating to 2016 Implementation of “Improve Tracking of Workplace Injuries and Illnesses” Regulation

WASHINGTON, DC – Following a review of the requirements put in place in 2016 regarding the “Improve Tracking of Workplace Injuries and Illnesses” regulation, the U.S. Department of Labor’s Occupational Safety and Health Administration (OSHA) has taken action to correct an error that was made with regard to implementing the final rule.

OSHA determined that Section 18(c)(7) of the Occupational Safety and Health Act, and relevant OSHA regulations pertaining to State Plans, require all affected employers to submit injury and illness data in the Injury Tracking Application (ITA) online portal, even if the employer is covered by a State Plan that has not completed adoption of their own state rule.

OSHA immediately notified State Plans and informed them that for Calendar Year 2017 all employers covered by State Plans will be expected to comply. An employer covered by a State Plan that has not completed adoption of a state rule must provide Form 300A data for Calendar Year 2017.  Employers are required to submit their data by July 1, 2018. There will be no retroactive requirement for employers covered by State Plans that have not adopted a state rule to submit data for Calendar Year 2016.

A notice has been posted on the ITA website and related OSHA webpages informing stakeholders of the corrective action.

Under the Occupational Safety and Health Act of 1970, employers are responsible for providing safe and healthful workplaces for their employees. OSHA’s role is to ensure these conditions for America’s working men and women by setting and enforcing standards, and providing training, education and assistance. For more information, visit www.osha.gov.

# # #

Beyond the costs of an injury — BWC Blog

A good read about prevention of injury and the need to address health disparities.

By Mark Leung, BWC Technical Medical Specialist, Recently promoted from the BWC Safety & Hygiene Fellowship program Occupational health and safety has been a public health focus for many years. Emphasizing worker protection and well-being advances the overall goal of reducing negative health outcomes in the future. The need to address health disparities within the […]

via Beyond the costs of an injury — BWC Blog

Origin of May Day | Bombing of Haymarket Square on May 4, 1886

International Labors Day – May 1 each year

According to the NIST Institute, May 1st of every year is known as International Labors Day and is dedicated to paying tribute to the Workers. 

It is also known as “May Day” and “International Workers Day,” and is a National Holiday in India and at least 80 other countries. 

apple-laptop-startup-photos

 

 

 

Origin of May Day

May Day originated by Labor Unions of the United States and Canada  in 1886 when on May 1st, the U.S. Labor Movement went on Strike to support an 8 hour work day and have better pay. 

 

Bombing of Haymarket Square on May 4, 1886

According to Wikipedia,  

“The Haymarket Affair was the aftermath of a bombing that took place at a labor demonstration on Tuesday, May 4, 1886, at Haymarket Square in Chicago. 

“It began as a peaceful rally in support of workers striking for an eight-hour day and in reaction to the killing of several workers the previous day by the police.  An unknown person threw a dynamite bomb at police as they acted to disperse the public meeting.”

The parties  to the civil conflict were the Federation of Organized Trades and Labor Unions (resulting in 4 deaths and 70+ injured) and the Chicago Police Department (resulting in 7 deaths and 60 injured).

President Grover Cleveland – 22nd and 24th President of U.S.

According to Wikipedia,

“Stephen Grover Cleveland was the 22nd and 24th Present of the United States, the only president in American history to serve two non-consecutive terms in office (1885-89 and 1893-97) . . . President Cleveland launched the Progressive Era.”

President Grover Cleveland Signed 8 Hour Work Day Into Law

President Grover Cleveland signed the 8 hour work day into law in 1894 as a result of the strike that occurred in 1886. 

U.S. and  Canada Celebrate Labor Day September 1st

The United States and Canada observe Labor Day on September 1st each year while most of the world celebrate Labor Day on May 1st.

Haymarket Massacre in Chicago as Origin of May Day

According to Wikipedia, “The Haymarket Affair is generally considered significant as the origin of International May Day observances for workers.” 

According to labor studies Professor, William J. Adelman:

“No single event has influenced the history of labor in Illinois, the United States, and even the world more than the Chicago Haymarket Affair.  It began with a rally on May 4, 1886, but the consequences are still being felt today.  Although the rally is included in American history textbooks, very few present the event accurately or point out its significance.”

Four Boring Foam Studies

Four Boring Foam Studies:

1)     Journal of Rehabilitation Research and Development, Vol. 27, No. 3, 1990, Pages, 229-238,“Load-bearing Characteristics of Polyethylene Foam:  An Examination of Structural and Compression Properties,” written by Eric J. Kuncir, MSBE;  Roy. W. Wirta, BSME;  Frank L. Golbranson, M.D.:   This work was supported by a grant entitled:  “Foot Interface Pressure Study,” from the Department of Veterans Affairs Rehabilitation Research and Development Service and was conducted at the DVA Medical Center, San Diego, California, U.S.A.”

“The use of cellular foams in the orthotics and prosthetics industries is widespread and ranges from applications as shoe insole material to prosthetic limb inserts.

“It is our impression that orthotic and prosthetic practitioners select interface materials, including cellular foams, in an arbitrary fashion based on availability and personal knowledge.

“Contributing to the arbitrariness of material selection is a lack of published information on detailed mechanical properties of cellular foams . . . We have studied the structural and compression properties of cellular foams.

“This discussion is relevant to orthotists and prosthetists because it addresses an overview of the properties of cellular foams, the knowledge of which may be useful in the determination of the function of a particular foam material in load-bearing applications.”

“Cellular polyethylene foams are best described as a mass of bubbles composed of a plastic and a gas phase.  The polymer is distributed in the walls of the bubbles and the lines where the buttles intersect (Blair, E.A., 1967).

“The bubbles are referred to as cells, the lines of intersection are called ribs or strands, and the walls are called windows . . . Depending on the configuration of this two phase gas/solid system and on the synthetic material used, cellular plastics exhibit a wide range of mechanical properties.”

OPEN CELL VS. CLOSED CELL FOAMS

“In general, two major descriptions are offered to characterize structural features of cellular materials.

“An open cell material is one which has open windows leaving many cells interconnected in such a manner that gas may pass from one cell to another.

“Alternatively, closed cell materials are made up of discrete cells through which gasses do not pass freely.”

“A physical test of the mechanical behavior of a material can be done by continuously measuring the force required to develop a degree of compression.  This information is useful because it aids in an evaluation of a foam’s response under load-bearing conditions.”

Compression data or polyethylene foam obtained by Skochdopole, 1965, in which compressive load versus percent compression for polyethylene foams of increasing open cell character was plotted.

The data show that compressive load of polyethylene foam increases as fraction of open cells decreases.

“When there is a small fraction of open cells, the compression force is distributed over a larger number of cell walls and ribs thereby increasing the compressive resistance.

“At larger degrees of compression, the data presented indicates that compressive load increases as the fraction of open cells decreases . . . This implies that foams of increased open cell character must provide less resistance to escape of gasses, which explains the reduction in compression resistance as open cell character increases.”

“It can be concluded that the influence of cell geometry on the mechanical properties of cellular foams is significant.  Specifically, increased compression strength is acquired as the cell diameter decreases.  In addition, decreasing the fraction of open cells increases the required force for a given degree of compression.”

“Closed cell polyethylene foam materials exhibit both time-related and non-time-related properties under load-bearing conditions.  The non-time-related properties happen under rapid cyclic loading conditions . . . The time-related properties happen when a load is sustained either a static load or an extended period of cyclic loading.”

2)     Journal of Rehabilitation Research and Development, Vol. 27, No. 2, 1990, “Reduction of Sitting Pressures with Custom Contoured Cushions,”  written by Stephen Sprigle, Ph.D.; Kao-Chi Chung, Ph.D.;  Clifford E. Brubaker, Ph.D., University of Virginia Rehabilitation Engineering Center, U.S.A.:
The authors state the following:
“Previous research indicated that matching a cushion to the shape of the buttocks results in less tissue distortion and lower interface pressures.”
“Material studies were determined by examining the load-deflection curves for flat foams of 1, 2, and 3 inch thickness.”
“It was found that sitting on contoured foam resulted in a lower pressure distribution than sitting on flat foam; and sitting on soft foam resulted in a lower pressure distribution than sitting on a stiffer foam.”
“Loaded contoured foam demonstrated increased enveloping of the buttocks, decreased foam compression, and a more uniform pressure distribution.  These attributes are typical of a safer sitting surface and may indicate less disuse distortion.”

The authors make the following statements:

TISSUE TRAUMA

“Wheelchair users often sit 12 to 16 hours a day while participating in daily activities . . . special seating support especially for spinal cord injured (SCI) persons and others with insensate skin.”
“Over the past three decades, many studies have focused on the biomechanical aspects of decubitus formation.  Tissue trauma is now recognized as a multidimensional process with externally applied pressure being identified as a primary contributing factor, (Bennett, L.; Kanner, D.; Lee, B. K.; and Trainor, F.A., 1979; Krouskop, T.A., 1983).”

TISSUE DISTORTION VS. TISSUE TRAUMA

“Recently, tissue distortion has also been identified as a potentially damaging condition, (Chung, K.C., 1987; Swart, M.E., 1985).”
“These two risk factors are related because distortion results from the external forces being exerted on soft tissue.”
“The original analysis of contact stresses was published in 1881 by Heinrich Hertz.”

 

3)     American Journal of Nursing, 1987,“Sitting Easy:  How Six Pressure-Relieving Devices Stack Up”:   written by Robin Chagares, R.N., M.A., M.S.N.; and Bettie S. Jackson, RN, Ed.D., F.A.A.N., Montefiore Medical Center, N.Y., U.S.A.:

The authors open with the following statements (1987 prices):

PREVENTING SKIN BREAKDOWN IS A PRIORITY

 “A single pressure sore costs more than $8,000 to heal.  Multiply that cost by more than a million hospital and nursing home patients who will develop pressure sores this year, and you see why preventing skin breakdown is a health care priority, (Hargast, T., 1979; Staggs, K., 1983).”

INTRINSIC FACTORS

The authors include the following findings:

“A number of intrinsic (within the body) factors such as:
·        immobility,
·        poor circulation,
·        malnutrition,
·        and elderly skin contribute to the development of pressure sores.

EXTRINSIC FACTOR(S)

“The only extrinsic (coming from outside the body) factor is pressure.”

“A healthy individual can develop pressure sores in six to twelve hours if left undisturbed in the same position, (Hargast, T., 1979; Staggs, K., 1983; Torrence, C., 1981).”

6 Pressure­-Relieving Devices Tested:

·        air doughnut pillow;
·        water donut  pillow;
·        Eggcrate cushion;
·        Spencegel pad;
·        Sheepskin;
·        Cotton-filled disposable pillow

RESULTS

“Of the six different pressure-relieving devices studied, the air donut was least effective in reducing inter surface pressures.  In addition, subjects reported it to be quite uncomfortable to sit on.

People Should Have More Than 1 Pressure-Relieving Device

All the other devices reduced inter-surface pressure about equally . . . having more than one pressure relieving device to choose from allows selection based on individual patient comfort.

“Pressure on capillaries (the smallest blood vessels) over time leads to tissue necrosis (degeneration.)  None of the devices tested minimized sitting surface pressures generated when sitting in one position.  To prevent tissue damage, people must be able to shift their weight or be assisted to alternate pressure points.”

4)     J.  Biomechanics.  Vol.  15, No. 7, 1982, “Model Experiments to Study the Stress Distributions on a Seated Buttock,” Narender P. Reddy, Himanshu Patel, George Van B. Cochran, Biomechanics Research Unit, Helen Hayes Hospital; and John B. Brunski, Center for Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, Ny, U.S.A.:
Buttock Stress States During Sitting

    “Mechanical stress states that develop in the buttock during sitting may exceed tissue tolerance and lead to decubitus ulcer formation in susceptible patients, such as those with spinal cord injury.
“The danger of this complication can be reduced by using suitable cushions to minimize stress magnitudes and gradients within soft tissues.
“In this investigation, a two-dimensional physical model of the buttock-cushion system was developed to aid in cushion design.”

5 Materials Selected for Initial Tests

“Although many cushion materials are in current commercial use, the following five representative materials were selected for these initial tests:

1)    Gel;
2)    Medium density foam;
3)    Soft foam;
4)    Stiff foam;
5)    Viscoelastic ‘T-Foam.’”

“In order of increasing maximum compressive stress generated in the buttock model, the material samples of equal thickness can be ranked as follows:

1)    Medium density foam;
2)    Soft foam;
3)    Gel;
4)    Viscoelastic foam;
5)    Stiff foam.”

“The enveloping property of a seat cushion is a measure of its tendency to wrap around the object it supports, (i.e., in the present case, the buttock model).  A good enveloping cushion provides a large contact area and a uniform stress distribution, (Chow, 1974; Cochran and Palmieri, 1979).’

Hemorrhoids, History & the Western World

Hemorrhoids

Hemorrhoids are one of the most frequent problems people in westernized countries face. There are estimates of up to 75 to 90 percent occurrence rates of hemorrhoids in the U.S. population (1, 2, 3, 4, 5). An estimated 50 percent of those over the age of 50 years require some type of conservative or operative therapy (4).

The cost to the community, both financial and in lost work days, is great; and by any standards, this condition must be considered a major health hazard (7).

Seating & Hemorrhoids

Preventative measures to reduce risk factors for the development of hemorrhoids should be taken before it is too late. It is important to minimize external compression from poorly designed seating as much as possible. External compression from poorly designed seating concentrates forces on small areas of the body. This results in high localized pressure. The pressure can compress nerves, vessels, and other soft tissues, resulting in tissue-specific damage. These changes may themselves result in disease or predispose other tissues to damage.

U.S. History & Hemorrhoids

Hemorrhoids have plagued men and women for centuries, inflicting pain equally on individuals at all levels of society and of all occupations: Emperors (Napoleon); U.S. Presidents (Jimmy Carter); baseball sluggers (George Brett); judges; policemen; truck and cab drivers; and jockeys (6).

Ancient History & Hemorrhoids

It has been said that Napoleon’s hemorrhoids were troubling him during the battle of Waterloo (7).

Proctology flourished as a specialty in Ancient Egypt. The surgical treatment of hemorrhoids was practiced in Ancient Greece, and Hippocrates suggested that the cause could be attributed to bile and phlegm (8).

The Western World vs. The Third World & Hemorrhoids

Today, hemorrhoids are considered to be one of the most common ills of men and women, a judgment made by those with vision limited to the Western World (7).

The high rate of hemorrhoids in westernized societies contrasts sharply with Third World countries. Only about one in 25 to one in 30 individuals is thought to have hemorrhoids as compared to one in two individuals in Westernized societies. One doctor recounted in 30 years’ practice in Africa, one of the only two patients he saw with severe hemorrhoids was a prince taking a semi-European diet (5, 7).

1) Primary Care, Volume 26, Number 1, March, 1999, “Hemorrhoids,” by Joy N. Hussain, M.D., Cairns Base Hospital, Australia.
2) Family Medicine Principles & Practices, 1998, Fifth Edition: Chapter 91, “Diseases of the Rectum and Anus,” by Thomas J. Zuber.
3) MJA, Vol. 167, July, 1997, Clinical Practice, “Hemorrhoids: A Clinical Update,” written by Adrian L. Polglase, M.S., FRACS, Clinical associate Professor and Colorectal Surgeon, Australia.
4) American Family Physician, September 1, 1995, “Non-surgical Treatment Options for Internal Hemorrhoids, written by John Pfenninger, M.D., and James Surrel, M.D.
5) Surgical Clinics of North America, Vol. 65, No. 6, December, 1988, “Hemorrhoids, Non-operative Management,” written by A. R. Dennison, M.D.; D.C., Wherry, M.D.; and D.L. Morris, M.D., Ph.D.
6) Southern Medical Journal, Vol. 81, No. 5, May, 1988, “Alternatives in the Treatment of Hemorrhoidal Disease,” by Emmet F. Ferguson, Jr., M.D., University of Florida, School of Medicine, Jacksonville, F.L., U.S.A.
7) Postgraduate Medical Journal, September, 1975, 51, 631-636, “Hemorrhoids – Postulated Pathogenesis and Proposed Prevention,” written by D. P. Burkitt, C.M.G., M.D., F.R.C.S., F.R.S., and C.W. Graham-Stewart, MS, F.R.C.S.
8) The American Journal of Proctology, Vol. 21, No. 3, June 1970, “An Epidemiological Investigation of Hemorrhoids, written by John Philpot, Ph.D., Rutgers, The State University, New Jersey, U.S.A.

Forward Bending & Low Back Pain

Spine, Volume 21, Number 1, pp. 71-78, 1996, “Analysis of Lumbar Spine and Hip Motion During Forward Bending in Subjects With and Without a History of Low Back Pain,” written by Marcia A. Esola, M.S., P.T.; Philip W. McClure, M.S., P.T.; G. Kelley Fitzgerald, M.S., P.T.; and Sorin Siegler, Ph.D., U.S.A.:

In this study, a motion analysis system was used to measure the amount and velocity of lumbar spine and hip motion during forward bending.

The authors begin by citing the following previous findings:

EPIDEMIC OF LOW BACK PAIN

“Disorders of the low back have reached epidemic proportions, (DeRosa, C.P., 1992).”

BILLIONS OF $$$ ANNUALLY, LOST WORK TIME & WORKERS’ COMP CLAIMS

“Epidemiologic studies show that billions of dollars are spent annually on the problem of low back pain, which is one of the most commonly-cited problems for lost work time in industry and Workers’ Compensation claims, (Chase, J.A., 1992; Frymoyer, J.W., 1988; and Pope, M.H., et al., 1991).”

FREQUENT FORWARD BENDING & LOW BACK PAIN

“Researchers have shown an association between frequent forward bending and low back pain, (Berquist-Ullman, M., et al., 1977; Magora, A., 1973; Mellin, G., 1986; Punnett, L, et al., 1991; Svensson H.O., et al., 1989; Videman T., et al., 1989).”

SLOUCHING WHILE SEATED / BENDING AT THE WAIST WHILE STANDING

“Prolonged sitting with the lumbar spine in a flexed position (slouching) and flexed standing postures (bending at the waist) are also associated with an increased risk of low back pain, (Anderson, G.B.J., 1991; Berquist-Ullman, M., et al., 1977; Magora, A., 1972; Punnett, L., et al., 1991; Riihimaki, H., et al., 1989).”

OCCUPATIONS INVOLVING REPETITIVE FORWARD BENDING

“Saunders reports that people with herniated inter-vertebral discs often have a history of an activity or occupation involving repetitive forward bending.”

“Nachemson (1981) has shown that inter-vertebral disc pressure increases 20 percent over that measured in standing when forward bending 20 degrees, and increases 100 percent when bending up to 40 degrees.”

INADEQUATE HIP FLEXIBILITY & EXCESSIVE LUMBAR MOTION

“It has been suggested that inadequate hip flexibility coupled with excessive lumbar motion during forward bending results in low back pain, (Biering-Sorenson, F., 1984; Sahramann, S.A., 1993). . .Sahramann (1993) suggests that excessive lumbar mobility leads to tissue overloading, micro-trauma, and ultimately the development of degenerative joint and disc disease. A person may experience low back pain at any stage of this sequence of events.

FORWARD BENDING = RISK FACTOR FOR LOW BACK PAIN

“Forward bending has been clearly recognized as a risk factor for low back pain. Altered movement patterns of the lumbar spine and hips during forward bending may help explain why forward bending is a risk factor for the development of low back pain.”

HAMSTRING STRETCHING HELPFUL 

In the conclusions, the authors state: “The results provide quantitative data to guide clinical assessment of forward bending motion.  Results also suggest that although people with a history of low back pain have amounts of lumbar spine and hip motion during forward bending similar to those of healthy subjects, the pattern of motion is different.  It may be desirable to teach patients with a history of low back pain to use more hip motion during early forward bending, and hamstring stretching may be helpful for encouraging earlier hip motion.”

MAINTENANCE OF LUMBAR LORDOSIS = DECREASED RISK OF LOW BACK PAIN,  ISCHIUM (BUTT BONE) PAIN, & COCCYX (TAIL BONE) PAIN

MAINTENANCE OF LUMBAR LORDOSIS = DECREASED RISK OF LOW BACK PAIN,  ISCHIUM (BUTT BONE) PAIN, & COCCYX (TAIL BONE) PAIN

Spine, Volume 22, Number 21, pp. 2571-2574, 1997, “Lumbar Lordosis, Effects of Sitting and Standing,” written by Michael J. Lord, M.D.; John M. Small, M.D.; Jocylane M. Dinsay, R.N., M.N.; and Robert G. Watkins, M.D., Kerlan-Jobe Orthopedic Clinic, California, U.S.A.:

The objective of the above-mentioned study was to document changes in segmental and total lumbar lordosis (inward curvature of the lumbar spine) between sitting and standing radiographs (x-rays).

“One hundred and nine patients with low back pain underwent radiography in the sitting and standing positions. The patients ranged in age from 21 years to 83 years (mean age, 47 years) and had had no prior lumbar spine fusion or clinical deformity. Seventy men and 39 women took part in the study.”

DECREASED LUMBAR LORDOSIS & LOW BACK PAIN

In their discussion, the authors state the following:

“Keegan (1953) in a study of the relationship between lordosis and sitting, found the most important factor in low back pain with prolonged sitting to be decreased trunk-thigh angle with consequent fattening of the lumbar curve.  Use of a lumbar roll that increases lordosis has been found to decrease low back pain, (Williams, A.M., et al., 1991).”

DECREASED LUMBAR LORDOSIS & BUTT PAIN / TAIL-BONE PAIN

“With decreased lordosis, sitting pressure increases over the ischium (butt bones) and coccyx (tail-bone) with resultant pain, (Drummond, D.S., et al., 1982 and 1985; Smith, R.M., et al., 1992.)

The following conclusions were made:

“Segmental and total lordosis were significantly different in the sitting and standing postures. Lordosis increased almost 50 percent when the patients moved from the sitting to the standing position. The clinical significance of this data may pertain to:

  1. The known correlation of increased intra-discal pressure with sitting, which may be caused by this decrease in lordosis;
  2. To the benefit of a sitting lumbar support that increases lordosis; and
  3. To the consideration of an appropriate degree of lordosis in fusion of the lumbar spine.”

 

 

 

Trade Release – OSHA – electronically submit injury and illness data on August 1, 2017 – Form 300

OSHA Electronic Filing August 1, 2017

Trade Release

Department of Labor, United States of America

U.S. Department of Labor
Occupational Safety and Health Administration
Office of Communications
Washington, D.C.
www.osha.gov
For Immediate Release
July 14, 2017
Contact: Office of Communications
Phone: 202-693-1999

OSHA launches application to electronically submit injury and illness data on August 1

WASHINGTON – The Occupational Safety and Health Administration will launch on Aug. 1, 2017, the Injury Tracking Application (ITA). The Web-based form allows employers to electronically submit required injury and illness data from their completed 2016 OSHA Form 300A. The application will be accessible from the ITA webpage.
Last month, OSHA published a notice of proposed rulemaking to extend the deadline for submitting 2016 Form 300A to Dec. 1, 2017, to allow affected entities sufficient time to familiarize themselves with the electronic reporting system, and to provide the new administration an opportunity to review the new electronic reporting requirements prior to their implementation.
The data submission process involves four steps: (1) Creating an establishment; (2) adding 300A summary data; (3) submitting data to OSHA; and (4) reviewing the confirmation email. The secure website offers three options for data submission. One option will enable users to manually enter data into a web form. Another option will give users the ability to upload a CSV file to process single or multiple establishments at the same time. A third option will allow users of automated recordkeeping systems to transmit data electronically via an application programming interface.
The ITA webpage also includes information on reporting requirements, a list of frequently asked questions and a link to request assistance with completing the form.
Under the Occupational Safety and Health Act of 1970, employers are responsible for providing safe and healthful workplaces for their employees. OSHA’s role is to ensure these conditions for America’s working men and women by setting and enforcing standards, and providing training, education and assistance. For more information, visit www.osha.gov.
# # #

Musculoskeletal Pain = Leading Cause of Early Pensions

Textbook of Pain, 1998, “Prevention of Disability due to Chronic Musculoskeletal Pain,” written by Steven James Linton:

The above-mentioned chapter in the Textbook of Pain, “examines procedures designed for use in health-care settings to prevent disability due to musculoskeletal pain.”

The following statement is made:

“Because musculoskeletal pain is a major source of suffering, health care, and utilization of compensation, there is a definite need for prevention.  However, prevention is not an easy task because disability is related to a developmental process in which multidimensional factors operate over time to produce significant lifestyle changes.  Research on risk factors indicates that although medical and workplace factors are obvious, psychosocial variables are central to the transition from acute to chronic pain.  The early identification of ‘at-risk’ patients is a key to allocating resources and initiating secondary prevention.”

“Unfortunately, we do not yet understand the exact mechanisms that produce musculoskeletal pain.”

ACUTE PAIN

“Acute pain – Pain which is generally defined as pain up to about three weeks is characterized by temporary decreases in activity, reliance on medication, and help-seeking.  It is accompanied by psychological distress; for example, fear, anxiety and worry, in addition to beliefs that pain is controllable through medical and active coping…The patient may have organic findings as well as muscle spasms.

SUBACUTE PAIN

“Subacute pain – Pain which is considered to be between 3 and 12 weeks.  Patients may exhibit altering patterns of increasing and decreasing activity, and withdraw or become reliant on medication.”

PERSISTENT OR CHRONIC PAIN

“Persistent or chronic pain – Pain which is defined as more than 3 months’ duration, activities may have decreased sharply. . .The pain becomes more constant although patients may experience ‘good’ and ‘bad’ periods.”

RECURRENT MUSCULOSKELETAL PAIN

“Musculoskeletal pain is usually recurrent in nature.  While most episodes of back pain remit rather quickly and most people return to work within 6 weeks, (Reid, et al., 1997), the majority of sufferers will experience several episodes of pain during the course of a year, (Frymoyer, 1992; Nachemson, 1992; VonKorff, 1994; Linton & Hallden, 1997).”

50 % OF ACUTE BACK PAIN SUFFERERS HAVE PAIN 6 – 12 MONTHS LATER

“More than 50 percent of patients with acute back pain will experience another episode within a year (Nachemson, 1992), and prospective studies indicate that almost half will still have significant problems 6 – 12 months later, (Philips & Grant, 1991; VonKorff, 1994; Linton & Hallden, 1997).”

MUSCULOSKELETAL PAIN = LEADING CAUSE OF EARLY PENSIONS

“Firstly, a large number of people suffer from musculoskeletal pain, making it a leading health-care problem even though only a minority develop persistent dysfunction.  Musculoskeletal pain is a leading cause of health-care visits, particularly in primary care,  sick absenteeism, and early pensions, (Frymoyer, 1992; Nachemson, 1992; Skovron, 1992).  However, several studies indicate that over 90 percent of those off work with an acute episode of back pain will return within 3 months, (Waddell, 1996;  Reid, et al., 1997).”

“Secondly, as shown above, musculoskeletal pain is recurrent in nature even though most patients return to work rather quickly after an acute episode.  Although acute sufferers usually feel better and return to work within a few weeks, this does not mean that they have recovered fully or permanently.”

“Thirdly, while up to 85 percent of the population will suffer from musculoskeletal pain, only a small number will account for most of the costs, (Nachemson, 1992; Skovron, 1992; Waddell, 1996).  In general, less than 10 percent of the sufferers may consume up to 75 percent of the resources, (VonKorff, 1994; Reid, et al., 1997).  Thus preventing disability and high-cost cases may result in large economic savings, so that these people constitute a special target for prevention programs.”

MUSCULOSKELETAL PAIN IN SWEDEN & THE NETHERLANDS

“Further, most of the money at this time is spent on compensation, while relatively little is spent on treatment, and almost nothing is invested in prevention.  In Sweden, about 85 percent of the total resources for musculoskeletal pain are spent on compensation as compared to 15 percent for all treatments and drugs, a figure which has remained fairly constant over a 15-year period, (Linton, 1998).”

“Similarly, in The Netherlands, a recent study of all costs due to back pain showed that 93 percent involved compensation and only 7 percent involved treatment, (Van Tulder, et al., 1995).”

PREVENTION NEEDS RESOURCES

“Consequently, until prevention is granted more resources, programs need to be relatively cheap; and this suggests incorporating them into existing practice routines.”

ERGONOMIC RISK FACTORS TO PREVENT

“A host of ergonomic factors, for example, lifting, heavy work, twisting, bending, manual handling, and repetitive work have been found to be associated with musculoskeletal pain, (Pope, et al., 1991; Skovron, 1992).”

“A recent review of some 60 studies revealed a relationship between musculoskeletal pain problems and job demands, control, monotonous work, time pressure, and perceived workload, (Bongers, et al., 1993).”

“If the problem does not remit within 2 – 4 weeks, a formal screening procedure is suggested.”