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.”

 

 

Driving = Risk factor for Low Back Pain

Occupational Medicine, Vol. 48, No. 3., pp. 153-160, 1998, “Musculoskeletal Problems and Driving in Police Officers,” written by D. E. Gyi and J. M. Porter, Vehicle Ergonomics Group, Department of Design and Technology, Loughborough University, Leicestershire, United Kingdom:

In the above-mentioned study, the Occupational Health Department of a rural police force in the United Kingdom had concerns with relation to driving and its link to musculoskeletal disorders.

“There are now an increasing number of researchers whose work implicates prolonged exposure to car driving as a risk factor for low back pain.  However, such epidemiological studies examining the relationship between car driving and back pain or other musculoskeletal troubles are difficult to conduct.  Driving as a task involves prolonged sitting, a fixed posture, and vibration, any of which could directly lead to musculoskeletal trouble.  It is likely that symptoms arise from multiple relationships and influences, (Rey, P., 1979).”

“These police drivers are also deemed to be at particular risk because of the following:

  • They are generally tall males and wear bulky clothing such that seat adjustment may be insufficient to obtain a good posture.
  • They drive fleet cars where the seat and suspension are exposed to excessive wear and tear.
  • They often have to drive in rapid response situations such that they are exposed to fast acceleration and deceleration.
  • Driving is often followed by strenuous physical activity such as lifting and running.
  • They spend most of their eight-hour shift driving or sitting in their vehicle.
  • They often have to take back-seat passengers, such that tall males are unable to take advantage of any seat adjustments that do exist.”

“In a survey of 2,000 U.S. police officers, the number and types of health disorders reported b these officers over a 6-month period were similar to those found in the general public over a 12 month period, (Hurrel, J., 1984).”

The results of the above-mentioned study agree with the findings of other studies that indicate driving a car is a risk factor for the development of low back pain.

WOMEN HAVE MORE MSDs

“Ergonomics” References:

1) Washington Post, March 21, 2001, “President Bush Signs Repealed of Ergonomics Rules, Administration Promises Business-Friendly Workplace Safety Regulations,” written by Mike Allen, Staff Writer:

“President Bush signed his first bill carrying national impact yesterday, repealing workplace safety regulations that he called ‘unduly burdensome and overly broad,’ and sent his administration to work on a business-friendlier substitute that is months or years away.”

President Bush said, “There’s an ergonomics — change in ergonomics regulations that I believe is positive. . .Things are getting done.”

After signing the ergonomics bill, President Bush issued a statement: “The Safety and health of our nation’s workforce is a priority for my administration,” he wrote.

“Together, we will pursue a comprehensive approach to ergonomics that addresses the concerns surrounding the ergonomics rule repealed today.”

“The ergonomics regulations, which were 10 years in the making, would have taken effect in October.”

One study (published in the Scandinavian Journal of Work and Environmental Health, 1994;20:417-26, “Job Task and Psychosocial Risk Factors for Work-Related Musculoskeletal Disorders Among Newspaper Employees,” written by Bruce Bernard, M.D.; Steve Sauter, Ph.D.; Lawrence Fine, M.D.; Martin Petersen, Ph.D.; and Thomas Hales, M.D,) investigating work related musculoskeletal disorders among newspaper employees found neck symptoms were the most frequently reported.   Women tended to have higher rates of tension neck syndrome than men. . .this finding may reflect the concentration of women in jobs involving more risk factors.

“Martha G. Burk, Chair of the National Counsel of Women’s Organizations, an umbrella for 120 groups representing 6 million people, said women suffer many ergonomic injuries from keyboard work and machine cleaning, and called the repeal ‘a slap in the face of women.’”

White House spokesman, Ari Fleisher, said President Bush “believes that we can protect the health and safety of workers without passing a regulation that is terribly burdensome to the economy and to the small businesses on which their growth depends.”

STOP THE PAIN

So what exactly are musculoskeletal disorders (MSDs) also known as cumulative trauma disorders (CTDs) also known as repetitive motion disorders (RMDs), also known as overuse syndromes, or repetitive strain injuries?

Scan

According to PEOSH (1997), “These painful and sometimes crippling disorders develop gradually over periods of weeks, months, or years.

“They include the following disorders which may be seen in office workers:

Carpal Tunnel Syndrome – a compression of the median nerve in the wrist that may be caused by swelling and irritation of tendons and tendon sheaths.

Tendinitis – An inflammation (swelling) or irritation of a tendon. It develops when the tendon is repeatedly tensed from overuse or unaccustomed use of the hand, wrist, arm, or shoulder.

Tenosynovitis – An inflammation (swelling) or irritation of a tendon sheath associated with extreme flexion and extension of the wrist.

Low Back Disorders – These include pulled or strained muscles, ligaments, tendons, or ruptured disks. They may be caused by cumulative effects of faulty body mechanics, poor posture, and/or improper lifting techniques.

Synovitis – An inflammation (swelling) or irritation of a synovial lining (joint lining).

“DeQuervain’s Disease – A type of synovitis that involves the base of the thumb.

Bursitis – An inflammation (swelling) or irritation of the connective tissue surrounding a joint, usually of the shoulder.

Epicondylitis – Elbow pain associated with extreme rotation of the forearm and bending of the wrist. The condition is also called tennis elbow or golfer’s elbow.

Thoracic Outlet Syndrome – a compression of nerves and blood vessels between the first rib, clavicle (collar bone), and accompanying muscles as they leave the thorax (chest) and enter the shoulder.”

Cervical Radiculopathy – A compression of the nerve roots in the neck.

Ulnar Nerve Entrapment – A compression of the ulnar nerve in the wrist.”

PEOSH (1997) further states: “These disorders can also be aggravated by medical conditions such as diabetes, rheumatoid arthritis, gout, multiple myeloma, thyroid disorders, amyloid disease and pregnancy.”

NO LIFEGUARD ON DUTY

Prevention is Better than Treatment 

Scan 8Now that most people spend a lot of their time doing repetitive motions, such as Gaming, Facebooking,  Twittering, using social media and all other types of interactions with computers,  musculoskeletal disorders, such as carpal tunnel syndrome, can happen outside the workplace.

You do not want to end up in pain for the rest of your life, so remember to take a break at least every hour from typing activities.

If you must spend your day sitting, as some people do, such as stenographers, remember to stand up at least once every hour.  While sitting, try to maintain your lumbar curve.  In other words, don’t slouch.

Scan 9
Twin stenographers sitting on Buttpillows, Patented Ergonomic Seating Cushions.

Sitting and the Prostate

Standing frequently throughout the day is especially important for men.  There is new research that links prolonged sitting to swelling of the prostate or prostatitis, and there is also research that links prostatitis to prostate cancer.  Prostatitis can affect the sexual health of men usually beginning at about the age of 50; so all you men out there, stand up at least once every hour.

 

What is Ergonomics?

After the 40 year fight for ergonomics programs, the passing of OSHA’s Ergonomics Standard in October 2000 and its repeal in March 2001, most people still don’t know what ergonomics is and how it affects us all at work and at home now that we are all on the computer so much.

merriam-webster.com/dictionary/ergonomics – Medical Definition of ergonomics. 1: an applied science concerned with designing and arranging things people use so that the people and things interact most efficiently and safely—called also human engineering, human factors engineering.

.techtarget.com – Ergonomics (from the Greek word ergon meaning work, and nomoi meaning natural laws), is the science of refining the design of products to optimize them for human use. … Ergonomics is sometimes known as human factors engineering.

http://www.osha.gov – Ergonomics: The Study of Work. U.S. Department of Labor. Occupational Safety and Health Administration. OSHA 3125. 2000 (Revised) …