Work-Related Chronic Low Back Pain

Return-to-Work Outcomes After Referral to Interventional Pain and Spine Clinics

Rathin N. Vora, MD, MPH; Bruce A. Barron, MD, MS; Anthony Almudevar, PHD; Mark J. Utell, MD


Spine. 2012;37(20):E1282-E1289. 

In This Article

Abstract and Introduction


Study Design A retrospective cohort study.
Objective To evaluate return-to-work outcomes in patients with chronic, work-related low back pain referred to pain treatment centers and/or spine clinics (PTCs/SCs).
Summary of Background Data Return-to-work outcomes in cases of work-related chronic low back pain after referral to PTCs and/or SCs have not been previously studied.
Methods A retrospective chart review of 230 consecutive patients was conducted from an occupational medicine program. Of these, 122 patients were referred to a PTC/SC and 108 patients were not. Multivariate logistic regression was used to develop a model to predict improvement in functional status and pain level after 1 year.
Results At the 1-year evaluation, there was functional improvement in the nonreferral group (P < 0.001) and no change in the referral group (P = 0.21). The change in pain level was similar. Time from injury to initial evaluation seemed to be the major factor contributing to poor outcomes in both groups.
Conclusion Referral to a PTC/SC did not yield improved functional outcomes in this cohort. A major factor contributing to this finding was the length of time to referral to PTC/SC after the initial injury.


The lifetime prevalence of low back pain (LBP) has been estimated at 15% to 45%,[1] and approximately one-quarter of adults in the United States reported back pain in the past 3 months.[2] Not surprisingly, back injuries continue to be one of the most common work-related injuries[3] that account for a major cause of long-term disability.[4] About 30% of all workers' compensation lost-time claims in the United States result from LBP[1] and it is the most common cause of disability in patients younger than 45 years.[5] The medical cost for LBP in the United States was estimated to be $11 billion in 1989,[6] with 5% of the patients responsible for 75% of the associated costs.[5] In addition to medical costs, there are costs related to indemnity, disability, employee wage loss, employer replacement and overtime, and legal fees. All of these factors contribute to a substantial burden on injured workers and their families, employers, and the workers' compensation systems as a whole.[7]

Chronic LBP is considered by many as a chronic health condition,[2] similar to diabetes and hypercholesterolemia, which cannot be cured but must be managed. Treatment of this condition has been approached through a number of multidisciplinary treatment programs. The level of success of these programs is debatable.[8–11] One of the many approaches in the management of chronic LBP includes management by pain treatment centers (PTCs) and/or spine clinics (SCs). These centers provide various modalities of treatment, including spinal injections, pain medication, and psychological and behavioral therapy. To date, there have been no reported studies evaluating outcomes in patients with work-related chronic LBP after referral to PTC/SC.

Studies that have evaluated pain intervention outcomes in patients with LBP have several limitations. First, the study designs and control groups are different, making comparative interstudy analysis difficult.[12–17] Second, the end point in most of the studies is pain control rather than functional improvement or return-to-work status, which is critical from an occupational perspective. Third, these studies often combine work-related and non–work-related chronic LBP. The purpose of our study was 2-fold: first, to evaluate the work status outcomes in patients having chronic, work-related LBP who were referred to PTC/SC and, second, to identify predictors of positive and/or negative functional outcomes in this population. Because work status after injury is one measure of objective functional capacity, we have used the return-to-work status as an indicator of functional status in this study.