Back Pain -- Reason for Compensation or Cash Cow?

April 11, 2007 — -- In the current issue of the Journal of the American Medical Association, Dr. Nortin Hadler, a rheumatologist, and his co-authors present a scathing attack on the use of regional back pain as a way to collect workers' compensation.

Hadler, a professor of medicine at the University of North Carolina at Chapel Hill and author of "The Last Well Person," says backaches are as widespread as the common cold and part of the normal aging process. But while backaches or colds can appear on the job, he says neither is caused by working.

He argues that physicians misdiagnose back pain as "injury," which can cost both employees and their employers dearly. Companies devote 2 percent to 4 percent of their gross earnings to workers' compensation, and workers, for their part, are given a medical diagnosis, even though the majority of the adult population suffers back pain at some point in their life.

Hadler says one in 10,000 workers has received compensation for back claims of at least three days' missed work.

When the ABC News medical unit asked experts to respond to the commentary, many agreed with the assessment:

Richard Deyo, M.D.
Professor of Medicine and of Health Services
University of Washington

There are some obvious exceptions, but by and large, I agree with this argument. Back pain is nearly ubiquitous, and it's often difficult to assign a precipitating cause. We've made the management of back pain in workers unnecessarily adversarial, to no one's benefit.

Harley Goldberg, D.O.
Director, Spine Care Services
Chief, Physical Medicine and Rehabilitation
Kaiser Permanente San Jose Medical Center

In general, the authors' argument is correct. Four in five people will have intermittent recurrent back pain, and more than 90 percent of back pain is uncomplicated. There have been excellent studies demonstrating that simply correcting "expectations" about the natural history of back pain will decrease worker absenteeism.