Back Pain -- Reason for Compensation or Cash Cow?

There is a correlation between disability and whether or not a person likes what she or he does. If she likes the work and is invested in it, she will return to work, even with pain. If she has no investment in the work and feels that she is entitled to compensation, she'll never return.

John Kostuik, M.D.

Chief, Spine Divison

The Johns Hopkins Hospital

Past President, North American Spine Society

The current system is broken. One needs to only look at the statistics on the number of people who return to work after receiving workers' compensation. In the late 1970s, about 67 percent of my patients returned to work after having a second surgery. This decreased to 44 percent in the 1980s and to less than 30 percent in the 1990s.

Being required to have legal help to gain compensation is problematic, since the greater the disability payment, the more the lawyer makes -- so, it pays to be ill.

The Other Side of the Argument

Other medical experts, however, took issue with the authors' characterization of the issue:

Stephen Ondra, M.D.

Professor of Neurological Surgery

Northwestern University

This argument seems to be born out of surprisingly faulty logic, personal opinion, frustration with the workers' compensation system, as well as a surprising lack of demonstrated knowledge regarding back pain and back injury.

The authors seem to lump back pain into one large group, but nothing could be further from the truth. It is true that back pain is not a disease or injury; it is a symptom of disease, injury or the degenerative processes of aging. But to imply that back pain is simply a normal part of the aging process is oversimplification on a dangerous level.

Given that logic, hip pain would be a diagnosis and relegated to a normal part of aging. At times, this may be true, but there are also many other causes ranging from tumor to trauma.

There is no argument that there is much abuse throughout the workers' compensation system. The answer is to assess how to improve the workers' compensation system and decrease abuse, not to denigrate and disenfranchise employees who legitimately injure their spine due to trauma or repetitive overuse.

Scott Boden, M.D.

Director, The Emory Spine Center

Emory University

This is actually not a new argument, and while in many instances it is valid, in other situations, workers with real injuries have real pain. Unfortunately, many patients in the workers' compensation system get teamed with lawyers who may have different motivations than getting the worker back to work quickly.

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