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Tackling lower back pain with words not surgery

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DANA POINT, California — What is said to workers grappling with lower back pain has the potential to lead to a better outcome than more aggressive treatments, according to experts who say the workers compensation industry is moving away from immediate medical imaging and surgery and toward conservative care. 

Don’t call it “your injury,” said Dr. Jennifer Christian, president and chief medical officer at Wayland, Massachusetts-based Webility Corp., to dozens of claims professionals at the California Workers’ Compensation and Risk Conference in Dana Point, California, Thursday. Instead, call it “your recovery process.” Don’t say “getting you back to work.” Say, “getting your life back to normal.” Don’t ask about pain; ask about progress. 

“(There are) people who have relatively moderate conditions who end up creeping toward catastrophe,” Dr. Christian said. “A lot of it has to do with words.”

Lower back injuries comprise roughly one-third of all workers comp claims, according to Mary O’Donoghue, Boston-based chief clinical and product officer, MedRisk Inc., who called both chronic, cumulative back injuries and more acute incidents the “leading cause of workplace disability.” 

Ms. O’Donoghue led panelists through a session that focused on trends that include less bed rest, medications and imaging, and more movement, physical therapy and psychological counseling.  

The traditional way for dealing with back pain was to send workers to an MRI scan, which often led to a doctor delivering bad news that surgery might be necessary according to panelist Dr. Matthew Walsworth, a radiologist with West Los Angeles VA Medical Center and faculty member at UCLA.

Instead the issues that pop up on an MRI screen can be likened to the “gray hair and wrinkles in the spine,” he said, referring to a case study of a 62-year-old man with back pain and an imperfect spine. 

“This is not a pristine spine but it is normal changes; if you want to grasp something to operate on, you could,” he said. 

Instead, treating physicians can delay an MRI and work toward a recovery solution, Dr. Walsworth added.

Part of that might include cognitive behavioral therapy, said panelist Michael Rosenthal, an assistant professor in the Doctor of Physical Therapy Program with San Diego State University. 

“MRIs trigger illness and increase likelihood of catastrophization,” Mr. Rosenthal told attendees. “They go from having a mild problem … then they get the results and they rate their pain at a higher level even though there has been little change” 

“(Their) perception of pain is not accurate … when patients start having pain outside of the proportion than what we expect,” he added. “Some patients may need a little more than reassurance and simple education … others may need more advanced psychological informed rehabilitation. You may send them to the best physical therapy clinic in California. … That patient may not respond very well without that multidisciplinary approach.”

Dr. Christian said claims handlers and employers can be on the front lines by helping to answer questions a worker suffering a back injury may have, instead of leaving it up to the doctor.

“They are wondering, how long am I going to be laid up? How long do I have to take it easy? When am I going to be back to normal, if ever?” she said. “As I realized, in medical school we are not trained to answer any of those questions. … The patient is left alone to figure this out.  

“What we say (and) how we say it … words can reassure or frighten,” continued Dr. Christian. “(Words) can build trust or confidence. … They can empower or undermine. Your words are either going to establish yourself as someone helpful, or create distance.”