Professional Documents
Culture Documents
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.
Some Experts AgreeWhen 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.
Oversimplifying is dangerous, though, and it must be remembered that the original intent of
workers' compensation was to protect workers clearly injured on the job, who were unable to
continue employment because of that injury.