2.4 Recovery from pain

Stages of Recovery from Low Back Pain

1. Acute Phase:

   • Initial Focus: Immediate medical attention; accurate diagnosis may not be possible due to the complexity of back muscles.

   • Common Treatments: Anti-inflammatory medications, ice, physical therapy.

   • Outcomes: 90% recover within three months; only 1–2% require surgery.

   • Updated Approaches: Rest alone is no longer recommended; however, early exercise and physiotherapy have limited long-term benefits.

   • Challenges:

     • Clinical Iatrogenesis: Harm caused by healthcare interventions (e.g., instilling fear through aggressive treatment or communication).

     • Inappropriate Workplace Response: Lack of prompt accommodations increases disability risk.

2. Subacute Phase (4–12 weeks):

   • Role of Vocational Rehabilitation:

     • Active involvement to help workers return to work.

     • Emphasis on prompt, workplace-related interventions (e.g., modified work duties).

     • Importance of communication and non-adversarial claims handling.

   • Outcomes: Prompt accommodation can reduce time lost from work by 35–50%.

3. Chronic Phase (12+ weeks):

   • Transition: Pain becomes a disability and potentially a handicap.

   • Challenges:

     • Ongoing medical management without functional progress can lead to frustration and psychological difficulties (e.g., depression, anxiety).

     • Confusion due to an array of treatment options and ineffective pain clinics.

   • Key Strategies:

     • Multidisciplinary programs focusing on pain-coping strategies are promising.

     • Early return to work, even with some pain, can boost confidence and maintain functional independence.

     • Workers should expect initial increases in pain and fatigue but gain long-term benefits.

Key Insights for Vocational Rehabilitation Professionals:

• Provide educational materials to reduce fear and anxiety.

• Encourage workplaces to offer modified duties promptly.

• Support workers with chronic pain in overcoming psychological barriers to returning to work.

• Ensure collaboration between physicians and rehabilitation professionals for effective interventions.

Multiple Choice Quiz

Questions:

1. What is the primary goal during the acute phase of low back pain recovery?
   a) Perform immediate surgery.
   b) Identify the exact muscle causing the injury.
   c) Provide medical attention and manage initial pain effectively.
   d) Avoid physical therapy until pain subsides completely.

2. Which of the following is a risk factor for clinical iatrogenesis?
   a) Early physical activity after an injury.
   b) Healthcare professionals instilling fear through remarks or treatment.
   c) Delayed use of pain medications.
   d) Lack of workplace accommodations.

3. During the subacute phase, which approach is most effective for returning workers to the workplace?
   a) Providing rest until all pain subsides.
   b) Offering modified work based on assessed capacity.
   c) Using only a single rehabilitation method.
   d) Delaying communication with the injured worker.

4. What is a key feature of managing chronic pain?
   a) Avoiding work until all pain is gone.
   b) Encouraging an early return to work despite pain.
   c) Relying exclusively on surgery and medication.
   d) Disregarding psychological impacts of chronic pain.

5. How can vocational rehabilitation professionals reduce time lost from work?
   a) Use aggressive medical treatments during the acute phase.
   b) Implement prompt workplace accommodations and educate workers.
   c) Refer workers to pain clinics without reviewing their effectiveness.
   d) Focus solely on medical management during the chronic phase.

Answer Key

1. c) Provide medical attention and manage initial pain effectively.

2. b) Healthcare professionals instilling fear through remarks or treatment.

3. b) Offering modified work based on assessed capacity.

4. b) Encouraging an early return to work despite pain.

5. b) Implement prompt workplace accommodations and educate workers.

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