Absent from Work: Nature versus Nurture

Low back pain is common and costly. It is a leading cause of chronic pain and an inordinately frequent cause of disability and lost productivity. According to a recent survey of U.S. workers, those who lost time because of back pain in the previous 2 weeks reported losing an average of 5.28 hours of productive time per week (1). Back pain accounted for nearly $20 billion of lost productivity and ranked second only to headache as a reason for loss of productive time. According to this survey, most of the loss was not from absenteeism but from reduced performance at work. Unfortunately, lost productivity accounts for only part of the total estimated work-related cost of musculoskeletal conditions in the U.S. workforce. The rest is due to medical costs associated with an ongoing chronic disability (for example, effects of medication; visits to the doctor; diagnostic tests; surgery; or visits to a chiropractor, massage therapists, or acupuncturist), the cost of training replacement workers, and the company's cost of maintaining productivity as a whole.

In this issue, Staal and colleagues (2) measured the effectiveness of an intervention to reduce lost time from work due to back pain. They compared a behavior-oriented, graded activity program with usual care. The participants were employees of KLM Royal Dutch Airlines at Schiphol Airport in Amsterdam. The study is important because it represents research into treatments that may help reduce the economic and societal cost of low back pain. We do not have effective treatments for low back pain. According to good-quality evidence, the traditional …