This paper reviews the scientific research on occupational back pain focusing on prevention and the Saudi Aramco experience. The challenges of translating the medical evidence into policy for this multi-factorial condition are discussed. Medical science is currently unable to clearly distinguish between back pain caused by work and that possibly due to other causes but affecting the individual's capacity to work. Back pain affects the majority of people at sometime in their lives and it is costly to medical services and industry. Once the risk factors for occupational back pain are identified, it can be prevented in the majority of cases or else it can become chronic and disabling. Failure to follow preventive programs may lead to a high incidence of occupational back pain.
Back pain is a complex phenomenon and despite a range of intervention aimed at reducing its impact, it continues to be a burden on individuals, employer and society. It is estimated that between 60 to 80 percent of any population will experience back pain at some point in time 1–8. Population surveys indicate high prevalence of back pain as many people do not report their pain, take time off work or seek medical treatment 9–12.
Prevalence data on back pain generally rely on musculoskeletal symptoms survey or questionnaires and hence there is lack of standardized methodology and reporting by researchers in this field. It has been estimated that back pain among nurses range from 47% up to 68% with a point prevalence of 30% and these figures differ from one country to another 13—19. On other hand, back pain is very costly to medical services and lost time from work where the direct cost approaches more than $25 billion while indirect costs vary widely with total of $100 billion per year 20–23. It is estimated that on average the cost of back pain claims is $6,807 per case in the USA24–26. Back injury rates are highest in industries and occupations involving manual handling such as in the construction and manufacturing industries 27–30.
The causes are multi-factorial and must be sought during the physician's examination. Failure to take a comprehensive history and carry out a physical examination can ultimately lead to treatment failure and injury recurrence. It is known that any spinal structure is a potential source of back pain. This is why back pain is considered to be symptom of wide range of possible injuries. For example the spinal nerves can be pinched by a prolapsed disk. Sudden unfamiliar or unexpected movements are the most frequent cause of muscular back pain. Some other causes of back pain include poor posture and lack of exercise 31,32.
To date, many studies of physical risk factors at work involved indirect measurement tools through self reported questionnaires rather than direct measurement of exposures 33,34. There is suggestive evidence that heavy lifting, driving and whole body vibration are linked to occupational back pain. There is also significant increase in the risk of work related backache from prolonged bending and twisting on the job. Furthermore, past history of back pain is believed to the most important single factor to predict the future recurrence of back injury 35–45. On the other hand, there is growing evidence linking psychosocial risk factors to the occurrence of occupational back pain. In particular, studies have linked the condition to monotonous work, high perceived workload, time pressure, lack of decision making authority and job dissatisfaction 46–48.
Both smoking and obesity have been linked to back pain in epidemiological studies 1,49–50.
Prevention is difficult because the risk factors and causes of back pain injury are poorly understood, however prevention of back pain can be aimed at three levels.
Primary Prevention (before incidence):
Primary prevention of back pain in the workplace is usually the most common strategy utilized by employers. Many cases of back pain could be prevented by workplace changes which focus on reducing the incidence of new episode of occupational back pain 51–54. This aims to increase the resistance of workers to back pain by teaching causes, risk factors, management and prevention of back pain 55,56. At Saudi Armco, all the educational material (pamphlets, videotapes) related to back pain were updated and a new pamphlet called "Back Pain Disorders" was produced.