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I have been off work with low back pain for six weeks now. I expected to be back on the job days after I hurt myself. The longer I'm off, the more depressed I get and the worse my pain is. The doctor has given me a prescription for a narcotic pain reliever. Should I take it? Will it help me get over the hurdle?
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Experts in the area of social science tell us that people who lose their jobs can suffer severe problems. They start out in a state of fearful distress that quickly becomes a despairing attitude of giving up. The loss of income makes things even worse. Chronic pain and work loss can become so tangled up, it's hard to separate them. One condition feeds into the other. As you have discovered, pain confounds work loss. And work loss intensifies the pain.
When chronic low back pain leads to disability and loss of work, doctors may prescribe strong (narcotic) pain relievers called opioids. This is done in an effort to help people get back to work. But critics of this approach say there's no proof that opioid use improves outcomes. In fact, there's some evidence that opioid therapy may actually be linked with increased risk of work loss.
To test the effect of opioid use on work loss, a study was done using data from Worker's Compensation. Two groups of Worker's Compensation claimants were compared. Everyone included in the study had filed a Worker's Comp claim for low back pain. One group was provided with opioid therapy. Some were taking weak (Class III or IV) opioids. Others were given strong (Class II) opioids. The opioid group was further divided into two subgroups based on whether or not they took opioids for up to 90 days or for more than 90 days. The second group had filed a Worker's Comp claim for low back pain but no one in the group was taking opioid-based medications.
Analysis of the data collected for the two main groups showed a significant link between opioid use and work loss. Workers taking any kind of opioid were 11 to 14 times more likely to suffer work loss compared to the reference (no opioid) group. Workers using strong (Class II) opioids were six times more likely to experience chronic work loss. The time frame used for this study was 90 days or more. And the overall costs for the opioid group was much higher than for the nonopioid group.
What's the answer to this dilemma? Well, there may not be an easy answer for all patients. Each case must be decided and followed on an individual basis. Sometimes a team approach is really needed. For example, strong pain relievers such as opioids used in combination with a rehab program can help move the focus from pain to function. For nonspecific low back pain (i.e., it's not caused by a tumor, fracture, infection or other serious medical problem), there is evidence that spinal manipulation by a chiropractor or physical therapist can be helpful.
Working closely with your physician will help ensure you get the full benefit of the opioid while minimizing or preventing any of its potentially harmful effects. Knowing that your goal is to get back to work will be helpful in keeping you on track in recovery.
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*Disclaimer:*The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic. |
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