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Am Fam Physician. 1998;58(1):220

Low back pain is one of the most common workplace injuries in the United States. Progression from acute injury to chronic pain and disability is dependent on a variety of factors. Previous studies have found that various psychosocial factors predispose patients to disability from low back pain. Williams and colleagues assessed the issue of job satisfaction as an independent predictor of low back pain outcomes such as pain, disability and distress.

Patients included in the study were men 18 to 50 years of age who had experienced daily acute low back pain for a period of six to 10 weeks. Patients were admitted to the study if back pain had been their only pain problem and if they were in good health otherwise. Reasons for exclusion included a prior back injury or surgery, major medical illnesses or the use of mood-changing medications. The 82 patients who were eligible for the study were reassessed six months after the injury. Job satisfaction was measured by the Job Descriptive Index, which measures six components of the job: the nature of the work, present pay, opportunities for promotion, supervision, co-workers and overall satisfaction. The modified Work Apgar test was used to obtain a single overall evaluation of job satisfaction. Pain, disability, psychologic distress and orthopedic impairment were also measured.

Patients with disability or chronic low back pain scored below the 25th percentile on their satisfaction with the actual work they performed in their job. They also scored between the 25th and 50th percentiles regarding satisfaction with supervisors and co-workers.

The authors conclude that job satisfaction is a factor in the transition from acute to chronic low back pain and disability. Job satisfaction was associated with better overall clinical outcomes at the end of six months. The type of work or social position had no impact on the outcome of acute low back pain. Interventions that focus on job satisfaction, rather than pain relief, may reduce the likelihood that acute low back pain will progress to chronic low back pain. Intervention could also reduce the number of injuries that result in long-term disability.

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