Back pain is the bane of many employers, including the United States army. Back pain is one of the most frequent causes of lost work, lost revenue and reduced quality of life among North Americans, despite millions of dollars of research and millions of dollars that have been put into developing and trying various methods of treatment.
Back pain is also very interesting. There is a lot known about it in terms of how patients feel about their back pain and how well they function. Much attention has been paid to how people catastrophize their back injuries. The worse they catastrophize (fearing the worst would happen if they re-injure themselves), the worse the pain and the functional outcome is.
Researchers in a previous study had looked at American military service men and women who had to be evacuated out of either Iraq or Afghanistan because of back injury. What they found was the soldiers who were treated in the country where they were serving had a higher return-to-duty rate than those who were evacuated to either Germany or back to the United States. In fact, “higher return-to-duty rate” may have been the wrong way to say it. What really happened was all the soldiers with back pain who were treated in Iraq, returned to their units. Compare this with only 2% who returned from treatment in pain clinics in Germany or Washington. Two percent.
The new study, the results of which were published in the most recent issue of the Archives of Internal Medicine, found that only 13 percent of soldiers with back pain returned to duty. While better than 2 percent, that’s still a very poor number and back pain, along with other disorders of the bone, muscles, etc., has the lowest return-to-duty rate of any illness or accident, after combat injury and psychiatric illness.
How do soldiers hurt their back? While they could hurt their back just as anyone back home can, soldiers have added risks, besides the most obvious of being hurt in combat. These risks include:
- Riding in heavy machinery over bumpy roads
- Carrying large amounts of heavy equipment
- Long road marches
- Heavy body armor
- Picking up heavy material
There are a few obvious reasons why a soldier who is far removed from combat may have a harder time managing his back pain, just as it would be in the general population. Back pain is a hidden injury that others can’t see. As a result, it’s easy to be not believed when you complain about your back. Back pain can also isolate a person. It’s hard to get up and about when your back is causing you severe pain. This could lead to depression and isolation, and it could make matters worse.
According to this press release from Johns Hopkins,
The military needs to find a way to get soldiers with back pain back to their units wherever possible, [Steven P.] Cohen [M.D., associate professor of anesthesiology at the Johns Hopkins University School of Medicine and a colonel in the U.S. Army Reserves] says. He suggests that could be accomplished if there were more pain management options in Iraq or Afghanistan, following the model used for soldiers with symptoms of combat stress. When those symptoms are treated at mental health clinics on base, approximately 95 percent of service members returned to their units. When treated in a transitional unit in nearby Kuwait, the figure was around 50 percent. When sent to Germany, fewer than 10 percent returned.