Houston Methodist. Leading Medicine

Lower Spine News

Workers Comp Struggles to Define Recurrent Versus New Back Pain

Worker's compensation reports show that low back pain returns in 14 to 45 percent of all clients. That's a pretty broad range. It's hard to use this information or make comparisons. Some of the difference is due to how a recurrence of back pain is defined.

Should each new claim filed be counted separately? How much time between episodes should pass before it is called a new problem? Can it be counted as a recurrence if the symptoms are different the second time?

In this study, researchers set up three different ways to count cases of back pain recurrence. The first method was a claim-based definition. In this way of counting, clients can have many episodes of care or work disability all on the same claim. A low count of recurrences is likely with this method.

The second definition uses work disability to figure recurrence rates. This method is called the disability-based recurrence rate. With this definition, each time the worker returns to the job (even temporarily), disability has ended. The next time back pain puts the client out of work, it counts as a new episode of disability.

The third care-based method measures recurrence rates by how much time goes by between doctor or physical therapy visits. The minimum gap between visits was set at seven or more days.

Here's what the study found about rates of back pain recurrence using these three definitions:

  • Claims-based definition: 7.9 percent recurrence rate.
  • Disability-based definition: six to 17 percent recurrence over three years.
  • Care-based definition: 12 to 49 percent recurrence.

    The authors discovered that most of the recurrences come during the first year. A client with early recurrence of work disability is probably a case of failed return-to-work. The authors suggest more help during the early stages of a worker's return on the job to prevent this from happening. They say this study clearly shows the need to consider follow-up for each episode of back pain for at least one year. Two years is ideal. Three years is too much time.

    One thing this study doesn't offer is a minimum gap of time for recurrence based on the care-based or the disability-based definitions. This could be the topic for future study. The researchers used a gap of one day without symptoms, but they don't know if this is the optimum time gap.


    Radoslaw Wasiak, PhD, et al. Recurrence of Low Back Pain: Definition-Sensitivity Analysis Using Administrative Data. In Spine. October 1, 2003. Vol. 28. No. 19. Pp. 2283-2291.

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