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Lower Back Pain: Hurt Doesn't Mean Harm

Exercise -- Despite Pain -- Means Faster Return to Work

Hurt Doesn't Mean Harm

It's a good plan, James Weinstein, DO, says in an editorial accompanying the study.

"Patients learn that the exercises do not cause harm even though they may cause pain. [They] gain confidence that they can work safely despite back pain," he writes. "In so doing, they unlearn behaviors in which they had associated freedom from pain with physical inactivity or absence from work."

Heidi Prather, DO, chief of physical medicine and rehabilitation at Washington University School of Medicine, also praises the approach.

"This is behavioral management, which says, 'Let's not focus on your pain level, let's focus on your function,'" Prather tells WebMD.

Weinstein points out that professional athletes -- and most "weekend warrior" amateur athletes -- regularly play with pain. So what's the difference between them and injured workers?

"Athletes and other professionals are highly motivated, have high self-esteem, are not depressed, and have a strong motivation to keep doing what they always do," he suggests. "Can we imbue the injured worker with some of the ideals and motivation of the injured athlete?"

Based on the van Mechelen team's study, the answer appears to be "yes." Their program changes how disabled workers see -- and cope with -- their lower back pain.

This approach doesn't mean physical therapists and doctors don't care about how much their patients hurt. Prather says it's still important for doctors to try to find -- and treat -- the root cause of patients' pain.

"I wouldn't jump to the big conclusion that we are telling everybody we don't care about their pain. That is not part of treating humans." Prather says. "Everybody interprets pain differently. And everybody is required to do a different job. So if the focus is on function, the end point is going to be different for everybody."


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