Returning the chronically unemployed with low back pain to employment Paul J. Watson a, * , C. Kerry Booker b , Lorraine Moores b , Chris J. Main c a Department of Anaesthesia, Pain Management and Critical Care, Leicester Medical School, University of Leicester, Leicester LE5 4PW, UK b Manchester and Salford Pain Centre, Hope Hospital, Salford M6 8HO, UK c Department of Behavioural Medicine, Hope Hospital, Salford M6 8HO, and University of Manchester, UK Received 14 April 2003; accepted 5 November 2003 Available online 10 December 2003 Abstract Much of the research into return to work following rehabilitation for low back pain in the literature reflects work done in those employed. Unemployment is a consequence of chronic low back pain which has considerable health and economic consequences for the individual and society. This paper describes an occupationally orientated rehabilitation programme for long-term unemployed people (mean duration of unemployment 38.9 months). The aim of the project was to identify factors which predict return to work and progress towards employment. Eight six subjects underwent a pain management rehabilitation programme incorporating vo- cational focussing and advice, subjects were followed up at 6 months to determine work status. At follow-up 38.4% of subjects were employed and another 23% were in voluntary work, or education/training. There were no significant differences on presenting characteristics between those who returned to work and those who did not. Subjects were divided into those who made positive progress (work, education/training or voluntary work) and those who did not (remained unemployed, dropped out of the pro- gramme or lost to follow up). Those who failed to make positive progress were characterised by longer duration of unemployment and higher scores on somatic anxiety and depression. A predictive model was able to identify 80% of those who failed to make progress but prediction of those achieving a positive outcome was poor (44% correct prediction). The factors predicting return to work in unemployed people with low back pain differs from the employed, the need for employment skills training and a vocational focus to rehabilitation are highlighted. Ó 2003 European Federation of Chapters of the International Association for the Study of Pain. Published by Elsevier Ltd. All rights reserved. Keywords: Low back pain; Rehabilitation; Vocational; Unemployment; Treatment outcome 1. Introduction Chronic low back pain represents a cost to society in terms of the cost of healthcare which in the UK has most recently been estimated at £1623 million (Mani- adakis and Gray, 2000). The wider costs include wage compensation and loss production for those who are employed and social support for those who become unemployed were even greater at £10668 million and even this may be an underestimation. Social costs in- clude incapacity benefits (IBs) for those unable to work, payments associated with injuries, benefits paid to those who cannot access work because of a history of back pain and additional payments which may accrue as a result of entitlement to these benefits. Previous authors have suggested that the chance of ever returning to work after a period of absence from low back pain reduces over time. Waddell (1987, 1992) suggested that by the time a person has been off work with back pain for two years they are unlikely to ever return to work. More recently Frank (cited in Waddell, 1998, p. 110) found that the chance of returning to work within 6 months was negligible in those who had been off work for more than one year. In this study we report an occupationally-orientated rehabilitation programme European Journal of Pain 8 (2004) 359–369 www.EuropeanJournalPain.com * Corresponding author. E-mail address: pjw25@le.ac.uk (P.J. Watson). 1090-3801/$30 Ó 2003 European Federation of Chapters of the International Association for the Study of Pain. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.ejpain.2003.11.003