VoL 13 No. 3 Ma,vh 1997 Journal of Pain and Symptom Management 179 Book Reviews Controlling the Costs of Pain-Related Disability Andrew Block, PhD Back Pain in the Workplace: Management of Disability in Non-Specific Conditions Edited by Wilbert E. Fordyce Published by IASP Press, Seattle, Washington, 1995, 75 pages, $25.00 In 1992, the International Association for the Study of Pain (IASP) convened an expert panel to address the worldwide "explosion of low back disability." The book Back Pain in the Workplace: Management of Disability in Non- Specific Conditions represents the major report of this group. The title of the book, however, is somewhat misleading. Although there is some general discussion of clinical manage- ment issues (see later here), the primary focus of the book is instead on "the ways in which society deals with disability attributed to non- specific low back pain" (p. 1). The goals of this report are both to "diminish the risks to health that result when a worker is inappropri- ately designated as disabled" and "to propose remedies for escalating disability costs." The unifying concept of the report is non- specific low back pain (NSLBP). Five or six categories of specific back injuries are defined by the authors, including disc herniation, spi- nal stenosis, spinal instability, fractures, tumors and infections, and possibly "true sciatica." All other diagnoses (constituting about 85% of all back injuries, according to the text) are con- sidered to be forms of NSLBP. In such condi- tions, the source of nociceptive stimulation is Andrew Block, PhD, is the director of The WellBe- ing Group: Behavioral Medicine Consultants, Plano, TX, USA. © u.s. Cancer Pain Relief Committee, 1997 Published by Elseviel,New York, New York seen as unclear, and the relationship of pain to suffering and that of pain to behavior are seen as influenced by a host of nonphysiological factors, such as environment, personality, emo- tions, and financial incentives. The authors' primary contention is that patients with NSLBP should not be declared permanently disabled, or considered to be permanently impaired. Disability and impair- ment are typically determined by considering two factors: the pathophysiological basis of the pain, and the effects of the injury on the patient's ability to function in certain tasks. Because pathophysiological basis of the NSLBP pain is uncertain, the only means for determining disability and impairment rests on the patient's functional capacities. Accord- ing to the authors, measurement of these functional limitations depends largely on the patient's "effort" and "tolerance" for activity. Unfortunately, neither effort nor activity intol- erance can be directly or independently assessed. Therefore, they should not be con- sidered in determining partial or total disabil- ity. The awarding of permanent disability sta- tus, with its attendant financial implications, should be based solely on the identification of one of the specific back pain diagnoses. The text provides much valuable epidemio- logical information on back pain incidence and its spiraling direct and indirect costs. These data certainly justify the need for sys- temic changes in the management of back pain and the assignment of disability. Further, the text provides interesting and somewhat unique discussions on the nature of pain, as well as the difficulties involved in diagnosis. 0885-3924/97/$17.00