My attention has been attracted by the special focus issue (#1/2008) of the journal dealing with the treatment prescribed for the management of chronic low back pain (CLBP). This picture belongs to the group of work-related musculoskeletal disorders affecting workers in a wide variety of occupations, which are a major cause of lost time from work, workers’ disability, compensation claims and health care costs (1).It might be useful to stress the importance of preventive interventions in the management of CLBP. The paper by Wai et al. (2) correctly analyses the modifiable lifestyle risk factors, such as smoking and weight loss, but does not address the value of the occupational factors able to cause the disorder.It might be interesting that the observation of the association between occupation and CLBP dates back three centuries. In 1700 Ramazzini reported that biomechanical overload and awkward postures were responsible for diseases affecting several occupations (3, 4). More recently, the National Institute of Occupational Safety and Health reviewed the studies on the relationship between low-back disorder and physical workplace factors (heavy physical work, lifting and forceful movements, bending and twisting, whole-body vibration and static work postures (5). The review provided evidence for a positive relationship between back disorder and heavy physical work and strong evidence that low-back disorders are associated with work-related lifting and forceful movements. Presently, there is a lot of evidence confirming these data and a model has been developed for determining the work-relatedness of CLBP for a worker with low back pain using both a personal exposure profile for well-established risk factors (6). As a consequence it could be recommended that all professionals (15 are listed in table 6 of the paper by Haldeman et al.)(7) who are involved in the management of CLBP explore their patients’ occupation before any treatment. It is worthy to remind that Ramazzini it was who suggested that, in addition to the questions recommended by Hippocrates (about the kind of pain or illness, about cause and duration), the physician should ask the patient one more, namely “what is your occupation?” (8).History-taking to investigate the occupational origin of health problems is presently taught to medical students, although it is not known whether all doctors have mastered this skill.
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