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Work-hardening programs may assist people in returning to their jobs despite back pain by actively simulating work-related tasks in a clinical setting, increasing endurance and decreasing fear of movement.

More passive programs, like back schools that just teach information in a classroom setting, generally tend to be less effective, Childs says. Addressing psychosocial factors may play a role in protecting your back as well, according to Menzel. She completed a pilot study in 2004 that showed that the use of cognitive-behavioral training in conjunction with the use of mechanical lifting aids was promising for reducing back pain in nurses compared to the use of the lifting devices alone.

The cognitive behavioral training group received instruction in muscle relaxation, job-stress management, cognitive restructuring (learning to change the perception of pain), conflict resolution, distraction and pain-coping strategies, as well instruction in and use of the lifting equipment. The control group received only instruction in and use of the lifting equipment.

Surgical options

For certain specific pathologies, surgery may be warranted to reduce back pain if conservative treatment fails to garner results, Lau says. In a microdiscectomy, some of the inner content of a herniated disk is removed through a small incision to relieve impingement on the nerves. In a laminectomy, the posterior part of the vertebra is removed, giving more room for the disk itself.

Intradiscal electrothermal therapy (IDET) is a minimally invasive technique used to treat significant wear and tear on the outer ring of the disk. A probe heats the disk wall, causing it to thicken and seal, reducing herniation.

A surgeon may recommend spinal fusion, actually connecting adjoining vertebrae by use of a bone graft or synthetic material. This increases the stability of the spine, but consequently reduces flexibility.

Flexibility may be maintained by replacing a damaged disk with an artificial one. The prosthetic devices, first approved by the FDA in June, use material similar to those in artificial knees and hips and allow normal movement of the spine.

No matter what the treatment advised for back pain, occupational health nurse Schaumleffel and others emphasize a positive attitude in dealing with the problem. “In learning to live with back pain, you have to stress the living part,” she says.

Not your grandfather’s handling techniques

Experts agree that the best way to treat back pain is to prevent it in the first place. But the “proper body mechanics” taught in nursing schools and at employee orientations may not be so proper after all in a patient care setting.

“If proper body mechanics were enough to protect a 120-pound nurse lifting a 250-pound patient, we wouldn’t have so many injuries,” says Nancy Menzel, RN, PhD, an assistant professor at the University of Florida College of Nursing who has studied back pain in nurses.

The problem, explains Butch de Castro, RN, PhD, MSN/MPH, senior staff specialist for occupational health and safety at the American Nurses Association, is that traditional lifting techniques are based on outdated studies that focused on men lifting 50-pound boxes with handles straight off the ground.

“But our patients don’t weigh 50 pounds, don’t have handles, and we’re not lifting them straight off the ground,” he says, so the techniques “have no practical application to nursing care in terms of patient handling.”

A safer way to reduce the risk of injury associated with moving patients is to eliminate manual patient handling altogether, he says. Nurses should lift or transfer patients using only assistive patient handling equipment such as ceiling lifts, transfer chairs, sliding boards, gait belts, or inflatable, mechanical, or friction-reducing lateral-assist devices.

This “no-lift” policy is the hallmark of the ANA’s “Handle with Care” campaign launched in September 2003, a comprehensive effort aimed at preventing back and other musculoskeletal injuries in nurses by effecting changes in practice through modifications in administration, legislation, and education.

“Safe patient handling prevents nurses’ injuries, improves patient care, and saves employers money in terms of workers’ compensation costs,” de Castro says.

The United States lags behind other nations such as the United Kingdom and Australia, which have had no-lift policies in place for nurses for more than 10 years, resulting in a significant reduction in incidence of back pain and injury in nurses.

The United States is moving forward, though. The Smart Patient Handling policy at Mercy Hospital of Folsom requiring that ancillary devices must be used for anything other than minimal assist “has decreased the incidence of back pain and injury due to patient handling,” attests Lori Schaumleffel, RN, COHN-S, coordinator of employee services. The idea of reducing or eliminating manual transfers is catching on throughout the country.
“We’re seeing more health care administrators taking safe patient handling to heart,” de Castro says, noting that more nurses are trying to alter policies in their facilities. “It just takes one champion within a health care facility to create change.”

For more information about safe patient handling, visit:

• American Nurses Association Handle with Care Campaign, www.nursingworld.org/handlewithcare
• Department of Veterans Affairs, VHA Patient Safety Center,
  www.patientsafetycenter.com

Anne Federwisch

Editor’s note Visit Education/CE at http://nsweb.nursingspectrum.com/ ce/ce283.htm to view our self-study module on lower back pain.

Anne Federwisch is a freelance writer.