Early identification and intervention in the prevention of musculoskeletal pain.

BACKGROUND: A large number of people suffer from upper extremity disorders, but a few apparently consume the majority of the resources. Early interventions are badly needed to prevent the development of persistent disability. Since psychological factors are central in the development of a chronic problem these might be utilized in this endeavor.
METHODS: A series of studies are described where a screening procedure based on psychological risk factors was employed to help identify people at risk for developing long-term work disability. The utility of a cognitive-behavioral group intervention that focuses on coping strategies as prevention was assessed in three randomized-controlled studies where participants had low, medium, and high risk, respectively.
RESULTS: The study with low risk showed no significant difference between the groups, while the studies with medium- and high-risk populations demonstrated significantly lower work disability than control groups receiving treatment as usual.
CONCLUSIONS: It appears to be feasible to identify patients with high levels of risk and to subsequently lower the risk for work disability by administering a cognitive-behavioral intervention focusing on psychological aspects of the pain problem.