Arthritis and the role of the physician in nonmalignant pain and disability.

Most adults will experience at least one episode of low back pain. It is the second most common symptom that prompts visits to the doctor's office. Back pain is subjective and often presents with few objective findings on a physical exam. It remains a diagnostic and therapeutic challenge to many practitioners. Psychosocial and economic issues, such as litigation, workers' compensation claims and depression may have an impact on the management and treatment outcomes (Helfgott, MD, Simon M., 2001). Workers' compensation programs have a mandate to compensate only those who deserve compensation. Therefore, disability rating exists to sort out those who cannot work from those who will not work (Sullivan, MD, 1992). When treating chronic nonmalignant pain the physician should make a decision to either function as the patient's advocate or the rater of the patient's limitations. This will increase the likelihood of a healthy patient-physician relationship during what may be a very vulnerable and stressful period. It is very important to obtain sound acceptable documentation of the diseased patient's limitations by choosing the proper cost effective diagnostic studies, which are appropriate for each individual case. This will result in establishing an accurate and correct diagnosis. This process should lead to offering the patient treatment options designed to achieve pain reduction and improvement of his/her activity of daily living.