Screening for patients at risk of developing chronic incapacity.

Formal investigations of psychiatric disorders and long-term personality characteristics have been relatively unhelpful in the prediction of future incapacity. Clinical studies of pain patients have led to a new range of more specific measurement instruments assessing different aspects of psychological functioning: such as pain behavior, distress, beliefs about pain, and coping strategies. Recent investigations of patients with acute back problems have identified a strong relationship between levels of distress, dysfunctional coping strategies, and future disability. Measurement instruments specifically validated for occupational settings still need to be developed, but preliminary studies suggest that fear of hurting/harming, job stress, and job satisfaction may be important factors. A pilot study into occupationally-oriented back pain management for the unemployed is reported. Results suggest that such clients may have significantly more rehabilitation potential than has previously been believed.