Absent from Work: Nature versus Nurture

Low back pain is common and costly. It is a leadingcause of chronic pain and an inordinately frequent cause of disability and lost productivity. According to a recent survey of U.S. workers, those who lost time because of back pain in the previous 2 weeks reported losing an average of 5.28 hours of productive time per week (1). Back pain accounted for nearly $20 billion of lost produc-tivity and ranked second only to headache as a reason for loss of productive time. According to this survey, most of the loss was not from absenteeism but from reduced per-formance at work. Unfortunately, lost productivity ac-counts for only part of the total estimated work-related cost of musculoskeletal conditions in the U.S. workforce. The rest is due to medical costs associated with an ongoing chronic disability (for example, effects of medication; visits to the doctor; diagnostic tests; surgery; or visits to a chiro