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.