Impact of Prescription Medicines on Work-Related Outcomes in Workers with Musculoskeletal Disorders or Injuries: A Systematic Scoping Review.
Yonas Getaye Tefera, Shannon Gray, Suzanne Nielsen and 2 others
PMID 37934329WHAT IT FOUND
Early, long-term, or high-dose opioid use is consistently linked to slower return to work and longer disability in injured workers.
Evidence for non-opioid medicines like NSAIDs and muscle relaxants is conflicting, with some studies suggesting they may also delay recovery.
Key findings
01Early opioid prescriptions (within the first two months of injury) are associated with impaired functional recovery and greater risk of work disability in acute low back pain.
02Preoperative opioid use is associated with less stable return to work after spinal surgery, particularly in workers' compensation settings.
03Evidence for skeletal muscle relaxants and NSAIDs is inconsistent: some observational studies link them to delayed recovery, while randomized trials often show no difference or positive outcomes.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The vast majority of included studies were observational (cohort), which can show association but not causation. Confounding by indication is a major limitation: patients receiving more or stronger medicines may have more severe injuries or pain, which independently predicts worse work outcomes. There was significant heterogeneity in the types of musculoskeletal conditions, medicines, and outcome measures across the 65 studies. Most studies relied on administrative workers' compensation data rather than direct clinical assessment of function. The review did not perform a formal quality appraisal or meta-analysis, so the strength of evidence varies between studies.
Declared interests
Funded by Monash Graduate Scholarship, Australian Research Council, and National Health and Medical Research Council. No commercial conflicts of interest were declared.
The easy way to misread this
Do not conclude that these medicines cause disability. The association is likely partly due to patients with more severe or complex injuries being prescribed more medication. However, the consistency of the link, especially for opioids, suggests medication use should be considered a marker for higher risk of work disability.