• Sitting

• Standing

• Bending

• Twisting

• Lifting

• Climbing

• Carrying

• Stamina

• Pain

• Activities in daily living, in severe cases

• Additional limitations caused by side effects of medication

• Driving a vehicle for long periods

Depending upon the course of treatment, individuals may have learned to avoid pain in the use of various pain medications. The counselor needs to be sensitive to an individual who may use alcohol in conjunction with these pain medications to increase (potentiate) the effects of the analgesic. A general statement is that there is a clear relationship between pain/disability and poor response to treatment. If two or more months of no improvement occur, the counselor should consider the influence of psychological factors in the continuance of the pain. This does not mean that the pain is not real; it means, rather, that beyond consideration of physical factors in the treatment and rehabilitation, it may be necessary to respond to psychological factors contributing to the adverse response to the pain.

There is a tremendous amount of controversy regarding the functional limitations associated with lower back conditions and the various treatments associated with these. If surgery is completed, it is most likely to be a laminectomy, which is a removal of the herniated fragment of the disk. All treatment requires careful monitoring by the physician and compliance on the part of the client. These patients do experience pain, regardless of the objective physical findings, and the counselor rarely faces a pure case of malingering. The counselor should also keep in mind that many individuals who experience low back pain may be struggling with psychological adjustment related to self-image. They often have, or have had, jobs paying relatively large salaries or hourly wages but requiring heavy, and in some cases risky, physical activity which is counter-indicated by their back pain. They are now faced with the option of low-paying, but non-risky jobs.

• The client will need a job that can accommodate frequent changes of body position.

• Has the person primarily worked in jobs that require much lifting and physical activity?

• Is there a history of long-term back problems, or are the problems recent? If the condition is a result of muscle strain, there is usually recovery and the back pain is considered temporary.

• Will the person require work modifications?

• How has the disability affected the person in school functions or everyday activities? This is an important consideration for individuals who have never worked or have a limited work history.

• Consider whether the extent of pain the individual experiences can be overcome by pain management techniques, work hardening programs, or by identifying a work goal which does not aggravate the condition. Also, consider whether the individual has the capacity to train for appropriate work goals, if required.