• Erik L Werner and Pierre Cote.
• Research Unit for General Practice, Unifob Health, Bergen, Norway. loewern@online.no
• Eur J Gen Pract. 2009 Jan 1;15(2):74-9.

BackgroundLow back pain (LBP) is a frequent diagnosis for sickness absence. The process of sick-listing is complex, and the doctor must integrate information from several levels in the decision.ObjectiveThe aim of this paper is to describe the main determinants of sickness absence for LBP.MethodsWe conducted a non-systematic search in Medline and personal files to identify determinants of sickness absence, and structured these into four levels of the sick-listing process. These levels are characteristics of 1) the sick-listed worker, 2) the sick-listing doctor, 3) the workplace, and 4) the cultural and economic conditions of the society.ResultsImportant characteristics of the sick-listed person seem to be poor mental health, including negative beliefs about LBP. Also, comorbidity and lack of coping abilities are found associated to sickness absence. The impact of the doctors' personal beliefs about LBP is not clear. Doctors in general seem to be frustrated by their gatekeeper role and the influence of other healthcare providers on the sick-listing decision. The workplace is an important factor in the sick-listing process, but the impact of physical working conditions is of less importance than social support, job control, and demands. On the society level, the economic awards in sickness absence and the general acceptance of being sick listed seem to be of importance for the individual's decision to claim sick leave.ConclusionThe sick-listing process for LBP is complex, and the determinants are mostly non-medical. It seems important to adopt a broad perspective of how a worker copes with pain and how these coping strategies interact with cultural, economic, and societal determinants of sickness certification.

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