Peritial social security assessment of urban transport drivers with low back pain and sciatica

Abstract

Introduction: Lumbar and sciatica pain (LP) are health problems that cause loss of productivity and absenteeism, generating high social security costs due to benefits. Urban public transport drivers show these symptoms at significant rates, generating high social security costs, with the granting of benefits. The causes vary considerably, ranging from localized diseases to psychosocial factors. The medico-legal experts at the Brazilian National Social Security Institute (INSS) must decide whether the person needs or not the benefit in order to grant the benefit to whom it is due.

Objectives: To present relevant aspects of the medical expert assessment of urban bus drivers with DL or sciatica in the last 35 years. Method: Bibliographic review in the Scielo, Pubmed, Cochrane and Science Direct databases. In addition, books on Orthopedics and Ergonomics were consulted. Results and discussion: The medical expert must dedicate himself, on a regular basis, to anamnesis, physical examination, evaluation of truth-telling, supplementary examinations and examinations in the workplace to arrive to an objective and impartial conclusion. The expert’s diagnosis of LP and sciatica depends not only on pathological, but on biopsychosocial factors as well. Conclusion: Since pain is a subjective symptom, establishing a diagnosis is a challenging task to the medical expert, who must be experienced to be able to identify the truth of the alleged symptom.  To perform an adequate evaluation of the bus driver’ health conditions, a series of examinations are conducted by the experts in the social security system: an anamnesis, to identify possible focal or psychosocial causes; a physical examination, to evaluate if the person has a real or simulated condition; supplementary tests, to corroborate and assist in the formulation of the diagnostic hypothesis; and an ergonomic evaluation, to verify external factors related to work that may affect the person’s health, as recommended by the Federal Council of Medicine. This evaluation should be as comprehensive and objective as possible; otherwise, a benefit may be improperly canceled, maintained or granted.