FfW Bulgarian report (English language) - Fit for Work Europe

2.4
A note
on definition
Introduction
Back pain and the majority of WRULDs are categorised as non-specific and episodic conditions
which may frequently be caused by, or be made worse by, work. They manifest themselves in
disparate ways and may cause periods of intense discomfort and incapacity which may affect
the ability of the individual worker to carry out their work. They may also abate for long periods.
Many people with these conditions, such as back pain, never seek treatment and most recover
on their own but the conditions can cause significant absence from work or lost productivity.
Back pain and WRULDs are often included in the occupational health and safety guidelines and
literature. Occupational health practitioners typically deal with these conditions.
On the other hand, RA and SpA are specific and progressive rheumatic diseases which are
not caused by work, but may be made worse by work and are often handled by general
practitioners and specialists, not within the occupational health arena. They are clinically
diagnosed conditions that progress in a broadly predictable way, if untreated. They can have a
significant impact on functional capacity at work and, in the long-term, participation in the labour
market. Most people with these conditions require clinical interventions over a prolonged period
of time and the management of these conditions for those of working age should involve the
frequent and active participation of clinicians, employers and occupational health professionals.
Together, these MSDs illustrate the effects of conditions from which a third of Bulgarian workers
may report at any one time. Improving our understanding of the effects of these conditions, how
staying in work can be beneficial, and what might be done to alleviate their impact, can yield
significant social and economic benefits.
In the absence of a consensus on a clinical definition of many MSDs, navigating the literature on
their prevalence, incidence, diagnoses, epidemiology, treatment and cost to Bulgarian society
is a difficult task. The lack of standardisation and validation of the terminology and classification
of MSDs is one of the reasons for the contradictory findings in the literature regarding the
diagnosis, epidemiology, treatment and rehabilitation of these conditions (WHO, 2003). Some
clinicians differentiate between ‘musculoskeletal conditions’ and ‘musculoskeletal disorders’.
The former refers to all clinical conditions affecting the musculoskeletal system and the latter, to
borrow a definition from the ETUI (2007), meaning ‘any affliction of the musculoskeletal system
that appears at work and causes discomfort, difficulty or pain when performing work’.
Until 2007 Bulgaria did not have an official definition of work-related musculoskeletal disorders
(Gladicheva and Chengelova, 2007). The most commonly used definition was defined by an
expert group at the University Clinic of Occupational Diseases:
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