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Chronic Pain Observations from Workers Compensation Case Management

Our daily review and support of legacy workers compensation claims has revealed common findings of pain management mistreatment and lack of "active listening" on the part of pain management providers. Very often, if a patient is treated for a specific condition such as pain associated with another underlying condition, the pain management specialist will prescribe dangerous opiate medication strategies to confront the immediate complaint. Without close monitoring and management, long term use then causes the patient to become addicted to the opiates while ignoring the underlying cause of the pain. The patients are often not "abusing" the medications being prescribed, however are being treated as if the medication is the only course to follow indefinitely.

The costs associated with long term use of opiate drugs are dangerous to the patient and the healthcare system. During the 1991-2011 timeframe, retail opioid prescriptions increased almost 300% in the United States as reported by the Centers for Disease Control. In a study funded by Kaiser Permanente and documented by the National Institutes of Health titled "Pain management in primary care: strategies to mitigate opioid misuse, abuse, and diversion", researchers found pain is among the most common reasons patients seek medical attention, and the care of patients with pain is a significant problem in the United States. Acute pain (mild-to-moderate intensity) represents one of the most frequent complaints encountered by primary care physicians (PCPs) and accounts for nearly half of patient visits. However, the overall quality of pain management remains unacceptable for millions of patients with acute or chronic pain.

Primary care physicians are busy and don't have the time to address all of the issues of the workplace occurrence and other comorbidities. Rather than spending the necessary time to address all of the issues, they prescribe opioid medications for short term relief. However, long term use of these medications creates addiction and dependency causing a downward spiral of health issues which are difficult to manage. Primary care physicians can become advocates for proper pain management and ensure that all patients with pain are treated appropriately. An entire range of options are available if the treating team including strategic case management is employed immediately after the occurrence. Those include:

  • Drug treatments such as non-prescription drugs like Aleve, Motrin, and Tylenol or stronger medications such as morphine, codeine, muscle relaxers and antidepressants
  • Nerve blocks (the blocking of a group of nerves with local anesthetics)
  • Alternative treatments such as acupuncture, relaxation, and biofeedback
  • Electrical stimulation
  • Physical therapy
  • Surgery
  • Psychological counseling
  • Behavior modification
  • Other holistic approaches in combination with standard therapies

Once the case is organized between the occurrence and comorbidity care issues, then the appropriate insurance coverages can be applied. For more information about this study and strategic case management approaches, please contact us.

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