Treatment for pain is the overall largest component of medical treatment in workers’ compensation claims yet often adjusters do not know how to use nurses effectively in the pain control scenario. Pain often presents the biggest challenge to medical providers who repair torn ligaments or fractured bones with ease but struggle to provide proper pain management for injured employees.
Pain is defined by the International Association for the Study of Pain as: “An unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.”
No Tests Can Measure the Level of Pain Experienced
Pain is unique to each individual. No tests can measure the level or the intensity of pain an injured employee experiences. Unfortunately, an injured employee prone to malingering, now has an easy avenue to avoid returning to work.
The level of pain cannot be tested by the treating physician. Common practice is to ask the injured employee to rate the pain on a level of zero to ten on a 10-point scale. A zero rating indicates no pain and 10 rating indicates pain preventing any body movement or function. Injured employees who do not want to return to work normally rate their pain higher on the 10-point scale than actually being experienced.
A medical provider determines the location of pain by various neurological tests involving touching and pressing key points on the limb or body and by requesting the injured employee to make various movements. This type of examination allows the physician to test reflexes, sensation, coordination, movement, and balance. Based on these tests plus the observations of the employee’s facial expressions, total body movements, and gait, the medical provider pinpoints the spot within the limb or body where the pain is originating.
The medical provider uses various technologies to identify the cause of pain. The most common ways include electromyography (EMG) and nerve conduction studies. The EMG gives the medical provider guidance in identifying which nerves or muscles are impacted by weakness or pain. Nerve conduction studies measure a nerve’s electrical system and allow the medical provider to determine if there is nerve damage.
Pain is most often described as either acute or chronic. Acute pain is sudden pain an employee feels immediately when a laceration, burn, or other occurrence causes damage to the skin, internal tissue, or bones. Chronic pain is on-going pain an injured employee feels over an extended period of time. Some medical providers define chronic pain as pain lasting more than six months from the date of injury. Others define chronic pain as pain lasting longer than the expected healing time for the injury.
Chronic pain is often described as ‘burning,’ ‘shooting,’ ‘aching,’ ‘stabbing,’ or like an ‘electrical shock.’ Chronic pain is also described in terms of stiffness, soreness, and tightness. Chronic pain can be at any level on the 10-point pain scale. Other medical issues are experienced by those suffering from chronic pain including the inability to sleep, depression, anxiety, and fatigue. The severity level of chronic pain is influenced by psychological and environmental factors.
Skilled Senior Nurse Reviewer Should be Assigned to Chronic Pain Cases
Proper management of chronic pain is often needed after a failure of surgery and other medical treatment methods are used to relieve an injured employee’s pain. When an injured employee is dealing with chronic pain, consider assigning a senior nurse reviewer (a nurse case manager with extensive clinical experience, at least 15 years) working for a medical management company to the injury claim.
Proper treatment of chronic pain requires a multidisciplinary approach to medical management. A skilled senior nurse reviewer working with a multidisciplinary team of board certified physicians can evaluate the treatment plan of the employee’s medical provider, recommend changes in the treatment plan if needed, or, in conjunction with the medical management company’s clinical panel, create a customized chronic pain management treatment plan for the injured employee. The team should be setting up goals for what should be accomplished and holding regular discussions on progress. An area that is often overlooked is screening and monitoring of the injured employee throughout the process.
Senior Nurse Reviewer Works with Medical Provider on Pain Management
The senior nurse reviewer continues to work with the injured employee and the employee’s medical provider, monitors the medical treatment, and follows up on the employee’s recovery progress. If changes are needed in the chronic pain management plan, the senior nurse reviewer works with the medical provider and the multidisciplinary team of the medical management company to revise the pain management program.
If you have long-term claims where the focus of the medical treatment is dealing with chronic pain, we can assist. Please contact us for a referral to a medical management company.
Author Michael Stack, CEO Amaxx LLC. He is an expert in workers’ compensation cost containment systems and helps employers reduce their workers’ comp costs by 20% to 50%. He works as a consultant to large and mid-market clients, is a co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is the founder & lead trainer of Amaxx Workers’ Comp Training Center, which offers the Certified Master of Workers’ Compensation national designation.
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