How You Can Prevent Pain Medication From Causing More Pain

Opioid-Induced Hyperalgesia

 

Anytime I discuss medical issues I always clarify that I am in no way a medical physician.  Whether it is to a claimant, or an attorney, I can only interpret medical in my own opinion based on training and years of experience in this business. I do also clarify to people that I always try to stay up to date on new medical issues, since they can have a direct application on the handling of workers compensation insurance claims. 

 

There has been some talk of late about a new issue involving opiate medications, coined “Opioid-induced Hyperalgesia” or “OIH” for short.  Oftentimes a claims adjuster has a file where a claimant is taking a large amount of opiate medications for pain.  Every time the adjuster reviews the medical records, or talks to the claimant, the injured party seems to be in more pain than before, despite the presence or even increased dosage of strong narcotic medications.  How is this possible?  If Oxycodone is doing nothing for pain control, then what other steps could you take for pain control?

 

In the past, an adjuster worried about narcotic pain medication causing addiction issues, dependence issues, and increased medication tolerance issues. In addition to that, these medications are costly, and they seem to be prescribed on every claim no matter what the severity. But OIH has raised new concerns about longer-term chronic pain issues and what to do before these claims get out of control. 

 

 

The Cause of OIH:

 

The exact cause of why OIH occurs is currently under medical investigation.  The leading theory continues to be the excitation of nerves through chemical pathways by certain types of narcotics.  Research has shown that some narcotics may have a higher propensity to cause OIH than others.  These are mainly known as the “phenanthrene opioid” class of medications, which includes codeine, hydrocodone, oxycodone, and hydromorphone.  In patients where OIH could be the culprit, switching to a non-phenanthrene medication such as meperidine or tramadol often times leads to adequate pain relief, much to the surprise to those involved.

 

In simpler terms, OIH may be caused by the narcotic itself increasing the level of pain that the patient may be experiencing.  Almost out of the blue, this medication that is supposed to be used as a pain reliever is actually worsening the pain, thus requiring larger and larger doses of medication for adequate pain relief.  As these doses increase, so do the risks for the more well-known issues with pain medication which include central nervous system issues, depression, addiction, drug-seeking behavior, and the risk of overdose. Even more, the financial costs of these medications begin to dominate the claim more than anything else, including wage loss.

 

 

What to Watch For:

 

Some common characteristics of OIH include:

 

  • Worsening pain over time despite increased dosages of opiate narcotics used for pain control.

 

  • Pain that becomes more diffuse in and around the area of injury.

 

  • Sensitivity to touch around the injured area specifically.

 

  • Subjective setbacks in the progression to MMI without diagnostic objective findings.

 

 

The Future of OIH

 

Although this is a newer phenomenon, the study of OIH can change the way physicians diagnose and treat chronic pain cases.  To date, if a patient’s pain in not controlled by whatever medication they are taking, it is common to step the dosage up to the next level, and re-evaluate pain at the next doctor appointment.  Because increased doses are used, the patient also has increased tolerance for pain medication, and at that point the dose must increase again. But if OIH were to be present early on, but not addressed specifically, then who knows if that medication would have ever helped this person’s pain, no matter what the dose?

 

There is a large potential for work comp claimants to experience OIH symptoms since narcotic pain relief is often used early on, usually at the first visit to the clinic.  When reviewing your comp files, especially those longer-term files where a person has had chronic pain symptoms of an escalating nature without any exacerbation of the injury, those files should be sent for an OIH evaluation by a medical professional.

 

 

Summary

 

I believe it is a safe assumption that OIH could be responsible for a significant percentage of claims dollars spent within the workers compensation system.  Cost drivers that can occur if this is not diagnosed will be increased medication costs, medication side-effect management, and addiction treatment.  These three issues alone can be responsible for large amounts of money spent on the claim.  The ability to identify OIH very early on in the life of a claim can save massive amounts of claim money, and also benefit the claimant who would not have to deal with the strong side effects of the long-term use of these dangerous medications. The ability to identify and treat OIH correctly will lead to better claim outcomes, earlier returns to the workplace post-injury, and an overall decreased burden on the work comp system as a whole. 

 

 

 

Author Rebecca Shafer, JD, President of Amaxx Risk Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. She is the author of the #1 selling book on cost containment, Workers Compensation Management Program: Reduce Costs 20% to 50%Contact: RShafer@ReduceYourWorkersComp.com.

 

Editor Michael B. Stack, CPA, Director of Operations, Amaxx Risk Solutions, Inc. is an expert in employer communication systems and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. He is a writer, speaker, and website publisher.  www.reduceyourworkerscomp.com Contact mstack@reduceyourworkerscomp.com

 


WORKERS COMP MANAGEMENT MANUAL:  www.WCManual.com

VIEW SAMPLES PAGES

MODIFIED DUTY CALCULATOR:  www.LowerWC.com/transitional-duty-cost-calculator.php

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.

 

©2012 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact us at: Info@ReduceYourWorkersComp.com.

 

The Best Tidbits of News From the Workers Comp Community

 

 
Date: August 21, 2012
Time: 11:00 am CST
Duration: 1 hour
 
Employers often think that there is nothing that they can do to control workers’ compensation costs. Many times they don’t know where to start, don’t have the resources to get the job done, don’t have the time to do it themselves or don’t have the staff to support the cost-reduction efforts.  Register Here
 
 
 
The 67th Annual Workers’ Compensation Educational Conference and the 24th Annual Safety and Health Conference are just around the corner. Set for August 19 through 23, 2012 at the Orlando World Marriott, the conference will again focus on the national workers’ compensation and safety industries, serving… Read the Full Post »
 
 
 
Published in Business Insurance, Author Mark Walls, Safety National, mark.walls@safetynational.com
 
One of the biggest cost drivers in Workers Compensation is seemingly “average” claims that take a turn for the worst and result in several years of medical treatment and disability.   Mark Walls, vp of claims for Safety National Casualty Corp discusses the common threads of “creeping catastrophic” claims.  Read Full Article…
 
 
 
Posted by Marianne Cloeren, MD, MPH, FACOEM – Managed Care Advisors
 
The organization Physicians for Responsible Opioid Prescribing (PROP) filed a petition with the FDA to change the labeling for opioid analgesics so that it does not include use for chronic non-cancer pain. They make the excellent point that research is showing lack of effectiveness and high risk. 

Here is more information from the president of PROP, Dr. Andrew Kolodny about this effort:

"I’m writing in the hope that you’ll submit comments to FDA supporting the citizen petition for label changes on opioid analgesics. 

As you may have heard, a couple of weeks ago PROP filed this petition with FDA. This request has received support from members of Congress, including Rep. Mary Bono Mack and Hal Rogers, so we believe that FDA is paying close attention. 

Here’s the link where you can submit Comments:
 
 
 http://www.citizen.org/documents/2048.pdf 

And here’s a press release about the petition that was issued by Public Citizen:
 
 
If FDA implements our request, opioid manufacturers will be prohibited from promoting long-term use of opioids for chronic non-cancer pain and the medical community will be informed that this practice has not been proven safe and effective. We believe that this will help reduce overprescribing of opioids. And since it’s overprescribing that’s harming pain patients and fueling the opioid addiction epidemic, the label change could help bring this public health crisis under control
 
 

Author Michael B. Stack, CPA, Director of Operations, Amaxx Risk Solutions, Inc. is an expert in employer communication systems and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. He is a writer, speaker, and website publisher.  www.reduceyourworkerscomp.com Contact mstack@reduceyourworkerscomp.com

 

 


WORKERS COMP MANAGEMENT MANUAL:  www.WCManual.com

VIEW SAMPLES PAGES

MODIFIED DUTY CALCULATOR:  www.LowerWC.com/transitional-duty-cost-calculator.php

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.

 

©2012 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact us at: Info@ReduceYourWorkersComp.com.

Broadspire Drug Abuse Summit and Other News from the Workers Comp Community

 
Broadspire Rx Summit
Danielle Lisenbey, chief operating officer for the Medical Management Services of Broadspire announced its first annual Rx Summit in Sunrise, FL March 22. As a leader in the industry, Broadspire's first Pharmacy Issues Summit should prove to be helpful. They write, “The purpose of the meeting will be to bring thought leaders from various organizations together to discuss relevant topics and issues surrounding pharmacy benefits in the workers compensation setting.

The intent is not to share the specifics of what various companies are doing, but rather to focus on the global industry issues themselves and what may be the possible trends and developments for the future. One key objective of the program will be to help to identify and define common threads that run through all components of the industry – across claimants, payors, employers and carriers.

Defining some of these commonalities will help the consumer to maneuver through the market. Each participant is invited to bring one operations executive and one clinical representative. This will be an opportunity to brainstorm and share ideas amongst industry peers that can help to influence positive impacts for all.”[WCx]

 
 
Email Mjaynes@choosebroadspire.com by March 15, 2012 for more information. The Summit is by invitation only.
 
 
Everything Business Corp! Magazine Tells how to Fuse Workplace Wellness Programs With Recovery
An article by Lisa Firestone addresses the way employers are continuing to struggle with a challenging economy. “Maximizing efficiency and productivity is no longer a goal to strive for, it is essential for continued growth and even survival,” she writes. “Recognizing this dynamic, it is not surprising that more and more employers are actively engaging in worksite wellness programs that have proven to be effective in lowering health care costs – in fact, according to American Journal of Health Promotion every $1 invested in a corporate wellness program returns $4 in reduced health care costs and $5 in reduced absenteeism over a period of three to five years.”
To read more on this topic, look here.
 
 
LexisNexis Communities Highlights Weekly WC Hot Stories
The Workers Compensation Law Community Powered by Larsons on LexisNexis offers this week three fascinating news articles:
 
1. The Defense of Intentional Self-Injury: Russian Roulette, Workplace Frustration, Accidental Drug Overdose, and More reviews Rashness Versus Intention in Self-Injury Cases, Impulsiveness Versus Intention in Self-Injury Cases and Suicide Test as Test for Self-Injury. It can be found here.
 
 
2. LHWCA: Responsible Employer Determination in Cases Involving Multiple Traumatic Injuries: Seeking Analytical Clarity is a thorough look at the same using relevant precedent, post-Albina board decisions, burden of proof; aggravation vs. natural progression: identifying the cause(s) of disability and sequential vs. simultaneous consideration of evidence. It can be found here.
 
 
3. Larson’s Spotlight on Recent Cases: Firefighter’s Rule Did Not Bar Tort Action against Homeowner examines the firefighters’ rule, an important exception to the usual third-party liability rules in which a firefighter (or other first responder) may not recover in tort from a landowner or occupier who has been negligent in starting or failing to curtail a fire. Read more here.
 
 
LexisNexis Editor Featured in Risk Management Magazine
Thomas A. Robinson, a contributing author and editor of LexisNexis resources including Larson's Workers Compensation Law and Workers Compensation: The Survival Guide for Business, wrote a fascinating article that was recently featured in the well-known RIMS magazine. Also a member of the LexisNexis National Workers Compensation Advisory Board, Robinson writes about 10 bizarre WC case that ended unexpectedly here.
 
The article is a great read and includes juicy stories such as what the courts decided when an obese employee broke a leg trying to get unstuck from a cafeteria booth, whether a construction worker who lost an eye trying to sledgehammer a found bowling ball on site and whether a fatal heart attack while holding a termination letter is still covered.
 
 
For more like it, sign up for the free weekly enewsletters in national and California editions by Robin Kobayashi here.
 
 
Need More, Faster WC Info? We have the Newsletter for You
Check out this LexisNexis newsletter that can keep you on top of what’s happening in our industry. Learn more here and sign up here.
 
 
Texas Department of Insurance Changes Pay Advance Form
The Texas Department of Insurance Division of Workers’ Compensation recently changed the form injured employees use to request pay advances on their WC settlement checks. The form, DWC Form-047, Employee’s Request for Advance of Benefits, and the DWC Form-053, Employee Request to Change Treating Doctor is for an injured employee to request an advance of his/her workers’ compensation income benefits. The DWC Form-053 is for an injured employee who is not part of a certified workers’ compensation health care network, and whose claim does not involve medical benefits provided through a political subdivision pursuant to §504.053(b)(2) of the Texas Labor Code, to request a change of treating doctor.[WCx]
 
 
Workers’ compensation system participants should use the revised DWC Form-047 or DWC Form-053 on and after March 7, 2012. Previous versions of the form will no longer be accepted after June 1, 2012. For more information, check here.

 

 

 

 

Author Rebecca Shafer, JD, President of Amaxx Risk Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. She is the author of the #1 selling book on cost containment, Workers Compensation Management Program: Reduce Costs 20% to 50%. Contact: RShafer@ReduceYourWorkersComp.com.

 


WORKERS COMP MANAGEMENT MANUAL:  www.WCManual.com

VIEW SAMPLES PAGES

MODIFIED DUTY CALCULATOR:  www.LowerWC.com/transitional-duty-cost-calculator.php

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.

 

©2012 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact us at: Info@ReduceYourWorkersComp.com.

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