Four Methods for Pain Management in Workers Compensation Injuries

Pain, real or perceived, is a key barrier and among the most difficult of workers compensation claims to resolve. Pain can originate from the injury or from surgical intervention/treatment. Pain management is used to treat conservatively an injury or can be a part of the post-surgery rehabilitation process.

 

 

The numerous treatment techniques, methods, and approaches are divided into three broad areas.

 

  1. Non-drug, noninvasive pain management.
  2. Noninvasive drug management.
  3. Invasive pain management. (WCxKit)

 

  1. Non-drug, noninvasive pain management

Common non-drug, noninvasive pain management techniques include:

  1. Physical therapy to assist the employee in restoring normal movement of an injured body part.
  2. Cutaneous stimulation – the use of hot packs and cold packs to heat or cool the skin and underlying tissue.
  3. Treatment modalities of hydrotherapy, ultrasound, neurofeedback and electrical stimulation.
  4. Exercise including stretching, flexion, walking, weight lifting (appropriate to the nature of the injury), and aerobic routines. These exercises may be active, passive, or resistive depending on the nature of the injury and associated pain.
  5. Electrotherapy – the most common form of electrotherapy is transcutaneous electrical nerve stimulation (TENS) used to reduce back pain by using low voltage electric stimulation on the sensory nerve system. (TENS is effective in some cases and ineffective in others.)
  6. Chiropractic manipulation of the affected areas — sometimes beneficial.
  7. Cognitive therapy includes teaching the employee coping and relaxation techniques.

 

  1. Noninvasive drug management

Both prescription and non-prescription medications are used by medical providers to control and eliminate pain. Several types of noninvasive pain drugs are:

 

  1. Aspirin, naproxen, ibuprofen, and COX-2 inhibitors, all nonsteroidal, anti-inflammatory agents (NSAIDs).
  2. Acetaminophen.
  3. Anticonvulsants and antidepressants used for “nerve” pain.
  4. Muscle relaxants used to reduce muscle spasms due to pain.
  5. Narcotics —  including opium, morphine, and heroin.These powerful drugs relieve pain but may entail the risk of addiction if not medically supervised properly.

 

 

  1. Invasive Pain Management

The use of needles and surgical insertion to control pain is normally referred to as invasive pain management, one of the most expensive approaches to pain control. Several techniques for invasive pain management are:

 

  1. Epidural steroid injections (effective for providing temporary pain relief in severe cases).
  2. Facet joint injections (also effective in severe cases).
  3. Surgically implanted spinal cord stimulators and peripheral nerve stimulators (not always effective).
  4. Lumbar sympathetic blockage.
  5. Stellate ganglion blockage.
  6. Implantable opioid infusion pump to deliver an opioid agent direct to the affected nerve(s).

 

  1. Pain Management Providers

If the medical provider wants to refer an injured employee to a pain management clinic, review the clinic’s website. If they specialize only in invasive pain management techniques, have your nurse case manager consult with the medical provider on the possibility of referring the employee to a pain management clinic that considers all three approaches to pain management, not just the pain control methods that earn the most money for the pain management clinic. There are generally 2 types of physicians that provide “pain management” services– anesthesiologists and physiatrists (physiatrists are called “PMR docs” which stands for ‘physical medicine and rehabilitation’). The first tend to go straight to invasive techniques, while PMRs will often start with less-invasive techniques and work their way up.

 

Donald H. Marks, MD, PhD, a  principal in Cognitive Engineering, LLC,  mentioned that he has found in the past that validating objectively claims of pain is difficult. For the last several years he has adapted functional MRI scans which can actually show, illustrate, demonstrate the pain and cognitive impairment.

 

Summary

As with other treatment options, pain management starts with the least invasive and less costly methods and steps up to more invasive and costly techniques to relieve the injured employee’s pain. It is very important to monitor progress to discover the best method achieving relief and to avoid a narcotic addiction for the patient.


Author Rebecca Shafer
, JD, President of Amaxx Risks Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and website 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. See www.LowerWC.com for more information. Contact: RShafer@ReduceYourWorkersComp.com.

 


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Learn the Role of Physical Therapy in Workers Compensation

When workers compensation injuries result in damage to the musculoskeletal parts of the body, it is often necessary for the treating physician to send the injured employee to a physical therapist. Physical therapy, also known as physiotherapy, is a type of medical service design to develop, maintain or restore the employee's normal body movements.
 
When an employee injures a limb or joint, or has surgery on a limb or joint, the treating physician will often recognize the employee's range of motion is limited, or the functioning of the limb or joint is below what it was prior to the accident or surgery. The injury has created an abnormal condition within the employee's body making it difficult for the employee to do normal tasks. The goal of the physical therapist is to assist the employee in regaining prior functioning level. A side benefit of this is often a reduction in pain from the injured body part.
 
With workers compensation claims, the injured employee is normally dealing with a physical therapist who specializes in working with muscles, tendons, ligaments, bones and joints. Other physical therapist specialist who could treat workers comp injuries may specialize in skin problems resulting from burns or wounds, or nerve injuries and related muscles, or breathing and lung problems.
 
The primary treating physician will have a working relationship with various physical therapist in the local area. The physician will recommend the physical therapist best suited for the type of injury the employee has. The physical therapy will be conducted in an out-patient clinic setting.
 
Depending on the severity of the injury and the need for physical therapy, the physician will prescribe the expected amount of physical therapy treatments the employee may need. The request for treatment will state something like three treatments per week for five weeks.
 
During the first visit to the physical therapist, the therapist will review the injury information provided by the physician, the amount of care the physician is prescribing and then determine a treatment plan to address the employee's needs. The treatment plan can include improving flexibility, endurance, strength, coordination and balance.
 
Usually the first step for the therapist is to introduce therapy designed to reduce swelling, stiffness or pain. The actual physical therapy sessions can include various modules of care. The initial modules can include water hydrotherapy, ultrasound, electrical stimulation, heat packs and cold packs. These are normally followed by stretching, walking, weight lifting and various types of exercise. The physical therapist will often teach the employee exercises to be done at home that are specifically designed for the employee type of injury.
 
In addition to the various modules of care provided by the physical therapist, the therapist will create a total treatment plan. This will include educating the employee on how to avoid re-injury and in how to avoid injury caused by repetitive motion. The best physical  therapists incorporate into their treatment plan not only the physical treatment, but also the psychological and emotional support needed by the injured employee.

At the end of the treatment period, the employee will return to the physician to be evaluated on the progress in recovering from the injury. Depending on progress made, the physician can request further therapy, end the therapy or try a different treatment approach. (WCxKitz)
 
The outcome of physical therapy will depend on several factors including the level of disability, the type of physical impairment, any complicating medical issues (like degenerative disc disease or diabetes) and the skill and expertise of the physical therapist. Physical therapy is normally less expensive than the alternative approach of surgery and is definitely less invasive. Overall, physical therapy benefits the employee in a high percentage of the cases where it is used
 
Author Rebecca Shafer, President, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers’ Compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing.  Contact: Info@ReduceYourWorkersComp.com  or 860-553-6604.  
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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.
  
©2010 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact
 Info@ReduceYourWorkersComp.com.

Sixty Percent of Roofers Left the Job Due to Chronic Pain

Researchers conducting a longitudinal study of 979 U.S. roofers between ages 40-59 discovered 10% left the roofing trade within a year, and of those leaving, 60% vacated their job due to chronic pain, work-related musculoskeletal disorders and poor health, according to a release from The Center for Construction Research and Training.
When that group was examined in a one-year follow-up, researchers report that they were four times more likely to suffer mild economic impact, 19 times more likely to suffer moderate economic impact, and 6.5 times more likely to experience severe economic impact from their early retirement. (WCxKitz)
Those workers younger than age 50 experienced the majority of the economic fallout from exiting the roofing industry. These and other results of the research appeared in the July issue of the American Journal of Industrial Hygiene.
The researchers categorized and compared the health status of the employed and retired roofers and discovered those who left work at the time of the study were older, had significantly lower physical functioning and general health scores, more bodily pain, marginally lower vitality scores, and more diagnosed musculoskeletal diseases (MSDs) and/or medical conditions, were more likely to have missed work and have more work limitations in the two years prior to the initial interview. (WCxKitz)
Roofers suffer a high rate of injury among the construction trades, and they command the third greatest rate of jobsite fatalities, behind ironworkers and power installers. With the number of workers over age 55 increasing at an annual rate of 2.5% and a projected shortage of skilled construction workers, the study provides an unwelcome light onto the future of the industry workforce.
The study’s identification of risk factors for exiting the trade – age and physically demanding work – point to a need to modify work practices, a change in work organization or modifying risk factors to prohibit disability and the attendant economic impact.
Author Rebecca Shafer, Consultant & Attorney, President, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers’ Compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing.  Contact: Info@ReduceYourWorkersComp.com  or 860-553-6604.  
 
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How to Deal with Severely Injured Workers Who are Addicted to Narcotics

One of the biggest quandaries of the workers’ compensation adjuster is facing  how to deal with the severely injured employee, now addicted to opioids or opiates, better known as narcotics, as a result of injury treatment.

 

Doctors often prescribed narcotics for the acute pain an employee suffers when first injured. Other medications are often ineffective for acute pain and the quickest and easiest way to mitigate the pain is through the use of narcotics. Doctors also often rely on narcotics for the employee with a chronic pain condition.

 

Narcotics are commonly prescribed for short-term relief of pain. However, their use long term may create problems for the employee. A study by the Yale School of Medicine found 24% of the employees with chronic back pain who were given narcotics developed a narcotics abuse problem. The study also reflected narcotics are effective for the short term (less than four months) but their long-term effectiveness was inconclusive.

 

The excessive use of narcotics not only creates a dangerous addiction problem for the employee, but also often results in poor return to work success, extended time off work, and increased cost of the workers’ comp  claim.

 

According to a 2009 study published by the National Council on Compensation Insurance (NCCI) the cost of narcotics is approximately 25% of the total medication cost in workers’ compensation claims. As the  claim gets older, the percentage of the drug cost related to narcotics grows, especially for back injury claims. The NCCI study confirmed the heavy use of narcotics in the treatment of workers’ comp injuries results in addiction and persistent use lasting for years.

 

The overuse of narcotics in the treatment of workers’ compensation injuries has been a problem for years in the workers’ comp industry, and the problem continues to grow. The workers’ comp adjusters, the nurse case managers, and other concerned insurance professional have all dealt with the problem of narcotic abuse. The best overall approach is to work with the doctors to promote the medically necessary and responsible use of narcotics.

 

Several studies suggest what is the best way to handle the use of narcotics in the treatment of workers’ comp injuries. The guidelines being used now by most doctors stress the lowest possible dosages and emphasizing psychological assessments before prescribing narcotics. While most doctors do prescribe the lowest possible dosage with their initial prescription given to the employee, most doctors do not take the time to perform a psychological assessment of the injured employee before prescribing narcotics, especially for the first visit by an injured employee in obvious pain.

 

One approach to the problem of narcotic addiction is for the doctors to establish a specific treatment plan with the start of narcotics. The doctor and the employee agree to the treatment plan and the amount of narcotics the employee will use. The doctor’s office performs either schedule or random urinalysis to verify compliance with the dosages specified in the treatment plan. A drug test let’s the doctor test to make sure the employee is in fact using the drugs prescribed, not selling them on the street. When a person who has been prescribed opiods tests negative the doctor must wonder why the patient is not using the drugs, and whether those drugs have perhaps been used for illegal purposes.


Some doctors
 concerned about the potential for narcotic addiction prescribe physical therapy and aerobic exercises as ways to ease the pain an employee is suffering. While this approach does not have the fast acting results employees often want (and get with narcotics), the side effects are beneficial to the employee. There ARE legitimate purposes for these therapies; many employers feel these therapies are “luxurious” over-the-top fun-time for employees which is normally not the case.

 

Due to the problems associated with narcotic use, some doctors are switching to prescribing a non-narcotic painkiller, Lidoderm delivered via a patch. The problem with Lidoderm is the cost. It is more expensive than the commonly used narcotics — OxyContin, Hydrocodone, and Oxycodone. In the long run, however, it  can be more cost effective then dealing with the employee with a narcotic addiction or an employee who is still in pain but has sold their medication for cash.

 

Another non-narcotic painkiller doctors may use is Celebrex, a nonsteroidal anti-inflammatory, but also costly. With Lidoderm and Celebrex, it is difficult for a patient to switch to them if they already started using narcotics. The employee will claim Lidoderm and Celebrex are ineffective because the patient starts experiencing withdrawal after switching to the non-narcotic painkillers. Neurofeedback can also be effective for treating pain, according to David Dubin, M.D. Neurofeedback helps the patient learn to self-regulate pain.

 

If the employee’s pain is not too severe, it can often be treated with over the counter medications like aspirin, ibuprofen, Aleve,Tylenol. The issue encountered with over the counter medications is the belief by many employees that their pain is unusual and they need something stronger to control it. (workersxzcompxzkit)

 

There is no easy solution to the problem of the overuse of narcotics in the treatment of workers’ comp claims. The nurse case manager and the workers’ comp adjuster need to promote the use of a specific treatment plan with a scheduled end date for the use of narcotics. The nurse case manager and the adjuster also need to  encourage the switch from narcotics to non-narcotic painkillers, combined with physical therapy where appropriate, as early in the treatment process as possible. It is imperative for the adjuster and nurse case manager intervene as much as possible to prevent narcotics addiction.


Author Rebecca Shafer,
 J.D., President, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers’ Compensation costs, including airlines, healthcare, transportation, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. Contact:  RShafer@ReduceYourWorkersComp.com  or 860-553-6604.

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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.


©2010 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com

 

Study Finds Integrative Care Reduces Disability Due to Chronic Low Back Pain

People with chronic low back pain that keeps them sidelined from work can recover an average of four months earlier if they take part in a specific type of rehabilitation program, a new study suggests. 

According to The Times of India, researchers based in The Netherlands and Canada evaluated the effectiveness of an integrated care program in 134 patients with chronic low back pain. All patients were aged between 18 and 65 years and had been absent from work due to low back pain for almost half a year on average. 

 
Patients were randomly assigned to either usual care or integrated care. Integrated care consisted of adjustments to the workplace and a graded exercise program to teach patients how to move safely while increasing activity levels. The main aim of the program was to restore occupational functioning and to achieve lasting return to work for patients in their own job or similar work. 
 
The usual care group received normal pain treatment with usually little or no workplace involvement. 
 
Patients completed questionnaires at the start of the study and after three, six, nine and 12 months. Sickness absence data was collected every month. 
 
Over the 12-month study period, patients who received integrated care returned to sustainable work after an average of 88 days compared with 208 days for patients receiving usual care, an average reduction of 120 days. 
 
After one year patients in the integrated care group also reportedly improved significantly more on functional status compared to patients in the usual care group. No statistically significant differences in pain improvement were found between the two groups. (workersxzcompxzkit)
 
The integrated care program was reported to reduce substantially disability due to chronic low back pain in both working and private life, according to the authors. 

Author Robert Elliott
,
executive vice president, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers' Compensation costs, including airlines, health care, manufacturing, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. He can be contacted at: Robert_Elliott@ReduceYourWorkersComp.com or 860-553-6604.


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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.
 
©2010 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ ReduceYourWorkersComp.com.

Chronic Pain Progams are New Feature for TPA

Chronic pain is the most prevalent health condition in the U.S. workforce, costing employers an estimated $60 billion annually.* The problem causes absences, medication dependence and reduced productivity.
 
In fact, of the costs associated with chronic pain, 76.6% are attributed to compromised performance while at work.**
 
Chronic pain management helps  employees regain quality of life and employers regain productivity.
 
Employers need to consider a chronic pain program with these attributes:
1.     Uses evidence-based medicine to create a plan of action for employees coping with chronic pain.
2.     Brings together a multi-disciplinary team to review the medical and psychosocialaspects of each case.
3.      Creates a defined and rigorous process for achieving goals.
4.      Continually monitors and supports the injured employee's progress.
 

The key to the success of each claim is an expert clinical staff and board-certified pain physicians, anesthesiologists, physiatrists, orthopedists, and psychologists or psychiatrists. When you are considering a new TPA, consider one with a chronic pain management program.

 For more information contact 866-625-1662.

*Pain Medicine, Volume 10, Issue 6, 2009 (p972-1000), American Academy of Pain Management.
**Focus 4:573-580, Fall 2006, American Psychiatric Association
 
Contributor:  Broadspire, a Crawford Company and leading third-party administrator to employers and insurance companies, offers a broad array of customized claim and medical management services designed to increase employee productivity and contain costs. Broadspire is a sponsor of the Workers’ Comp Kit® Blog. www.ChooseBroadspire.com

 
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©2010 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ ReduceYourWorkersComp.com.

Chronic Pain Management Matters

In 2006,  The Center for Disease Control and Prevention (CDC) released its 30th annual report on the health status of America, “Health, United States, 2006” which found that the overall health of the nation seemed to be improving or holding steady, but highlighted one particular condition as needing further attention: pain.   

Pain is a common  and troubling condition around the world. In a 2005 European study, it was estimated that 20% of the world’s population deals with some form of chronic pain. In Europe, chronic pain accounts for over 30 billion euros in lost productivity. In 2002, an American study found common pain conditions caused 13% of workers to experience a loss of productivity over a two-week period. The estimated cost to corporate America was $61.2 billion dollars that year. In fact, pain has been such a prominent health care issue that the 106th U.S. Congress passed Title VI, Sec. 1603, of H.R. 3244, declaring the period between January 1, 2001 and December 31, 2010 the "Decade of Pain Control and Research."


 
Solutions  

 Conventional treatment  of chronic pain is time-consuming and often very expensive, particularly for those claims that continue without resolution over the course of several years. For this reason, it is important that employers and payers understand the dynamics and drivers of the costs associated with chronic pain.  By employing a focused, multi-disciplinary clinical approach very costly segments can be targeted.  It is then possible to manage effectively chronic pain from the overall costs associated with medical care and treatment as well as loss of a productive workforce.

Using evidence-based  medicine to create a plan of action for those individuals with inadequately managed chronic pain promotes the achievement of optimum results.  Medical management programs can provide information and resources to the claimant's current treating doctors, clinics and hospitals. These types of consultations with providers help achieve the following objectives:

1.     Safe, rational and effective management of the chronic pain population

2.     Maximized functionality and return to work

3.     Management of medical costs

4.     Focused and designated processes/people to reduce internal duplication of effort

5.     Document measurable results and ROI metrics

 

How It Works

A Chronic Pain Program, for example, uses a defined and rigorous process. After an initial eligibility assessment, a highly skilled and experienced medical team of specialty physicians and nurses reviews the medical and psychosocial aspects of each case. The team establishes a list set of customized strategies in the form of recommendations to achieve ultimately the goals and objectives for each case. The team then monitors the impact of interventions during subsequent meetings and follows the case through to timely resolution.

 

The key to the program  is the expertise clinical and claim professionals bring to each claim. A highly experienced staff performs the data analysis, oversight and management of the process. An expert panel of specialized pain physicians (anesthesiologists, physiatrists, orthopedists, and psychologists or psychiatrists) provides guidance. Other contracted resources such as selected, accredited pain management facilities and urine drug monitoring labs help ensure that patients are compliant with prescribed regimens. 

     

A Chronic Pain Program  has the power to make a sizable difference. With proven methods, resources, and expertise it can provide the support and control to help employees beat pain back and return to productivity.

 

Guest Authors:  Candy Raphan, RN, BSN, ARNP, MAOM and Dr Jacob Lazarovic, MD, FAAFP.  For more information contact us at 404-300-1602.


Podcast/Webcast: Claim Handling Strategies
Click Here:

http://www.workerscompkit.com/gallagher/podcast/  Claim_Handling_Strategies/index.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.
 
©2010 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ ReduceYourWorkersComp.com

Head Injuries are the most costly workers compensation claims

Head injuries are the most costly workers’ compensation claims. According to NCCI, the average incurred cost per claim for a head injury in a work-related injury is $46,898 in 2004-2005 (the most recent statistics I could find)(page 55 of National Safety Council’s 2008 Injury Statistics).

More than 5 million Americans suffer with traumatic brain injury (TBI), mostly the result of car accidents and falls — many of which are work-related. TBI is more disabling than most realized. The typical presenting symptoms are memory loss, decreased concentration, difficulty staying on task, fatigue and other, often vague complaints. Because little is seen on MRI or CT scan, symptoms seems “psychological” or even exaggerated, and it is not difficult to dismiss complaints as psychological or such a person as a symptom magnifier.

Until recently there has been no effective treatment. There is an emerging technology called EEG biofeedback, or neurofeedback that is unusually effective in helping with this very real problem. Neurofeedback looks at the brain as a bioelectric system; large neural networks firing in a coordinated manner. Problems are analogougs to the spark plugs in a car not firing properly. A “disregulation” occurs, and the brain does not function properly.

Neurofeedback helps the brain balance and self-regulate. Physiological changes are seen in the brainwaves, which are electrical recordings of the brain function analogous to an electrocardiogram (EKG), which is an electrical recording of the heart.

Neurofeedback technology has been found very effective for certain pain syndromes, ADD (as effective as Ritalin, making continued medication unnecessary), acute anxiety, and PTSD. There are also reports of effectiveness in some RSD (reflex sympathetic dystrophy).

Neurofeedback is a rapidly emerging technology. Not all neurofeedback systems and programs are equally effective even when you can find a practitioner. For further information you can contact Dr. Dubin at MD@ReduceYourWorkersComp.com.

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