Experts Ponder WC Beyond Opioids

Nancy Grover

Boston, MA ( – Take some athletic tape, package it up with Ben Gay and lidocaine and voila! You’ve created ‘medicine’ and can charge thousands of dollars.

Dermatological kits are increasingly being seen in the workers’ compensation system. These are essentially branded compounds that manage to evade restrictions on compound medications. The increased use of them may be an unintended consequence of the decreased prescribing of opioids in the workers’ compensation system.

“If we’re saying ‘no’ to opioids, you’ve got to have something in the toolbox because we aren’t yet changing the idea that ‘I have a prescription, I feel better,” said Nina Mcilree, MD, VP of Medical Management at Zurich Insurance. Mcilree participated in a panel discussion on Alternatives to Opioids for Pain Management at the Workers Compensation Research Institute’s Annual Issues and Research Conference here.

Mcilree also cautioned about another potential problems when providers act too quickly to try to relieve an injured worker’s pain. “Be very careful that [physicians] are not jumping to invasive procedures very quickly.” she said. An immediate MRI or surgery for low back pain, or the improper use of spinal cord stimulators or epidural steroid are examples of procedures that are sometimes done too soon. “They can be very effective at the right time, but not necessarily the frequency I’m seeing,” she said. “I’m concerned that without a pill, we’ll see [more] invasive procedures.”

Talking with and educating prescribing physicians about the medical necessity – or lack thereof – of these procedures is one way to address the problem. Equally important is to help injured workers better understand their pain and their options.

“Three things: education, education, education,” said John E. Christian, president and CEO of Modern Assistance EAP, who runs a program for unionized workers in Massachusetts. “The conversation I have [with journeymen and apprentices] is, ‘what’s your most important tool? Your body. You have to ask [the physician] what are you giving me? How long will I be on it? Is it addictive?’ I want to educate my members so when there is a perfectly good alternative that’s not addictive, they get it.”

Part of educating injured workers, providers and others is to focus less on eliminating pain and more on recovery of the injured worker. “Function and quality of life are important,” said Albert Rielly, MD, of Massachusetts General Hospital. An injured worker has “physical therapy for 8 months for low back pain and it doesn’t help; why keep doing that? It’s especially important for providers to take the time to ask, ‘what am I doing with this intervention? Will it improve your quality of life, your function?’ If not, do something else.”

“I have to educate people who want something to take their chronic pain away,” Rielly continued. “It’s really their attitude; that’s where CBT comes in.”

CBT, or cognitive behavioral therapy, has been shown to be one of the more effective strategies to help some injured workers deal with chronic pain. It’s a short term series of sessions that helps the person gain new insight on their situation.

“People think pain is the problem, but it’s really a symptom,” Mcilree said. “Chronic pain is a brain adaptation that is misinterpreting things that should not be painful.”

CBT and other similar techniques also help address what is a common underlying issue among injured workers who have chronic pain and get stuck in a disability mindset.

“We haven’t dealt with the population that really have poor coping skills and need help with them,” Mcilree said. “While not part of the compensable injury, it will drive the compensable injury cost.”

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