The Conservative Care Debate: Can it Help Address Pain, and Combat the Opioid Crisis?

Cindy Ferraino

Columbus, OH ( – With a focus on reducing the amount of lumbar back surgeries as well as formulating a plan of attack on the opioid crisis, the Ohio Bureau of Workers’ Compensation (BWC) created the “60-day” rule to treat back conditions that have been attributed to an injury on the job.

Based on statistics evaluated by the BWC, it has been reported that conservative care measures that were utilized for work-related injuries have reduced the amount of narcotics prescribed. Also, 67 percent of patients were able to return to work without undergoing surgery, according to NFIB.

Since Jan. 1 2018, the BWC requires an injured worker to receive 60 days of conservative care before seeking alternative methods to treat the injury. After conservative care is completed, the injured worker is assessed to see if further treatment is needed which may or may not include a recommendation for spinal fusion surgery.

“Conservative care is an aggressive approach to treating back injuries with conditioning and strength training, “ Danny Sanchez told Sanchez is the VP of Operations and Clinical Outcomes at On-Site Physio in Jacksonville, FL.

As a physical therapist, Sanchez supports the conservative care approach and said he believes it is a positive step toward treating low back injuries without the use of narcotics and surgical intervention.

“Opioids can mask the pain. Conservative care can help address the source of the pain,” Sanchez said.

In addition to providing non-surgical treatment and avoiding the use of narcotics, conservative care can also potentially be cost-effective and beneficial to injured patients.

“Employers are looking toward conservative care to reduce the high cost of workers’ compensation and getting their employees feeling better and getting back to work,” he added.

Despite the praise for recognizing conservative care as a vital component for the treatment of on-the-job back injuries, there has been some opposition to the new mandate.

“In my opinion, the conservative care approach for lumbar back injuries is an interference on how a doctor can treat their patients, and the doctor’s expertise is ignored,” Thomas Marchese said, an Ohio-based work comp attorney.

While the premise behind the 60-day mandate is one way to find a solution to the opioid problem, Marchese said he realizes that the mandate is just a cookie-cutter approach that has created a bigger issue for doctors.

“It is hard enough already for a doctor to deal with workers’ compensation when trying to treat an injured patient. Now, an additional step in the workers’ compensation process can prolong the effective treatment the patient should have received after the injury occurred,” he added.

There are some exceptions to the new mandate. As per the ruling by the BWC, the 60-day mandate will be removed if lumbar surgery is recommended and approved for “progressive functional neurological deficit, spinal fracture, tumor, infection, emergency/trauma care, and/or other catastrophic and spinal pathology casually related to the injured worker’s allowed condition.”

Even with the exceptions to the mandate, the conservative care approach is still debated as a suitable non-surgical treatment for lumbar back injuries.

“Statistical analysis can’t replace the effectiveness of a surgery that has been done for so many years by experienced orthopedic surgeons. This is going to chase the doctors out of the workers’ compensation system,” Marchese said.