February 26, 2010

Chronic pain management in workers' comp

Recently, I attended the 2010 Health and Productivity Forum jointly sponsored by the Integrated Benefits Institute (IBI) and the National Business Coalition on Health (NBCH) in San Antonio. I had been invited to participate in a panel discussion by Gary Anderberg, of Broadspire, who, as I have written previously, is one of the smartest people I'm fortunate to know.

With me on the panel were Dan Shaughnessy, Director of Disability Programs, Textron, Inc., and Mike Machanich, Chief Executive Officer, Workers' Comp Solutions. Gary's charge to us was to discuss the effect of national health care reform on workers' compensation. Thanks a bunch, Gary. But we had a stimulating discussion as we opened that colossal can of worms. I'll write more about this in another post. One of the issues our panel tossed around was chronic pain. We've written about chronic pain many times over the last few years. Here are links to a couple of the relevant posts:Workers Comp Drugs: Paying too much...For the Wrong Medicines!; The Pain Conundrum.

Our concern is that the treatment of chronic pain often involves what is to us a highly problematic overutilization of narcotics. So, I was a bit surprised to learn of Broadspire's well thought out and relatively holistic approach to treating this debilitating and often times life-changing medical condition. With that in mind, I invited Broadspire's medical team to submit a guest blog post for the Insider. Our one requirement was that it be informative to our readers, but not a self-serving advertisement for Broadspire. The company accepted our invitation, and what follows is Broadspire's approach to the treatment of chronic pain. I'd be remiss if I didn't add that Broadspire is not a client of Lynch Ryan's and our publication of this guest blog post does not constitute an endorsement of the company's products or services.

Chronic Pain Management Matters
Candy Raphan RN, BSN, ARNP, MAOM and Dr Jacob Lazarovic, MD, FAAFP, Broadspire

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 effectively manage 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 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:

  • Safe, rational and effective management of the chronic pain population
  • Maximized functionality and return to work
  • Management of medical costs
  • Focused and designated processes/people to reduce internal duplication of effort
  • Documented and measurable results and ROI metrics
How It Works
Broadspire's Chronic Pain Program, for example, uses a defined and rigorous process. After an initial eligibility assessment, a 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 ultimately achieve 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.

| 3 Comments

3 Comments

What I find interesting is the lack of emphasis on other modalitites besides medications for chronic intractable pain.

Many diagnoses respond very well to Electrotherapy (EMS, TENS etc.) and can be much more cost effective for chronic pain situations not to mention the lack of addiction and other problems.

Insurers do utilize Electrotherapy but appear to be clueless as to how much they are overpaying, with companies automatically sending patients needless monthly supply packages and other tactics to inflate the bill.

Any comments will be appreciated.

Thanks,

Sy

No mention of accupuncture treatments-- those have been effective for some populations.

Chronic pain is one of the most difficult conditions in medicine. Often pain, once established, cannot be completely eliminated. In these cases, integrated programs with physiatry, psychiatry, nursing, physical therapy, and anesthesia pain management can offer hope for improvement in functional capacity regardless of pain level. The three different types of pain (somatic, visceral, and neuropathic) each require different types of medications to treat effectively.
It is noted that for many chronic pain problems, if opioids are effective, there is no theoretical ceiling to dosage and dosage can and should be adjusted upwards for effect as needed. Many persons are fully functional on very high doses of opioids. It is important to differentiate between addiction, in which a person takes a substance to enjoy its psychoactive effects, and habituation, which is a physiological state of tolerance to the side effects of a substance which develops with chronic use. With opioids, the only side effect which persists is constipation. That said, however, if an opioid is not effective in managing a pain condition it should be tapered and discontinued. Other medications can be trialed in conjunction with opioids if a mixed pain syndrome presents. Beware the "pain program" which does not use many disciplines, especially if it includes no psych component. Chronic pain alters brain function and this can be helped by consistent, well-managed psychiatric/psychological care as an integrated part of the program. It won't work without this.

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This page contains a single entry by Tom Lynch published on February 26, 2010 7:15 AM.

Cavalcade of Risk and News You Can Use was the previous entry in this blog.

On redefining disability is the next entry in this blog.

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