Pain Management:  It Just Makes Sense

Recently, I attended a Workers’ Compensation conference where there was a discussion regarding which physician specialties should be included on a company’s Workers’ Compensation panel.  Specifically, they discussed the benefits of incorporating an interventional pain management physician on the panel of providers.

The reaction of many led me to realize there is some trepidation when one considers sending a patient for pain management. I believe this arises from the misconception that pain management is a “last resort” for a patient, accompanied by uncontrolled spending and no measurable improvement.  That is the farthest from the truth.

Amidst a national opioid epidemic, it has never been more important to get an injured worker to the right pain physician early in the recovery process to prevent opioid (or other) addiction, decrease the risk of acute pain transitioning into chronic pain, and lower the ballooning costs of treating the injured worker.  Although we are experts in dealing with difficult and oftentimes drawn out cases, our pain management services can be most cost effective when the patient is seen within weeks of the initial injury.

Studies have shown that acute pain, if not properly managed, has a much higher risk of becoming chronic pain.  Higher pain intensity is a predictor of a longer and/or more expensive claim.  The temptation of the under trained physicians is to treat pain with high doses of opioids with no stop date in mind.

In injuries outside of work, fifty percent (50%) of patients taking opioids for three (3) months are still on opioids five (5) years later.  This percentage is likely higher in the population of injured workers.  Having a physician willing to judiciously administer and appropriately wean opioids early on will decrease complications and control costs.

A trial in the United States Department of Veterans Affairs (VA) health system compared liberally escalating doses of opioids with a “hold the line” dosing strategy.  Surprisingly, there was no significant improvement in a patient’s function with the higher opioid using group. If a physician is not following the widely-accepted national guidelines on opioid prescribing, the onus is then on the payer to remove that physician from the treatment picture and to provide the injured worker with safer care from a more conservative physician.  Such a change will benefit the worker and help decrease long-term costs.

Workers’ Compensation management may sometimes delay treatment by a pain physician because of the legitimate concerns over containing monthly costs.  However, the real key to sustainable reduced medical expenses is directing the injured worker to the right pain physician early on while in the acute phase of the injury.  Allowing such a physician to triage the patient from the initial occurrence will prevent the unneeded use of expensive name brand medications, curb the escalating doses of addictive opioid medications, avoid unnecessary invasive surgery, and appropriately designate only the necessary conservative specialty services to promptly treat the injury.  This approach requires finding the right strategic partner to help navigate the dangerous waters of overly-aggressive and unproductive medical care.

Michael Schurdell, MD, is a board-certified anesthesiologist with subspecialty certification in Pain Management. He received his Bachelor’s Degree in Microbiology from Brigham Young University and his medical degree at University of Texas Medical School at Houston. Dr. Schrudell completed his residency in Anesthesiology at Emory University School of Medicine and subspecialty training fellowship at Wake Forest. He has acquired advanced training in multimodal therapeutic approaches to pain, which include the use of minimally invasive techniques. To learn more or to schedule a patient, please visit us at ThePhysicians.com

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