Musculoskeletal disorders – injury or pain in joints, ligaments, muscles, nerves and tendons – are the second largest contributor to disability worldwide, with lower back pain being the leading cause of disability globally. Some disorders arise suddenly and are short-lived, such as fractures, sprains and strains; however, others lead to lifelong conditions associated with chronic pain and disability.1
These conditions, and the chronic pain that is so often associated with them, can cause a host of problems for employers – absenteeism, lost productivity, increased healthcare and workers’ compensation costs. For the individual, chronic pain can lead to poor physical function, cognitive impairment and overall reduced quality of life. The Bureau of Labor Statistics reports that musculoskeletal disorders account for an average of 11 days away from work and 31% of workers’ compensation costs.2 More specifically, back injuries are the most common type of workplace injury among employees, according to the Occupational Health and Safety Administration.3
To manage chronic pain, many have turned to opioids. In fact, the dramatic increase in opioid prescriptions to manage pain has contributed to a now recognized epidemic. Nearly two million Americans have developed a prescription opioid use disorder (OUD), and more than 600,000 have developed OUD from using heroin and fentanyl.4
Overprescribing of opioids has resulted in misuse and abuse – 128 people die every day from an opioid overdose.5
The burden of managing pain and the subsequent opioid crisis have come to a tipping point – there is an immediate need for more safe, long-term solutions. Underdiagnosis and undertreatment of chronic pain remain valid concerns, but greater utilization of opioids is not seen as a viable treatment option.
As case managers, it is important to educate, support, provide resources and alternatives and develop an individualized plan for patients living with chronic pain. We spoke with experts Michelle Despres and Kevin Glennon from One Call, a leader in specialty network management services for the workers’ compensation industry, during this year’s virtual CMSA conference. Following is a recap of their thoughts on this very complex topic.
DETERMINING AN INDIVIDUALIZED PLAN OF ACTION
The pain experience is complex and has a biopsychosocial component that requires a multifaceted approach. For starters, pain scales are subjective but can provide a reference point for a patient. We know one person’s 2 out of 10 pain level might be similar to another’s response of 7 out of 10 in terms of how they function. But, when a person can indicate improvement or worsening based on a number, there is value. More importantly, it provides an objective baseline that is actionable based on ability and function, and pulls the focus away from pain alone.
ALTERNATIVE: PHYSICAL THERAPY
When musculoskeletal disorders cause chronic pain and disability, it is important to uncover the root cause of pain to prevent delayed return-to-work and mounting claim costs. Physical therapy acts like a detective by working to identify the root cause. Once that happens, a treatment regimen can be established to break the pain cycle.
For example, a patient may be experiencing lower back pain resulting from tightness in the hips. The problem stems from the hips, not the back; however, the pain source, not the root cause, is often addressed. Patients are prescribed medications to help ease the pain, but there is no long-term solution. Instead, a physical therapist should provide the patient with a regimen of hip stretching to address the root cause of the back pain.
A 2016 report from The Centers for Disease Control and Prevention stated that non-pharmaceutical pain treatment, such as physical therapy, might do a better job at controlling pain conditions over other, more popular treatments options.6 When a severe injury or pain occurs, physical therapy should be one of the first treatments of choice.
The quicker a patient connects with a physical therapist after injury, the quicker trust is established. A physical therapist can then encourage a patient to become actively engaged in their recovery versus just being a passive recipient of it.
Research findings suggest that patients achieve better outcomes and help drive lower costs when they have the skills and confidence to manage their own health.7 Similar to engaged employees leading to increased productivity, engaged patients lead to quicker recovery timelines.
ALTERNATIVE: MEDICAL MARIJUANA
Many individuals with chronic pain have also turned to medical marijuana as an alternative form of pain management. According to the National Center for Complementary and Integrative Health, medical marijuana, also known as medical cannabis, has been used for more than 3,000 years as a medical treatment for a plethora of conditions. It is estimated that 2.1 million Americans use medical cannabis, and a recent study revealed that more than 62% of individuals who use it do so to treat chronic pain.8
The evidence for cannabis’ treatment efficacy across different conditions fluctuates extensively. A survey conducted from 2013-2015 of 244 participants with chronic pain aimed to discover whether using medical cannabis for chronic pain would change individual patterns of opioid use. Among the participants, medical cannabis use was associated with a 64% decrease in opioid use, decreased number and side effects of medications, and 45% reported an improved quality of life.9
One Call’s team and high-quality provider partners can set patients up for success. For example, more than 90% of our clients’ injured workers who have undergone physical therapy through One Call have functional strength and minimal to no pain at time of discharge. Eighty-five percent have functional range of motion at time of discharge. We stay involved every step of the way to ensure the underlying injury and accompanying pain are treated.