Current Pain Management Techniques and Effectivenessof this Inconsistently Applied Treatment
Current Pain Management Techniques and Effectivenessof this Inconsistently Applied Treatment
Today, pain management practices are varied, hard to classify, and inconsistently applied across the country. How many times have you cringed upon a receipt of another recommendation for pain management care? Following this reaction, how many of you have asked one of the following questions: Is this treatment necessary? What type of treatment will the claimant receive? Is this the appropriate physician to supply this treatment? How long will this treatment proceed and how much will it cost? Clearly, you should not be alarmed by your reaction or subsequent questions as these thoughts are currently crossing the minds of multiple parties involved in the process of supplying medical treatment to injured workers. “In fact, pain has been such a prominent health care issue that the 106th U.S. Congress passed Title 6, Section 103, of H.R. 3244 declaring the period between January 1, 2001 and December 31, 2010 the decade of pain control and research.” Lynch Ryan Workers’ Comp. Insider Weblog about Workers’ Compensation, www.workerscompinsider.com, February 2010. With that being the case, where do we begin?
Let’s begin with the basics. What is pain? Webster’s Medicine Dictionary defines pain as a state of physical, emotional or mental lack of well being or physical, emotional, or mental uneasiness that ranges from mild discomfort or dull distress to acute often unbearable agony, may be generalized or localized, and is the consequence of being injured or hurt, physically or mentally, or of some derangement of or lack of equilibrium in the physical or mental functions. Going one step further, if a person is suffering from chronic pain, this condition can evoke emotional reactions, such as fear or even terror, depending on what that person believes about the pain signals. Chronic Pain Coping Techniques – Pain Management by Andrew R. Block, Ph.D., June 1, 2007. In common terms, pain is the body’s way of telling us that something is wrong. Workers’ Compensation Outlook, Vol. 20, II, November 2009.
Based upon these definitions, a person’s experience with pain not only relates to a physical status but also involves his mental status. So much so that the important role the mind plays in chronic pain is clearly recognized in medical literature. The International Association for the Study of Pain’s definition of pain states that “pain is always subjective and is defined by the person who experiences it.” Chronic Pain Coping Techniques – Pain Management by Andrew R. Block, Ph.D., June 1, 2007. Additionally, stress, anxiety and depression all can worsen the progression of pain. Workers’ Compensation Outlook, Vol. 20 No. 2, November 2009. Thus, an injured worker’s attitude can also affect the motivation to return to work or even to get well. Workers’ Compensation Outlook, Vol. 20 No. 2, November 2009. Unfortunately, if left undetected, the cycle of pain and depression can continue to worsen over time. Workers’ Compensation Outlook, Vol. 20, No. 2, November 2009.
For these reasons, early detection and intervention is critical, however, keep in mind that claims often do not appear catastrophic at the onset. Many become problematic over time, as claimants become physically deconditioned, dependent on medication, and susceptible to depression and anxiety. The challenge is to identify which claims are likely to move in that direction and to intervene as soon as possible to help support a better outcome. Workers’ Compensation Outlook, Vol. 20, No. 2, November 2009.
Considering the subjectiveness of chronic pain, it is no wonder that there are so many differing opinions on how to treat this condition. Moreover, although the current techniques to treat this condition are primarily the same, how the treating physicians decide to administer these techniques can be inconsistent. Currently, the usual treatment supplied to a person suffering from chronic pain includes the use of narcotic pain medications. As such, a majority of injured workers are on a constant up and down scale with their use of opiates defined as “any morphine-like compound that produces pain relief which increases the probability of addiction, the duration of the claim and, of course, substantially increases costs.” A Bitter Pill for Workers’ Comp” (Article) by Peter Rousmaniere, April 15, 2002. In terms of cost, a national study estimated that in 2010, “the cost to corporate America to fund treatment for this chronic condition was 61.2 billion dollars.” Lynch Ryan Workers’ Comp. Insider Weblog about Workers’ Compensation, www.workerscompinsider.com, 2010
Additional techniques include neurobiologic therapies targeted at specific neural networks and systems. This treatment is a form of therapy in which neuropsychologic signals are initiated or influenced with the intention of changing the function and performance of the nervous system to achieve therapeutic effects. Am. Academy of Pain Medication, Pain Medicine Position Paper, Vol. 10, November 6, 2009. A common example of this form of treatment would include the implantation of a spinal cord stimulator.
More recently, neurobehavioral therapies have been included in the practice of pain medicine aiming to connect the mental aspects of chronic pain with the physical aspects. This treatment focuses on reducing stress and the stress response by incorporating relaxation treatment, meditation, biofeedback and hypnosis, all of which have been proven to enhance pain control, well-being and coping. Despite these techniques and the benefits provided individually by each form of treatment, concerns persist as to how to collectively apply these techniques in a way to provide relief, effect a cure, and potentially return the injured worker to gainful employment.
Due to this lack of consistency on how medical providers are treating this condition, the number of pain medicine associations continues to grow throughout the world in an attempt to develop a cognitive plan for future research and treatment procedures for individuals suffering with chronic pain. Pain Medicine Physician Paper, The American Academy of Pain Medicine, Vol. 10, November 2009. In spite of these multiple pain medicine associations, it is unfortunate that the inconsistencies in administering treatment for chronic pain continues, therefore extending time periods for continued treatment with little relief to the injured worker, and increasing the costs to corporate America to fund this continued care.
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. Therefore, a cognitive plan must be developed to focus how injured workers with chronic pain are treated. Lynch Ryan Workers’ Comp. Insider Weblog about Workers’ Compensation, www.workerscompinsider.com, 2010. The key to improving the current concerns would require the expertise of clinical and claim professionals working together to perform data analysis, oversight, and management of the injured worker’s progress. Lynch Ryan Workers’ Comp. Insider Weblog about Workers’ Compensation, www.workerscompinsider.com, 2010. Pain Medicine Physician Paper, The American Academy of Pain Medicine, Vol. 10, November 2009. Ultimately, the goal should be:
“safe, rational and effective management of chronic pain, maximize functionality and return to work, management of medical costs, focused and designated processes/people to reduce internal duplication of treatment, documented and measureable results.” Lynch Ryan Workers’ Comp. Insider Weblog about Workers’ Compensation, www.workerscompinsider.com, 2010
Clearly, effective treatment of persistent pain requires the highest level of clinical reasoning, selectively coordinating medical skills, the strategic use of resources, and the orchestration of diverse areas of medical expertise. Workers’ Compensation Outlook, Vol. 20, No. 2, November 2009. Unfortunately, pain treatments will remain fragmented unless and until a unified organizational model of pain medicine is implemented which would provide cost-effective pain care and would prohibit unnecessary and avoidable human suffering and societal expense. Workers’ Compensation Outlook, Vol. 20, No. 2, November 2009.
In conclusion, society’s purpose in treating injured workers continues to be returning them to gainful employment. In treating chronic pain, all those involved in the workers’ compensation arena should work together in an effort to decrease the inconsistencies and increase the effectiveness of treatment for chronic pain.