Chronic over-prescription of opioid painkillers is fostering a culture of “sickness” in the American workplace. This was the conclusion recently drawn by a panel discussion, in which we participated, including experts with deep experience in workplace injury, health care, insurance and pain management.

News accounts support this dire claim, including current stories chronicling the increase in heroin use among sufferers looking for a cheap alternative to prescription meds, or the recent Mayo Clinic study that found that one in four people prescribed opioids progressed to longer-term prescriptions.

Historically, prescribing physicians have had few arrows in the [pain management] quiver and painkillers, short-term, are certainly effective for many. But now practices find themselves challenged to come up with new ways to treat pain sufferers, particularly those with workplace injuries that the workers comp system refers to as catastrophic  - overburdening the system and remaining largely unresolved to avoid opioids.

Working in concert with employers, the insurance community and other health care professionals, practices have the potential to resolve patient injuries more effectively and return patients to “normal” safely and more quickly.  Stakeholders in the system must embrace these five essential changes that have the potential to curtail this continuing “sickness.”

1. Eliminate unproven therapies in favor of accurate diagnosis, followed by evidence-based treatment.

It’s my opinion that the classic model is not successful due to outdated modes of thinking. The current model of treatment consists of using lots of non-steroidal anti-inflammatories (which are meager in efficacy to begin with), referral to physical therapy that is often perfunctory, with a reliance on passive physical therapy (instead of active physical therapy). For persistent complaints, are often provided repeated cortisone injections, which are well known to inhibit tissue healing, rather than trying to regenerate tissue. When  these treat fail, patients then often undergo surgery, with various surgical procedures that have become embedded in classic traditional orthopedic treatment, such as partial meniscectomies (removal of a piece of cartilage in your knee that cushions and stabilizes the joint), and spinal fusion procedures. The current medical literature has demonstrated that in many patients partial meniscectomy is no better than physical therapy or even sham meniscal surgery. And yet 700,000 partial meniscectomies are performed every year. (Dr. Gerard Malanga)

Proper diagnosis is closely linked to proper treatment, and providers need to focus more heavily on accurate diagnosis to deliver appropriate care. Yet some 30 percent of patients are misdiagnosed: in the worst cases, what could have been an injury that might heal within weeks with proper treatment can, if improperly diagnosed and treated, snowball into a life-altering, permanent injury that prevents that worker from ever going back to work. Too often, providers choose a conservative intervention in the beginning of a workers’ compensation case, usually due to its low cost. But when applied in the wrong circumstances, conservative treatment can cost more in the long run, as later, more costly treatment is required.

2. Identify at-risk workers early, and invest in wellness as well as sickness.

When we’re dealing with a work-related injury we’re dealing with a very specific population – they make a living pushing, pulling & lifting. In our research, that frequently means an educational level at high school or less. As patients, they’re very ill equipped to really understand how to access the medical system, never mind judge what is good from bad care, so that places a huge burden on the claim professional charged with bringing that claim to a successful result. (Michael Shor, MPH Managing Director, Best Doctors Occupational Health Institute)

At the same time, preventing patients from spiraling downward at the onset of injury is crucial. Energi, Inc. has had demonstrable success with use of nurse case managers (NCMs) for those entering the workers’ comp system. Energi assigns NCMs to every patient, providing services from filing the claim, helping to guide treatment and care, and accompanying patients to doctor visits.

Energi retained Risk Navigation Group, LLC (Risk Navigation) to conduct an analysis of medical management outcomes in two samples of claims. Risk Navigation examined incurred losses to determine if there was a distinction in the disability duration outcomes between two programs, one using NCMs for all claims and the other using NCMs in less than 40 percent of claims. Use of NCMs demonstrated a materially and financially advantageous effect on both overall medical management and, more particularly, a diminution of disability duration in similar claims. Specifically, “days of disability” were reduced from 316.9 to 85.65 when NCMs were activated from “day one.” According to study authors, some companies consider it an extra cost, but nurse case managers have been known to help close workers’ compensation cases at 70 percent of what they would normally cost.

Another example of a company investing in wellness is Horizon Casualty’s innovative Pain Management Medical Home. Anecdotally speaking, patients with an unhealthy lifestyle (e.g. smokers, overweight/ obese, etc.) combined with the psycho-social aspects of negative relationships at work or at home tend to be more likely to have a negative post-injury experience. Strategic new initiatives such as the Pain Management Medical Home approach put people on the best therapeutic course early in their care by implementing a care team approach. The care team consists of a diverse set of healthcare providers, including a Physical Medicine and Rehabilitation physician, a functional rehabilitation provider, and a psychologist. This holistic approach to the patient’s care applies a biopsychosocial model to health care.