Mitigating Chronic Pain in Workers’ Comp

KEY TAKEAWAYS:

--The first four key practices are: determining compensability quickly; communicating the claims process and status to the injured worker; providing quality, evidence-based medical care; and identifying delayed recovery factors.

--Perhaps the most important practice is working with the doctor and employer to encourage stay-at-work (SAW) and return-to-work (RTW), even when that requires modified duties.

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Injured workers often feel lost in the complex workers’ compensation benefit delivery systems. Difficult to understand, these systems leave injured workers confused, disbelieved and disrespected, which feeds a sense of hopelessness and abandonment. This can potentially contribute to the development or instigation of chronic pain perceptions and a poor outcome.

There are five key practices for a patient-centered approach that, when quickly addressed, are most effective in mitigating potential chronic pain issues in workers’ compensation. The first four are: determining compensability; communicating the claims process and status to the injured worker; providing quality, evidence-based medical care; and identifying delayed recovery factors. Perhaps the most important practice is working with the doctor and employer to encourage stay-at-work (SAW) and return-to-work (RTW), even when that requires modified duties.

Prompt communication among the healthcare provider, patient, employer and any other stakeholder to expedite treatments for the employee to return to full functionality and work will lead to the best outcome. For many workers, it is work itself that acts as a preventative measure as it supports an employee’s perception of being valued.

Factors That Contribute to Creating a Chronic Pain Patient

To support health, employers can provide a work environment that protects and promotes workers’ physical and psychological health and safety. Doing so requires attention to how cases of injured workers are handled. Let’s take a look at several workers’ compensation factors that contribute to creating a chronic pain patient:

• Employers who do not respect injured workers’ complaints and injuries and treat all injuries as fraudulent claims.
• Employers who do not immediately report all injuries, thereby delaying prompt compensability determination and benefits.
• Employers who create barriers that delay return to work.
• Employers (front-line supervisors or managers) who do not regularly communicate with injured employees while they are recuperating.
• Delays in compensability determination by the claims administrator.
• Delays in medical treatment authorization that lead to a lack of access to quality, evidence-based medical care due to a complex and unnecessary authorization process.
• Failure to recognize underlying delayed recovery factors.
• Inaccurate or delayed diagnosis by the medical provider.
• Physicians who focus on pathology and not on the whole person.
• Healthcare providers who do not provide the time for meaningful patient interaction and education.
• Healthcare providers who do not follow evidence-based medicine treatment protocols.
• Healthcare providers or injured workers who have hostility toward the employer/payer.
• Attorneys who do not focus on assisting the injured worker in returning to health and work.
• Lack of communication among stakeholders that delays care and leads to chronic pain and unemployability.

Delayed recovery and ever-worsening disability are often even more pronounced in individuals with poor coping skills and other behavioral, characterological, personality and psychological issues. Underlying personality structure and motivation are often determinants for disability. Chronic pain complaints may be linked with significant disability.

See also: State of Mental Health in the Workplace

What Can Be Done?

By facilitating better medical outcomes, we can get injured employees back to work faster and steer clear of the traps that can lead a patient into a downward spiral, both medically and psychologically. There are nine key factors that influence positive outcomes:

1. Recognizing when there are delayed recovery factors that may increase the likelihood of chronic pain.
2. Recognizing that pain medicine escalation without benefit is a risk factor for a poor outcome.
3. Minimizing delays in compensability determinations and treatment authorizations, which may result in poor and costly outcomes.
4. Making prompt referrals to appropriate medical professionals, including alternative therapies when possible, for an injured worker identified as a risk for chronic pain.
5. Emphasizing appropriate communication with the injured worker.
6. Setting appropriate expectations for recovery and return to work for modified or full duty.
7. Overcoming fear of reinjury through communication and education.
8. Supporting physical activity and alternative therapies for pain management.
9. Encouraging the injured worker to seek support from family, friends, social and, if appropriate, religious communities.

Better, faster medical outcomes are a win-win for injured workers and their employers. Following these best practices can more effectively address the needs of injured workers and provide them with the attention they deserve, resulting in getting back to work faster and a positive experience overall.

As first published in WorkCompWire.