Workers' Compensation.

Chronic Pain in Workers' Comp is Complex

Chronic pain is often a challenging condition best addressed through multidisciplinary care. When treatment is provided through the workers' compensation system, clinical management is more complex for a number of reason:

- Compared to other patients, Injured workers are generally more distressed and have poorer outcomes both clinically and vocationally. (Newton-John 2012).

-Injured workers are much more likely to have mental health disorders (e.g. anxiety, depression) than other patients, often developing these disorders after the work-related injury occurred. These disorders often go unrecognized and untreated. Failure to follow a comprehensive, multidisciplinary approach may contribute to prolonged pain disability. (Dersh 2002)

-Injured workers receiving daily opioid (narcotics) medications in high doses have poor outcomes; this has prompted many states do adopt regulations limiting opioid prescribing.

-High dose opioid treatment places injured workers at risk for addiction.

-Research finds that injured workers with addiction who receive multidisciplinary care are likely to have poor outcomes relative to other program participants who do not have problems with addiction or psychiatric disorders.. This research did not study programs that included addiction-specific treatment as a specific care component. (Dersh 2007)

-Insurance companies may be resistant to accept psychiatric disorders, especially addiction, as compensable, work-injury related conditions. However, when addiction contributes to disability, companies usually recognize the need to address addiction as part of the overall recovery plan and may consider multidisciplinary treatment that includes addiction counseling without accepting addiction as part of the claim.

-Substance use disorders (i.e. abuse, addiction) complicate the treatment of chronic pain. Untreated, the combination of substance use disorders and pain leads to deterioration in health and function. In most cases, over time, it also leads to increased costs for insurance companies.

Denial is part of addiction. Getting better requires honesty. When opioid treatment for a work injury contributes to the development of addiction, treatment for this condition should be compensable. When addiction is unrelated to a work injury, addiction treatment should be coordinated with medical care, including services received under workers' compensation.
Consider these action steps:

1) If you are addicted or worried you might be become addicted, share your concerns with a family member or friend.

2) If you are represented by an attorney, discuss your concerns; your conversation is privileged and confidential.

3) If you are concerned about the amount of medication you are taking, share your concerns with your prescribing clinician and/or your case manager. A second opinion or consultation with addiction specialist may be appropriate.
4) If you completed any of the self-tests on this website, share the results with your healthcare provider.

5) Share this website as a resource for family, friends, and those involved in managing your medical care.
References:

Dersh, J., Mayer, T., Gatchel, R.J., Towns, B., & Polatin, P. Psychiatric comorbidity in chronic disabling occupational spinal disorders has minimal impact on functional restoration socioeconomic outcomes. Spine, 2007, 32 (17) : 1917-1927.

Dersh, J., Gatchel, R.J., Polatin, P., & Mayer, T. Prevalence of psychiatric disorders in patients with chronic work-related musculoskeletal pain disability. Journal of Occupational and Environmental Medicine, 2002, 44, 459-468

Franche, R.L., Carnide, N., Hogg-Johnson, S., Cote, P., Breslin, F.C., Bultmann, U., Severin, C.N., & Krause, N. Course, diagnosis, and treatment of depressive symptomatology in workers following a workplace injury: A prospective cohort study. Canadian Journal of Psychiatry, 2009, 54 (8): 534-546

Newton-John TR MacDonald AJ. Pain management in the context of workers compensation: a case study Translational Behavioral Med. 2012; 2 (1): 38–46.