Despite what some might hope for, there is no magic cure for pain and its woes.  Wishing for a quick fix, does not make it so. Trying medication after medication is a search unlikely to be successful.  Instead, comprehensive treatment plans and patient education play the most important roles in successful pain management. A biopsychosocial approach to the whole person and their environment is the key to addressing ingrained beliefs and long-standing patterns of behavior. This is the only effective method to stop the cycle of complaints and additional drug use.

Not only is an injured worker’s health at stake, but, as insurers and employers well know, complex pain cases in workers’ compensation are expensive. However, this costly risk to health is not simply due to opioid medications. Paradigm Analytics found that opioid spending may account for only 13% of the entire cost of complex pain cases. Certainly it is vital to focus on controlling opioid use, but that on its own is not enough to remedy this public health problem.

Compounding the problem is that chronic pain patients frequently have limited skills and understanding of medical conditions.  One study found that 57% of patients exhibit low health literacy (Devraj et al. 2013). Injured workers need assistance to make educated decisions between complex choices and adhere to treatment regimens.

The Biopsychosocial Components of Pain

Combine this limited health literacy with possible misleading beliefs about pain, and you get what Paradigm Outcomes often sees, patients accepting an accumulation of treatments that are not effective and often cause adverse effects. Pain has biological, psychological and sociological components from the moment an injury occurs. As in other medical conditions, addressing one without the others is likely to result in incomplete recovery. In addition, each component is notably complex. Even the physical aspects of an injury are complicated—chronic pain specialists take into account neuropathic pain, myofascial pain, nociceptive pain, and deconditioning, as well as the possibility of flexibility impairment. Add to that psychological and social concerns like fear avoidance, social pressures, catastrophizing and the indirect benefits of being involved in a workers’ compensation case, and it’s easy to see why chronic pain can be so difficult to manage effectively.

Paradigm Outcomes’ Systematic Care Management^SM approach is designed to respond to the unique needs of the whole individual, managing multiple aspects of medical treatment, accountability and lifestyle change to help people return to work and to healthy living.

The Role of Medications in Chronic Pain

Medication cannot be the primary intervention in successful chronic pain treatment; rather it should enhance restorative treatment such as therapeutic exercise.  Restoration of function and physical fitness must be fully integrated into the recovery plan. In fact, physical therapy and exercise is the number one treatment protocol. And how often do we see providers insisting on compliance with fitness prescriptions or reinforcing their importance?

While there can be many valid reasons for a treating physician to prescribe medications, problems occur when pain-related conditions are overdiagnosed and ineffective medication use goes on too long. Polypharmacy can result in overmedication, and an increased risk of interactions or side effects, declining effectiveness and impaired physical function. Paradigm Outcomes recommends separating out each clinical issue and pain complaint and asking why each medication is being prescribed and to what end.

First Do No Harm

There are so many ways to facilitate wellness that do not put injured workers at risk. Sleep hygiene, physical health and fitness, cognitive behavioral therapies, and the identification of environmental confounding factors are all important factors of chronic pain management. Medications must be prescribed responsibly and discontinued if they are not effective within a reasonable period of a few weeks to a few months.

At Paradigm Outcomes, overall health comes first. This means following evidence based guidelines and avoiding a trial approach to treatments. If a medication produces unreasonable side effects, it must be discontinued in a responsible search for the right combination of medications—or the removal of the need for medications altogether. Comprehensive case management helps us keep patients accountable for taking the medications they should … and stopping or removing medications that aren’t safe and effective.

For more information on managing pain and appropriately prescribing pain medication within the context of a rehabilitation plan, follow Paradigm Outcomes on LinkedIn, Twitter, and Facebook.