At Paradigm Outcomes, we understand the importance of treating the whole person in order to effectively overcome chronic pain. Opioid and other medication therapies alone may mask symptoms but are unlikely to help a patient struggling through recovery to return to health and work. Comprehensive treatment involving cognitive behavioral therapies, changes to social and environmental conditions, and physical fitness can make a lasting difference where opioid therapies cannot. But success requires a treatment strategy, since simply plugging in a series of interventions can set up a series of failures (lack of functional improvement, adverse effects, escalation).

Where Do Medications Fit?

Understanding and reinforcing responsible prescribing practice is a key component of the Paradigm Outcomes case management plan. Here are some powerful tips and insights for understanding how the right prescription practices in the right context can help a chronic pain patient improve and return to full function.

In concert with a case manager, the injured worker’s medical team must:

1. Clearly define the problem. This may involve medical evaluation and discussion among multiple care providers. Identifying biomedical as well as psychosocial factors is the key.
2. Specify the therapeutic objective. Once all parties understand the problem, it’s important to clearly define the objective so that the patient and every care provider understand the goal and how they will measure progress. This is an opportunity to determine if the injured worker truly comprehends their symptoms and their response to their symptoms.
3. Select a drug therapy that is likely to be appropriate to the situation. Don’t “throw the book” at a problem, but take a concerted look at exactly which drug or combination therapy has the best chance of a successful outcome. What symptom or impairment are you treating?
4. Initiate drug therapy, potentially at the same time as non-pharmacolgic therapies. Treating the whole individual can raise chances of success. Humans are biopsychosocial beings.
5. Instruct the patient on proper methods for taking the medication. Provide appropriate warning and instructions to help raise health literacy and thus the potential for success. Emphasize important details on repeat visits. Taking more is not better.
6. Evaluate therapy. Keep track of the patient’s progress on a regular basis. If the treatment does not work as planned, make guided changes after a few weeks or months (depending on the drug).
7. Consider drug cost. If the cost of a drug falls outside an individual’s means, it’s unlikely that the medication will be taken as prescribed, inhibiting chances of treatment success. Equivalent less costly alternatives is a reasonable physician responsibility.
8. Use available tools to reduce prescribing errors. Quality medical software can recognize contra-indications during the prescription process, flagging potentially dangerous combinations that a physician might miss, especially if a patient is prescribed medications by more than one doctor. In addition, physicians often refill chronic medications on “auto-pilot”, so urging reassessment is important.

Treatment of pain should never be pharmacological only, and only one medication should be added or changed at a time. Regular evaluation for effectiveness of treatment and the presence of side effects should be mandatory to protect patient health and quality of life. That’s the Paradigm way.

For more information on managing pain, and appropriately prescribing pain medication within the context of a rehabilitation plan, replay parts one and two of Paradigm’s “It’s Not Just Opioids” webinar series. You can also read Dr. Moskowitz’s WorkCompWire Leaders Speak column on the same subject.