Tag Archives: pain management

Educate Stakeholders on Effective Alternatives to Opioids

September 12, 2018 by 

A combination of ibuprofen and acetaminophen does a better job of relieving acute pain than opioids. Despite clear evidence that the combination of the less dangerous medications provides equal or greater pain relief, many physicians still prescribe opioids for injured workers with pain.

Doctor holding a note that reads, "Explore non-Opioid Alternatives" for article, Educate Stakeholders on Effective Alternatives to OpioidsThis statement was just one point made in a recent session at the Workers’ Compensation Institute’s Annual Conference in Orlando presented by:

  • Marcos A. Iglesias, Chief Medical Officer of Broadspire
  • Mark Pew, senior VP for Product Development & Marketing at Preferred Medical.

The Problem

The opioid epidemic in the U.S. has been well documented in recent years. Researchers say Americans consume more opioids than any other country, regardless of the myriad physical and psychological problems associated with their unnecessary use.

While stakeholders in the workers’ compensation system have made progress in curbing the unnecessary use of opioids in recent years, it will take a concerted effort of educating providers as well as employees about chronic pain, and effective treatment alternatives said Iglesias and Pew.

Findings released by the Society for Internal Medicine on a one-year comparison of patients with chronic low back pain who were treated with either opioids or ibuprofen included:

  • No difference in function
  • Those given opioids had statistically worse pain control

Among the side effects of opioids are

Even Small Quantities of Opioids Prescribed for Minor Injuries Increase Risk of Long-Term Use

Source: Perelman School of Medicine at the University of Pennsylvania
May 17, 2017

short term opioid use rish graphOverprescribing of opioid medications for pain has contributed to a record-high number of drug-related deaths in the United States in recent years. A significant part of the issue, experts say, is the vast amount of variation in opioid prescribing habits for minor injuries such as ankle sprains — which don’t require treatment with such risky drugs in the first place.

For example, patients who received their first opioid prescription for an ankle sprain treated in U.S. emergency departments (EDs) commonly received prescriptions for anywhere from 15 to 40 pills, according to new research from the Perelman School of Medicine at the University of Pennsylvania.

Those who received 30 or more pills compared to less than 15 pills were twice as likely to fill an additional opioid prescription within three to six months. The authors say the results point to the urgent need for policies and guidelines to address when opioid medications are indicated for minor injuries and to reduce the number of pills supplied for opioid prescriptions. The study will be presented today during the plenary sessions at the Society for Academic Emergency Medicine annual meeting in Orlando, FL.

“The substantial variation in prescribing patterns of such extremely addictive medications for minor injuries results in many thousands of pills entering the community, and places patients at an increased risk of continued use and potentially addiction,” said lead author M. Kit Delgado, MD, MS, an assistant professor of Emergency Medicine and Epidemiology at Penn. “It’s vital that we identify and understand the root causes of this growing issue.”


4 Urine Drug Testing Questions To Deliver Better Work Comp Outcomes

By ReduceYourWorkersComp.com 03/09/2017

DOT screening via computer
Central Coast IndustrialCare gets DOT results in as little as 15 minutes

Urine drug testing (UDT) is one of the more controversial and misunderstood tools in the workers’ comp system. While medical guidelines support the tests for injured workers who are prescribed opioids, stories of over testing injured workers —and overcharging payers — abound. There are also questions about what type of testing to use, the frequency of the tests, and what to do with the results.

UDT used judiciously and paired with clinical expertise can be invaluable in ensuring injured workers get the right medications at the right time. Understanding some of the basics will help you get the best bang for your UDT buck.

Types of testing

 •  Forensic. UDT has been around for decades, beginning with its use to identify illicit drug users in criminal and civil proceedings as well as the workplace. This forensic, or ‘gotcha!’ model is designed to determine yes or no that someone is taking certain, typically illegal drugs. An initial screening — presumptive — test is performed and any positive results are sent for confirmation.

The types of tests include in-office point of care. Results from these tests can come in minutes. However, they are not necessarily designed to detect the use of medications at therapeutic doses, something critical in a clinical setting. Also, the tests are not available for all drugs, such as synthetic drugs of abuse. Since oxycodone is a semi-synthetic opioid, it may not always be detected in these tests.
•  Clinical. This model puts the focus on the patient-provider relationship and is used as part of patient care in various settings, including pain management. The idea here is to identify the presence of specific prescribed medications, non-prescribed medications and illicit substances to benefit the therapeutic goals of the patient.

Definitive testing, typically used in this model, provides information about specific drugs and metabolites and can detect drugs at much lower concentrations, which presumptive tests do not. The results of these tests, however, may not be available for 24 hours or more.

The type of test used for an injured worker depends on a variety of factors, including the physician’s assessment of the patient’s risk. The types of medications also has a bearing on the most appropriate tests. If there are multiple opioids, for example, presumptive tests may not provide enough information to help the physician.

Why Test:

Guidelines published for prescribing opioids to injured workers support the use of UDT to help identify safe and effective treatment options.  Some of the reasons to undertake UDT include:


Help for Drivers Impaired by Edible Marijuana

photo of medical marijuana candy bar
Candy bars laced with medical marijuana are seen on display at the Alternative Herbal Health Services cannabis dispensary April 24, 2006 in San Francisco, California. (Photo by Justin Sullivan/Getty Images

Though marijuana edibles are becoming increasingly common, scant information exists on how to test drivers for impairment following their consumption.

For the first time, research published today in AACC’s Clinical Chemistry journal evaluates the performance of roadside saliva tests for tetrahydrocannabinol (THC) following consumption of edibles, showing that lower THC cutoff points are needed for these tests to effectively detect marijuana ingestion.

Consumption of marijuana edibles has expanded along with legalized medical and recreational use of this drug, and almost one-third of all marijuana is now either eaten or ingested in drink form. Marijuana-associated traffic accidents and fatalities have also increased rapidly in states where this drug has been legalized, with THC prevalence among U.S. weekend nighttime drivers increasing from 8.6% in 2007 to 12.6% in 2013 and 2014.

THC is the main psychoactive constituent in marijuana, and unlike with alcohol, no breath test exists that can accurately detect it. As an alternative, saliva tests show potential as quick roadside sobriety tests for cannabis. However, the efficacy of roadside saliva tests following edible cannabis consumption has never been studied before.

In this study, a team of researchers from the National Institute on Drug Abuse led by Marilyn A. Huestis, PhD, set out to fill this critical gap in roadside marijuana testing knowledge. The researchers gave occasional and frequent marijuana smokers brownies laced with 50.6 mg of THC. Over the course of 48 hours, the researchers then collected saliva and blood samples from the participants at several time-points Continue reading Help for Drivers Impaired by Edible Marijuana

100 Conclusions on the Health Effects of Marijuana – New Report

Nearly 100 Conclusions on the Health Effects of Marijuana and Cannabis-Derived Products Presented in New Report

By WorkersCompensation.com 01/16/2016

medical marijuana daily dose trayA new report from the National Academies of Sciences, Engineering, and Medicine offers a rigorous review of scientific research published since 1999 about what is known about the health impacts of cannabis and cannabis-derived products – such as marijuana and active chemical compounds known as cannabinoids – ranging from their therapeutic effects to their risks for causing certain cancers, diseases, mental health disorders, and injuries.

The committee that carried out the study and wrote the report considered more than 10,000 scientific abstracts to reach its nearly 100 conclusions.  The committee also proposed ways to expand and improve the quality of cannabis research efforts, enhance data collection efforts to support the advancement of research, and address the current barriers to cannabis research.

“For years the landscape of marijuana use has been rapidly shifting as more and more states are legalizing cannabis for the treatment of medical conditions and recreational use,” said Marie McCormick, chair of the committee; the Sumner and Esther Feldberg Professor of Maternal and Child Health, department of social and behavioral sciences, Harvard T.H. Chan School of Public Health; and professor of pediatrics, Harvard Medical School, Cambridge, Mass. Continue reading 100 Conclusions on the Health Effects of Marijuana – New Report

Medical Marijuana – Without Any Marijuana!

By WorkCompAcademy.com 11/29/2016

Medical Marijuana logoSacramento, CA – The workers’ compensation community is bracing for the potential, and some say eventual, tidal wave of claims for medical marijuana as a form of treatment for pain related industrial injuries. But soon it may be possible to provide the claimed benefits of “medical” marijuana – without any marijuana at all!

Science Daily reports that Indiana University neuroscientist Andrea Hohmann took the stage at a press conference Nov. 14 in San Diego to discuss research conducted at IU that has found evidence that the brain’s cannabis receptors may be used to treat chronic pain without the side effects associated with opioid-based pain relievers or medical marijuana.

The study was discussed during the annual meeting of the Society for Neuroscience, the world’s largest source of emerging news about brain science and health. Hohmann was joined by three other international researchers whose work focuses on similar topics.

“The most exciting aspect of this research is the potential to produce the same therapeutic benefits as opioid-based pain relievers without side effects like addiction risk or increased tolerance over time,” said Hohmann, a Linda and Jack Gill Chair of Neuroscience and professor in the IU Bloomington College of Arts and Sciences’ Department of Psychological and Brain Sciences.

Chronic pain is estimated to affect nearly 50 million adults in the United States. The rise in opioid-based pain relievers to treat chronic pain has also contributed to an opioid addiction epidemic in the United States, with 19,000 deaths linked to prescription opioid abuse in 2014. In Indiana, the use of needles associated with prescription opioid abuse led to a major HIV outbreak in the state’s southeastern region, prompting the governor to declare a public health emergency in 2015.

 Continue reading Medical Marijuana – Without Any Marijuana!

As States Legalize Medical Marijuana, Doctors Struggle With Knowledge Gap

August 15, 2016 | Kaiser Health News – www.kaiserhealthnews.org

caduceus with marijuana leafMedical marijuana has been legal in Maine for almost 20 years. But Farmington physician Jean Antonucci says she continues to feel unprepared when counseling sick patients about whether the drug could benefit them.

Will it help my glaucoma? Or my chronic pain? My chemotherapy’s making me nauseous, and nothing’s helped. Is cannabis the solution? Patients hope Antonucci, 62, can answer those questions. But she said she is still “completely in the dark.”

Antonucci doesn’t know whether marijuana is the right way to treat an ailment, what amount is an appropriate dose, or whether a patient should smoke it, eat it, rub it through an oil or vaporize it. Like most doctors, she was never trained to have these discussions. And, because the topic still is not usually covered in medical school, seasoned doctors, as well as younger ones, often consider themselves ill-equipped.

Even though she tries to keep up with the scientific literature, Antonucci said, “it’s very difficult to support patients but not know what you’re saying.” Continue reading As States Legalize Medical Marijuana, Doctors Struggle With Knowledge Gap

Investigating and Handling Repetitive Use Injuries

Repetitive use injuries account for a significant portion of claims in many workers’ compensation programs. Whilcartoon about Carpal Twitter Syndromee these injuries can occur in any employee, they are becoming more prevalent in the aging American worker force. It is important for claim management teams to investigate properly these claims to reduce the costs of claims.

A Case Study: The Anatomy of Repetitive Use Injuries

Frank Smith is a dedicated employee and has been working at the Acme Widget Company for over 20 years. He has never missed a day of work since starting. During a typical 8-hour shift, he will twist some knobs, pull some levers and walks back and forth along the
widget-making machine. The day after working a longer than normal shift due to high demand for widgets, Frank wakes up and is experiencing numbness and tingling in his arms. He is later diagnosed with bilateral carpal tunnel syndrome with rotator cuff impingement in his shoulders. Are these conditions work-related?

Common Features of Repetitive Use Injuries

The legal definition in every jurisdiction varies on compensability for these injuries. Courts will look at a variety of factors when determining if such conditions are compensable. There are some common aspects across all states workers’ compensation laws: Continue reading Investigating and Handling Repetitive Use Injuries

Moving Patients From Drugs To Independence

Illustration of various types of chronic pain
According to the National Center for Health Statistics chronic pain health care costs and lost productivity has reached nearly $100 billion a year. It affects approximately 76.2 million people - more individuals than diabetes, heart disease and cancer combined.

Republished with permission from PRIUM’s Evidence Based

Last week I visited two facilities in California that are successfully doing what we all want done – transitioning injured workers to non-narcotic methods to manage their chronic pain.  I often hear a cynicism regarding effectiveness/cost as “pain management clinics” have accumulated a bad reputation over time for high expense and high recidivism rate.   After detailed in-person discussions and evaluation of case studies, I believe these two have shown success that break the mold:

  • Savvy Health Solutions: The F.I.T. Academy (Functional Intervention Training) program works outside of the medical model to restore function by treating the whole person in a fitness environment.  They challenge the physical, intellectual and motivational components of the person, with an ultimate goal of independence and personal responsibility and maximized ADL’s.  As long as the injured worker doesn’t need medical oversight during the detox process, they will work in conjunction with the treating physician and employer and claims adjuster to define the most appropriate path to the goal.  Founder Paul Wright says it takes patience (approximately 40 sessions over 4-5 months), but he showed me several pictorial examples of “before” and “after” (even meeting one of their patients) and their data that showed a 69% decrease in WC claim costs and 65% reduction in the length of open claims.
  • Pacifica Pain Management Services: Dr. Gary Mills has created a comprehensive non-narcotic pain management program that lessens pain by emphasizing pain syndrome management and reducing drugs, depression and dysfunction.  In some cases an in-patient detox with full medical supervision is required, but the residential inpatient approach (with a 60% individual / 40% group model and 2:1 staff to patient ratio) allows their team of MD, PhD, PT and personal trainers to recalibrate how the patient deals with pain through a full daily schedule for 4-6 weeks.  Interestingly, they mandate a 1-year contract of continuous engagement with the treating physician and claims adjuster (and visits every 2 weeks) to be the continued conscience.  Their outcomes (69-72% stay “clean” when they fully exit the program) exceed the industry (typical goal of 50%).

While these two facilities are focused on northern California, there are others (like Solutions Recoveryin Las Vegas, whom I’ve also vetted) that likewise have solid methods and positive results.  The key I have found is patience – while guidelines typically suggest 6-8 weeks / 180 hours for a FRP (functional restoration program), that likely isn’t enough time to enact lifetime changes.

When judging a pain management or functional restoration program, the first questions must be:

  1. Show me examples where you’ve been successful
  2. Show me your recidivism rate

Without demonstrated success of transitioning patients to a lifetime of managing their chronic pain without narcotics, you will likely be throwing your money away.

One of my projects this year is to identify centers of excellence because our corporate goal (and my personal goal) is to get patients off harmful drugs, whatever the method.  So if you have suggestions of other successful facilities I would be pleased to hear from you.