Functionality is key to helping injured workers with chronic pain. While that may seem obvious, that’s not the approach typically taken for these patients. Instead, payers, medical providers and others involved in a claim are often in lockstep on the need to identify and eliminate a single physical source of the pain — even when that may result in multiple surgeries, a myriad of additional medical procedures, addictive medications and, ironically, little to no relief from the pain.

These so-called creeping catastrophic claims start with a seemingly minor injury that deteriorates into a nightmare of expense and multiple medical services with no end in sight. While such cases are not the norm, they are one of the major cost drivers in the workers’ comp system.

The problem stems from a lack of understanding of what causes pain and an unwillingness to provide the necessary resources to address it. Payers ultimately may find themselves scratching their heads as to why a simple back injury has been on the books for 10 years and is costing millions. But those willing to embrace the latest research findings and spend extra money toward the start of certain claims will see vastly improved medical outcomes and significant cost savings.

Biomedical vs. Biopsychosocial

There are essentially two approaches to pain management. Biomedical assumes all pain symptoms can be traced to a specific physical ailment. The medical provider need only find and ‘fix’ the bodily problem and the pain should disappear.

But chronic pain is complex. For many people, it’s a combination of biological, psychological and social factors that drive and even worsen the initial ailment. For some injured workers, a ‘quick fix’ to completely eliminate all pain is unrealistic. But they can learn to manage their pain. The only way to appropriately treat these injured workers and give them any hope of returning to work is to analyze and target all of their underlying maladies.

The biopsychosocial approach to injured workers with chronic pain is a multidisciplinary effort that should include, at the very least, a physician pain specialist, a physical therapist and a psychologist. Additional experts, such as occupational therapists and neuromuscular massage therapists may also be needed. One these at-risk injured workers have been identified, a coordinated and goal oriented process should begin, with the end result of functional restoration for the injured worker.

This model for helping injured workers in chronic pain is well documented in scientific studies, and is even promoted by the Federal government. In an effort to stem the national opioid epidemic, the Centers for Disease Control and Prevention issued a Guideline for Prescribing Opioids for Chronic Pain. Its first recommendation pointed to nonpharmacological treatment options as frontline strategies.

“The contextual evidence review found that many nonpharmacologic therapies, including physical therapy, weight loss for knee osteoarthritis, psychological therapies such as cognitive behavioral therapy (CBT), and certain interventional procedures can ameliorate chronic pain,” it said. “Nonpharmacologic physical and psychological treatments such as exercise and CBT are approaches that encourage active patient participation in the care plan, address the effects of pain in the patient’s life, and can result in sustained improvements in pain and function without apparent risks.”

Role of PT

Getting injured workers back to functionality — and work — is best accomplished with a clear understanding of the specific tasks and movements required. Whether that involves a parent being able to lift up his children, a mechanic who must be able to raise his head and arms to work underneath a car, or a truck driver who sits for long periods of time and must be able to turn his head enough to avoid a collision, employees need tools and encouragement to aid in their own self recovery.

By working one-on-one, especially in the home and/or the worksite, a physical therapist can make adjustments and help the worker undertake the efforts with minimal pain and reduced risk of reinjury. The worker can gain confidence at his ability to again function, reducing or eliminating his chance of delayed recovery or becoming permanently disabled.

The collaboration of all medical providers, the claims adjuster and employer can optimize recovery for the injured worker with psychosocial issues. The role of the physical therapist as a vital part of this team cannot be overstated. By focusing on function improvement rather than just pain control, the patient can once again become integrated into his pre-injury life.