It is heartening to see the workers’ compensation system continuing the battle to prevent opioid abuse, misuse and diversion. While our industry has done a tremendous job in combatting the problem, it is by no means a done deal. The statistics still paint a horrific picture of the issue. The government estimates more than 100 people die daily as a result of opioid abuse.

One of the best ways to address this issue is by using alternative methods of pain management, including physical therapy. In its latest annual look at upcoming trends, Sedgwick speculated that 2018 would bring more collaboration among payers and providers to steer people away from opioids and toward safer alternatives. This is exactly what we need to protect injured workers and get them back to function and work quickly.

Latest Stats

The latest figures from the U.S. Department of Health and Human Services continue to show the grim reality:

• 116 people died each day from opioid-related drug overdoses in 2016.
• 1 million people had an opioid disorder
• The economic costs of the opioid epidemic are $504 billion.

Drug overdoses are the leading cause of injury deaths in the United States. In a report issued last year, the Centers for Disease Control and Prevention said half the people taking an opioid for at least 30 days would be on the drug for at least 3 years. Other statistics indicate that a majority of people who take an opioid for 90 days are still taking them 5 years later.

Opioids Effects

Opioids affect the brain’s reward/pleasure center. As Dr. Teresa Bartlett, Sedgwick’s senior vice president of Medical Quality explains, opioids attach to and stimulate receptors in the brain that release endorphins. Initially they increase pleasure and relieve pain. Over time, however, the repeated stimulation of the receptors creates a tolerance, requiring more of the drug to achieve the same effect. Within a relatively short period of time, the receptors become desensitized to the opioids. This affects the person’s mood, behavior, breathing and perception.

Opioids can slow the person’s breathing, blood pressure and alertness. By skipping a dose, the person may experience a variety of additional side effects, such as:

• Restlessness
• Irritability
• Muscle and bone pain.
• Insomnia
• Sweating
• Diarrhea
• Vomiting 

Chronic opioid abuse changes the brain. Even someone using opioids for the first time may experience life-threatening side effects, such as respiratory arrest.

Despite the effects of opioids, some providers nevertheless will increase dosages in response to a patient’s complaints of pain. But research shows that chronic opioid therapy has only a modest effective on relieving pain.

Alternative Pain Management Remedies

Early intervention therapy is one of the best alternatives to opioids and bed rest to treat pain among injured workers. Immediate physical therapy can increase mobility and shorten recovery times. Functional recovery should be the focus, as that can reduce the chances of pain becoming chronic.

Ideally, the therapist should work with the patient not only to deal with his current pain, but also show him proper movements. Working one-on-one with the injured worker on his actual daily work tasks is key to reducing and preventing chronic pain.

Increasingly we are seeing a push to PT and other non-opioid treatments for injured workers with pain. A variety of medical guidelines, including those from the CDC, suggest PT and other alternatives as a first line treatment for chronic pain, rather than opioids.

In its trends report under the category ‘Leveraging Interdisciplinary Care’ Sedgwick anticipated more of a push toward this effort this year:

“We anticipate more collaboration between employers, physicians, pharmacists, claims specialists and patients as they move away from long-term drug therapy and instead test its alternatives in pursuit of returning a person to long-term health and productivity. This may mean we see variations on more traditional options like physical therapy and pharmacy management, or perhaps broader utilization of tools such as physician-patient opioid contracts, pain coaching partnerships, behavioral health networks, or alternative therapies like yoga, meditation and acupuncture.”

In another section of the Sedgwick report, “Shifting Tide of Policy” the TPA predicted additional actions to curb unnecessary opioid abuse:

“From the overall compliance perspective to the individual claims response, structure is being built around the use of drugs within a claim in an effort to curb potential dangers. Governments, pharmacy retailers and employers are looking for ways to take back control through legislation, drug formularies, first fill limitations and more.”

Conclusion

The opioid crisis in this country did not happen overnight and it will take time and a concerted effort by all of us to fully address it. But continuing to focus on PT and other alternatives to treat chronic pain among injured workers is a crucial step.