To better understand pain management, one must understand pain itself.
For years, healthcare providers, insurers, patients and their families relied primarily on prescription drugs as a solution to pain management and the return to functionality. They later discovered “pain” to be a highly complex problem. This reliance upon prescription medications, however, had already put America on the path to opioid addiction.
What often begins as the legitimate search for pain management following an accident, injury or surgery spirals out of control. People become dependent on opioids leading to loss of health and social interaction and untold numbers of deaths. Healthcare professionals today are turning to a variety of alternatives, including holistic and behavioral solutions, to better manage pain.
The damage has already occurred. Some 500,000 Americans died from legal and illegal opioids between 2000 and 2019; some 107,000 died in 2021 alone, notes the U.S. Centers for Disease Control. Social isolation, the loss of access to treatment and other issues exacerbated by the COVID-19 pandemic increased the use of prescription pain pills, as well as other illicit drugs.
The costs are unsustainable. In the business community, chronic pain suffered by over 50 million Americans accounts for $80 billion a year in lost wages and nearly $300 billion in productivity, notes the Washington Post.
As we’ve written previously, Broadspire has been at the forefront of painkiller dependency. Broadspire physicians Eddie Sassoon, M.D., and Ira Posner, M.D., have been working professionally within their own practices and with Broadspire directly to address the issue and implement actionable solutions. With our PBM partner, Optum, Broadspire (Crawford’s Global TPA) has implemented medical management and opioid reduction programs to prevent misuse and protect injured workers from potential adverse effects.
It’s become imperative for employers, healthcare providers and third-party administrators to be a partner in the employee’s path to reasonable, effective pain management. By limiting or eliminating the use of opioids, improving collaborative efforts, and educating patients and society, we can help injured workers control their pain, prevent dependency, and eventually return to work.
We’ve learned much in the past 20 years about the pain process and pain management, addiction and recovery. We now know the difference between the disease of addiction and dependency disorder, which occurs when the body becomes used to a drug’s effects and goes into withdrawal if the user stops its use.
We long knew the impact of Iatrogenesis, or the causation of a disease, a harmful complication, or other ill effects by any medical activity, including diagnosis, intervention, error or negligence. This includes over-prescribing caused by physician-induced demand.
Aware of these issues, many surgeons and other physicians who commonly would prescribe opioids for acute or chronic pain now are searching for more lasting and less harmful alternatives.
How can we improve the process of pain management? Below are some protocols Broadspire professionals are implementing…
- Ask questions to better understand the problem. Ask about the patient’s pain and its actual or suspected causes and their ongoing need for medications. What is the patient’s social setting? Are they getting support at work, at home or from their medical provider? Is it true pain, or dependency or some other cause? Listen closely to the answers to see the story more clearly.
- Know the patient’s tolerance for pain - or likelihood for addiction. If prescription pain medications are indicated, this also requires a multi-tiered approach. Our suggested pain management model encourages the psychologist, addictionologist or pain management doctor perform a comprehensive assessment of chronic pain management to determine their levels of pain, anxiety, depression, family history and risk for addiction. If prescription painkillers are indicated, treat with the lowest therapeutic dose. Some doctors also will prescribe naloxone, in case the patient, a family member, child or even a pet, accidentally ingests and overdoses on narcotics.
- Educate patients to reduce their fears. Many patients - even providers - don’t know the difference between dependency and addiction, or the role different healthcare providers can play in recovery. To reduce patient anxiety, we recommend health care professionals help define the problem, the medical solutions being proposed, even the terminology. With so many professionals involved, strive to be a calming voice amid their storm.
- Collaborate on multidisciplinary solutions. Healthcare providers often see the patient only through their own discipline. Instead, incorporating a paraprofessional approach. This may include medical doctors, psychologists, social workers, even exercise physiologists. If an obese patient requires knee surgery, for example, a dietician and social worker can work alongside an orthopedist to address causative issues and comorbidities in order to improve outcomes.
- Explore alternatives. Western medicine has learned much from Eastern and non-traditional remedies. Beyond prescription medications and NSAIDs, medical professionals, even HR departments, insurance providers and workers' compensation professionals, should consider yoga or massage therapy, pain management training, acupuncture, aquatic therapy, meditation and other coping strategies. Even workplace ergonomics can improve injuries borne from repetitive motions or poor-fitting workspaces.
At Broadspire, we have found that by collaborating to help patients better manage their pain, employers, healthcare providers and third-party administrators can reduce or eliminate the use of opioids, prevent dependency, improve the worker’s quality of life and get them back to work and living.
