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Georgia: Pain Management Perspectives for Panel Physicians

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By: Michael Schurdell, MD, Rome, Georgia

 

Recently, I attended a workers’ compensation conference where there was a discussion regarding which physician specialties should be included on a company’s workers’ compensation panel. They specifically discussed the benefits of incorporating an interventional pain management physician on the panel of providers.  The reaction of many lead me to realize there is some trepidation when one considers sending a patient for pain management. I think this arises from the misconception that pain management is a last resort for a patient, accompanied by uncontrolled spending and no measurable improvement.  In the setting of a national opioid epidemic, it has never been more important to get the injured worker to the right pain physician early in the recovery process to prevent opioid addiction, decrease the risk of acute pain transitioning into chronic pain, and decrease the ballooning costs of treating the injured worker.

Although we are experts in dealing with difficult drawn out cases, our services can be most cost effective when the patient is seen within weeks of the injury. Studies have shown that acute pain not properly managed has a much higher risk of becoming chronic pain.  Higher pain intensity is a predictor of a longer and more expensive claim.  The temptation of under trained physicians is to treat pain with high doses of opioids and no stop date in mind.  We know in injuries outside of work, 50% of patients taking opioids for 3 months are still on opioids 5 years later.  This is likely higher in the population of injured workers.  Having a physician willing to judiciously administer and appropriately wean opioids early on will decrease complications and control costs.  A trial in the Veterans Affairs (VA) health system compared liberally escalating doses of opioids with a “hold the line” dosing strategy.  Surprisingly, there was no significant improvement in function with the higher opioid using group.  If a physician is not following the widely accepted national guidelines on opioid prescribing, the onus is on the payer to remove that physician from the treatment picture and to provide the injured worker with safer care from a more conservative physician.  Such a change will benefit the worker and help decrease your long-term costs.

A well-meaning case manager may sometimes deliberately delay treatment by a pain physician because of their concerns about containing monthly costs. The real key to sustainable reduced medical costs is directing the injured worker to the right pain physician in the acute phase of the injury.  Allowing such a physician to triage the patient from the initial occurrence will prevent the unneeded use of expensive name brand medications, stop the escalating doses of addictive opioid medications, avoid unnecessary invasive surgery, and appropriately designate only the necessary conservative specialty services to promptly treat the injury.  This approach requires finding the right strategic partner to help navigate the dangerous waters of overly aggressive unproductive medical care.  For over twenty years, The Physicians’ Spine and Rehabilitation doctors have been the leaders in assisting the injured worker to find an economic treatment plan to control pain, help reach maximum medical improvement, and promptly return the worker to being a productive member of the work force.  Our physicians take a functional and rehabilitative approach to pain management and are highly knowledgeable of Georgia Workers’ Compensation guidelines and protocol.  Our main objective, when treating injured workers, is to get them functional and back on the job as quickly as possible.  Our physicians work closely with employers, case managers, carriers, and the injured worker to achieve that goal.  To learn more or to schedule a patient, please visit us at ThePhysicians.com