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Paduda: Chronic Pain, Opioids and Workers' Comp

By Joe Paduda

Monday, September 9, 2019 | 560 | 0 | min read

The hammer is starting to fall on the opioid industry, and the repercussions are echoing through the comp industry.

Joe Paduda

Joe Paduda

Johnson & Johnson owes Oklahoma $573 million after losing its case in the state. Purdue Pharma’s owners are trying to settle all suits for $10 billion-$13 billion. A huge case in federal court in Ohio will go to trial next month.

In work comp, opioid spend has been cut in half over the last three years, but the reductions are not consistent across the states. Workers Compensation Research Institute's latest report has insights into where the problem is most severe, which helps you figure out where to allocate resources. Kudos to authors Dongchun Wang, Vennela Thumula and Te-Chun Liu for putting together the report.

Meanwhile, we’re being inundated with “alternative” treatments for chronic pain. One just-published study (hat tip to Dr. Steve Feinberg) shows that invasive procedures are pretty much useless. Here’s the takeaway:

There is little evidence for the specific efficacy beyond sham for invasive procedures in chronic pain … Given their high cost and safety concerns, more rigorous studies are required before invasive procedures are routinely used for patients with chronic pain.

BTW, for clinicians, Steve wants you to consider attending the CSIMS meeting coming up next month.

As we transition away from opioids, how do we help patients with chronic pain? What works, what doesn’t, and why? And most importantly, how do we work with treating physicians to solve the problem?

Of course, a key reason docs have over-prescribed invasive treatments is financial. There’s a ton of money in doing stuff to patients, compared to a few pounds of money for working with patients. But that’s only part of the story.

Simply walking into a physician’s office with a fancy dashboard and telling the physician that doing X is in their best interest does not work. To get docs to change behavior, you have to understand why they are doing what they are, provide them accessible data showing why that’s not helpful, and get them involved in change.

Is that a lot of work? Well, maybe. Break it down into chunks and it’s not so daunting.  Identify a few docs you want to work with, talk with them about the issue and develop solutions together. This takes time, patience and, most of all, a commitment to listening and understanding.

The payoff is trust between you and the treating physician, which leads to a lot less work for your frontline staff, and a lot better outcomes for your work comp patients.

What does this mean for you?

You need a plan to help patients with chronic pain. And that plan has to include treating physicians. 

Joseph Paduda is co-owner of CompPharma, a consulting firm focused on improving pharmacy programs in workers’ compensation. This column is republished with his permission from his Managed Care Matters blog.

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