Chronic pain imposes a huge toll, sometimes deadly, on injured workers. The financial cost to claims payers, if modestly set at 15% of annual benefits paid, comes to $10 billion. What would happen if claims payers devoted one-tenth of 1% of that on applied research to pursue advances in prevention and treatment? 

Presently, the workers’ comp industry spends little to nothing on applied medical research, despite repeated confirmation that field-tested alternative treatment waits in the wings.

The common treatment approach of opioids makes no effort to cure. It masks the pain, enabling dependency and addiction in up to a quarter or more of cases, a rough estimate drawn from a review of opioid risks published in the April 2015 issue of the journal Pain. A fresh National Safety Council survey reports that many prescribed opioid users do not regard risks seriously and are casual about sharing their meds with others. Helios reports that 60% of injured workers get an opioid prescription.

Any major advance in conservative care would rescue hundreds of thousands of workers from miserable fates and save billions of dollars. And conservative alternatives exist. Even if they worked a third of the time, that would be far better for workers and insurers.

Many providers of conservative chronic pain care say adjustors tell them they have a ton of chronic pain cases, but refer few. I’ve never seen a report on claims outcomes from conservative care. There’s no industry forum to study treatment alternatives.

One approach is commonly referred to as functional restoration. It uses an interdisciplinary biopsychosocial team approach. Perhaps a hundred medical practices deliver this care to injured workers. For instance, Feinberg Medical Group, in Palo Alto, California, offers a team of psychiatrists, psychologists, physical therapists and others. 

Plenty of scientific articles endorse this approach, as do evidence-based medicine guidelines.     

Consider, also, treatment that applies the “neuroplasticity” model of chronic pain. The model says that brain structure changes with stimulation. Pain sensitivity can rise and fall. Norman Doidge, a physician, has written about this with clarity, most recently in his newly published “The Brain's Way of Healing: Remarkable Discoveries and Recoveries from the Frontiers of Neuroplasticity.”

Several clinics have adopted this model, including Bay Area Pain Medical Associates, in Sausalito, California, and Calmar Pain Relief, in West Warwick, Rhode Island.  

A.I.M. Mutual, a New England workers’ comp insurer, has referred several dozen difficult chronic pain cases to Calmar with results it calls “promising.” But the insurer is stymied in advancing the treatment’s potential due to the absence of an applied research infrastructure in workers’ comp.

A supportive ecology is probably essential for rapid development of treatment innovations in health care, including:

• A consortium of independent medical treatment teams.
• A shared database with exactingly accurate descriptions of patients, diagnoses, treatments and outcomes.
• The support of insurers, which goes beyond paying for treatment to careful referral, claims professional engagement and top executive commitment.

There is probably too much wishful dependence on federally funded research. Workers’ comp insurers should no longer wait passively for a replacement for painkillers as the main line of treatment, but instead actively commit.

Only workers’ comp is deeply interested in long-term functional and economic outcomes of care. Only workers’ comp is compelled to align medical advances to 50 benefit systems.  Only workers comp, as a health care payer, is so profoundly affected in patient count and payment for pain for musculoskeletal impairments. 

Unless the workers’ comp industry invests directly in applied research, there is no chance that conservative approaches will become the norm.

Further Research and Reading

Contact national managed-care organizations or the author for short, incomplete lists of representative conservative care providers committed to treating injured workers.

Rob Aurbach, “Practical Individual Resilience: A Neuroplastic Approach.” AMA Guides Newsletter, March/April 2015.

Chris Brigham, Living Abled: Your Guide to Injury and Illness Recovery (describes functional restoration).

Norman Doidge, The Brain’s Way of Healing: Remarkable Discoveries and Recoveries from the Frontiers of Neuroplasticity (describes the science).

David Hanscom, Back in Control: A Spine Surgeon’s Roadmap Out of Chronic Pain (memoir of learning conservative care plus practice guide).