by Jennifer M. Smith, Esq. and Alissa C. Atkins, Esq.

We recently hosted a pain management seminar and town hall meeting with guest speakers Dr. Randy Rizor, of the Physicians’ Spine and Rehabilitation Specialists of Georgia, and Dr. Hal Silcox, III, of Peachtree Orthopaedics. The informative and lively presentation focused on a topic which is frequently a concern in workers’ compensation claims and was particularly timely due to the increased media coverage on the dangers of over-prescription and abuse due to the high addictiveness of opioid pain killers.

Opioid drugs are not only highly addictive, but are also not necessarily effective, depending on when and how they are used. Both Dr. Rizor and Dr. Silcox addressed that the use of opioids for treating work-related injuries needs to be closely evaluated as too often it is the go-to answer in treating pain following an injury and frequently it is prescribed longer than necessary. However, in some instances introducing pain management early in a workers’ compensation claim versus later may actually shorten the overall duration of the claim.

Opioid painkillers can inhibit recovery: Emphasis should be on physical activity and return to work
One of the primary points of Dr. Rizor’s presentation, “Improving Outcomes in Work-Related Pain Syndromes” is that the continued use of opioid painkillers in workers’ compensation cases, or use of these painkillers for the wrong or inappropriate reasons, actually inhibits injured workers from improving. Dr. Rizor explained that opioids can be helpful for palliative care, or relieving or preventing suffering in individuals who are suffering from cancer and other types of diseases. When used for rehabilitative purposes, or when the goal is for the individual to improve function, opioid prescriptions should be extremely limited, if used at all. Dr. Rizor further explained that how the claim is handled during the first few weeks following the injury can usually determine where the claim will be years after the injury. He stressed the importance of physical activity and getting the claimant back to work, even in a light duty capacity, as quickly as possible. This is extremely helpful in preventing the “fear/avoidance” syndrome in injured workers that can inhibit their recovery and ultimately result in longer duration of the claim as well as employees who do not return to work.

Continued opioid use often leads to increased chance of surgery and does not lead to improved outcomes
Dr. Rizor emphasized that early opioid prescribing often leads to subsequent surgery and lengthy opioid use, particularly in claimants with back pain. He demonstrated this point with statistics showing that when claimants receive opioid prescriptions within two weeks of their low back injury, they are three times more likely to have back surgery for the same objective injury as those who do not receive opioid prescriptions.

Changing claimants’ expectations: When to refer to pain management
In his presentation, “Orthopaedic Surgery and Pain Management”, Dr. Silcox continued the same theme regarding the concerns of over-prescribing opioid pain medications in workers’ compensation cases, but provided the perspective of an orthopedic surgeon. He discussed when and why orthopedic surgeons refer to pain management. In his practice, the injured worker is provided guidelines at the onset of treatment for opioid prescriptions to inform the worker that opioids will not be prescribed beyond 45 days. This sets expectations from the beginning of the claim that the focus of treatment will not be prescription medications. The guidelines also indicate the stages of the injury in which opioids are appropriate and when they are not. Once again, managing expectations can help prevent the “fear/avoidance” behavior that can be detrimental to recovery. Dr. Silcox suggested that there must be a definitive diagnosis to justify prescribing opioid medication for pain for more than three weeks. In addition, he explained that referrals to pain management should be for treatment plans focused on epidural steroid injections, joint injections, sympathetic blocks and non-narcotic pain management of non-terminal pain, rather than for narcotic medications.

We greatly appreciate both doctors for taking the time to speak, and all who attended. For anyone who wanted to be there but could not attend, if you are interested in receiving an electronic version of the written materials from the seminar, please email Alissa Atkins or Jennifer Smith.