TREATING PATIENTS IN WORKER’S COMP REQUIRES PASSION: Worker’s Comp is tough. Treating injured workers who have pain and need to get off opioids is very challenging. Many doctors fear delving into the Worker’s Comp arena and do not want to treat Worker’s Compensation patients. It takes constant training and a passion for helping people. It is tough work, but it can be very rewarding. When working to get patients off narcotics, it is important to understand alternative treatments must be offered. It takes time to wean injured workers off opioids, especially the “Legacy Claims” (claimants who have been on narcotics for years.) It is important to remember that “working hard for something we don’t care about is called stress. Working hard for something we love is called passion.”

THE PENDULUM HAS SWUNG SEVERAL TIMES ON GUIDELINES FOR PRESCRIBING OPIOIDS: Opioids were not heavily prescribed until the late 90’s-early 2000s, which coincided with the development of OxyContin and extended-release opioids. The hospitals started driving doctors to prescribe opioids. If a patient rated their pain 7 out of 10 or higher, the solution was to prescribe narcotics. It was considered inhumane not to prescribe the medications, or they could risk lawsuits. Many patients were treated with primary care physicians instead of with a PM&R (Physical Medical and Rehabilitation) provider, which resulted in the overprescribing of medications. Now, the pendulum has swung the other way; prescribing medications is scrutinized, and strict guidelines and rules are in place.

ADDICTION VS PSYCHOLOGICAL DEPENDENCE: It is imperative to differentiate whether the claimant is addicted to the narcotics or whether they have a psychological dependence on them. Many claimants take the medications as prescribed, and they are not addicted to them. The claimant has psychological dependence, meaning they are used as a crutch. It is very frightening to them to think about what they will do if they have pain and do not have the medications. It is vital to wean them off the medications slowly. During this weaning time, alternatives such as good hands-on physical therapy, a weight loss program, yoga, and other recommended pain de-escalators should be initiated. 

ASSESS PSYCHOLOGICAL PROFILES PRIOR TO SURGERY AND OPIOIDS: It is imperative that the doctor gives the correct medical diagnosis. Listen to the patient and make sure that the pain generator (what is causing the pain) matches the diagnosis. This is key to avoiding unnecessary surgeries. The doctor should discuss with the claimant if they suffered any past childhood traumas or abuse. Find out if they have family members with a history of drug addiction or alcoholism. The doctor should also discuss any history of depression with the claimant and their support systems at home. This is very important to determine because drugs make the pain and the depression worse.

CELEBRATE THEIR SUCCESSES: When a patient is finally weaned off of the narcotics, they feel like a different person. Patients have reported that they were living in a fog and didn’t even know it. They feel like they finally woke up. Doctors need to celebrate their milestones and keep encouraging them. It is important for the providers to fight for them and build their trust. It is extremely rewarding to see patients regain their quality of life and function.