This episode of ADJUSTED features Pain Management Specialist, Jeffrey Hazlewood, M.D. This episode discusses treating injured workers for pain, psychosocial issues, opioids, and more.
Dr. Jeff Hazlewood practices Physical Medicine and Rehabilitation/Pain Management in Lebanon, TN, and he is an Associate Staff Member at Vanderbilt Wilson County Hospital in Lebanon. After receiving his medical degree from the University of Tennessee, Memphis, he completed his residency at the University of Alabama, Birmingham, where he was chief resident. A Fellow of the American Academy of Physical Medicine and Rehabilitation, Dr. Hazlewood is Board Certified in Physical Medicine and Rehabilitation with a subspecialty Board Certification in Pain Medicine. He also is a Certified Lifecare Planner. He is a member of the Medical Impairment Rating Registry and has received training on the 5th and 6th Editions of the AMA Guides to the Evaluation of Permanent Impairment. He also teaches the 6th Edition Impairment Rating course to doctors and attorneys.
His society memberships include the American Academy of Physical Medicine and Rehabilitation, the American Association of Neuromuscular and Electrodiagnostic Medicine, the American Academy of Physician Lifecare Planners, the Tennessee Medical Association, The Tennessee Pain Society, the American Medical Association, and the Rotary club. He is an experienced speaker on various aspects of pain management and topics in Worker’s compensation and Lifecare Planning. Dr. Hazlewood also previously served as an assistant medical director for the Tennessee Division of Worker’s Compensation. He primarily is a treating physician, but also performs Medical Record Reviews (regarding causation, ratings, and appropriate pain management per evidence-based medicine guidelines) and IMEs.
Alternatives to Opioids
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 are afraid to delve 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, and prescribing medications is now scrutinized, and there are strict guidelines and rules 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 should be initiated, such as good hands-on physical therapy, a weight loss program, yoga, and other recommended pain de-escalators.
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 avoid 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.