Pitfalls of Pain and Disability

The workers’ compensation system is a highly complicated multi-dimensional system that not only includes injury, resultant pain and functional disturbances, but legal, financial, persistent pain, family, social and psychological issues. In addition to these issues the injured party’s problems must be resoled or stabilized in all facets so that they can move on with their lives. They must resolve their workers’ compensation injury claim and return to a new level of functional activity. The system is fraught with problems. On initial impact an injury causes pain and resultant impairment and disability. Chronic pain states are frequently associated with chemical dependency or addiction, as well as ongoing psychological, financial and social sequelae. The flaws in the system that help destabilize recovery from injuries are initial lack of freedom of choice of providers, difficulty with authorization of services for treatment in a timely manner, opposing attorneys that create adversary physician’s opinions resulting in opposing diagnoses and differing treatment recommendations. Liability issues interfere with access to treatment, and the legal issues result in control over treatment options and the time of treatment, therefore, influence recovery or resolution of the injury. Injured workers may have lack of knowledge of their rights or may be manipulated by employers or case managers. Frequently, these issues affect ongoing pain and impairment from the injury, and make decisions regarding surgical intervention unclear. These decisions are often coupled with legal maneuvering and delays. Medication use escalates, and includes drug dependence, abuse and addiction.

Chronic pain is defined as a complex, personal, subjective, unpleasant, sensory and perceptual experience that may or may no be related in any way to an injury, illness or other bodily trauma. Psychosocial, ethno cultural, motivational as well as biological physiological, chemical and other factors influence it. In managing a patient with retractable chronic pain and the inevitable accompanying suffering, which often leads to chronic debilitation, the pain should be viewed as a form of learned goal-directed behavior and the process of itself as a conditioned psychosocioeconomic disorder.

Evaluation & Treatment of Chronic Pain

Pain syndromes with ongoing difficulties should be treated in an integrated health care system capable of dealing with the issues that are persisting.

Paradoxical Pain

Many forms of acute pain are treated with narcotic medications for pain relief. In time, after the acute process, we are led into the world of chronic pain. Persistent chronic pain is frequently associated with ongoing use of narcotic medication and other ancillary medications that one can become dependent on.
Narcotic medications increase the sensitivity to pain. That means that narcotics in themselves increase the perception of pain, both in sensitivity of the area of injury and surrounding areas to touch and pressure, resulting in an increased perception of pain.

The benefits of using narcotic analgesics are that they can reduce pain, improve function and restore people to an optimal functional state. The cons or complications of ongoing narcotic use are the development of dependency/addiction, reduced functioning, persistent pain and paradoxical pain. The side-effects of ongoing use are the development of agitation, restlessness, sleeplessness, anxiety and muscle cramps. Other secondary pain syndromes such as reflex sympathetic dystrophy, chronic regional pain syndrome, chronic myofacial pain syndromes (fibromyalgia, decreased functioning, increased pain and persistent disability or worsening impairment) are all problematic consequences of prescription drug dependency.

Frequently, those of you are referred to a variety of health care providers, of which gives their point of view. Many clinics advocate the use of escalating and varying medications. Others state that psychotherapy may be the solution. Still others say that fewer drugs may be the solution, and others may indicate surgical options and/or interventional care. Many of you go from place to place and get lost continuously in (the problem). The best approach is to enter into an integrative health care system and (get into the solution). The best places for that treatment are where one can go into a system with a fully integrated approach for stabilizing one’s problems.

Managing Pain & Co-Existing Prescription
Drug Dependency Disorders

In the last issue we talked about the effects of pain killers in the form of narcotics, and how these medications can increase pain sensitivity. As a result, narcotic pain killers can lead to paradoxical pain. The concept of paradoxical pain with the use of narcotics over time can lead to the colonization of pain and the resulting dual diagnoses of chronic pain and chemical dependency.

Treatment to alleviate chemical dependency drastically cuts the cost of care (“for every dollar spent on chemical dependency studies show you save between seven and seventeen dollars”). More importantly, treatment allows for healing and stabilization of the injured client so that they can return to a normal lifestyle and a productive meaningful existence.

There are many obstacles to treating this combined problem. There are judgmental issues, as well as different health care issues. Many pain clinics struggle with the problem of addiction, and many chemical dependency treatment centers struggle with treating pain conditions. There are currently systems in place to treat both disorders effectively in a cooperative fashion.

Appropriate use of medication means to take the medicine as prescribed. With dependency (without abuse or addiction) the physiological effects of narcotics can lead to ongoing negative consequences in one’s life (increased pain and decreased function). Side-effects such as sleeplessness, agitation, muscle spasms, persistent pain and escalating pain can occur with the use of narcotics; tolerance develops which indicates dependency. Later, negative consequences of ongoing drug use herald the onset of addiction.

Many clients are predisposed to chronic pain syndromes because of prior history of drug use or abuse, a family history of alcohol or drug use, and/or psychological traumas preceding the injuries. The majority of dependent patients with impaired functioning are predisposed to these issues. Workers’ compensation is responsible for paying for the high cost of medications needed for drug dependency or addiction that result from the injury. They are also responsible for the treatment of chemical dependency prior to one’s claim.

Frequently, providers and/or the patients themselves are referred to a variety of health care providers, each of which gives their point of view. Many clinics advocate the use of escalating and varying medications. Others state that psychotherapy may be the solution. Still others say that fewer drugs may be the solution, and others may indicate surgical options and/or interventional care. Many of you go from place to place and get lost continuously in (the problem). The best approach is to enter into an integrative health care system and (get into the solution). The best places for that treatment are where one can go into a system with a fully integrated approach for stabilizing one’s problems.

Bay Recovery provides rehabilitative services in an integrated health care complex of physicians, physiotherapists, psychologists, rehabilitative care practitioners, including holistic health practitioners, physical therapists, massage therapists, acupuncturists and chiropractic care providers. Bay Recovery also provides residential treatment for the more difficult problems.

By providing an integrated health care program, Bay Recovery Centers can provide stabilization of even the most complex workers’ compensation cases and chronic pain disorders. As a result of such care, patients are treated effectively and stabilized. Therefore, both patients and health care providers reach a satisfactory conclusion that benefits both and eliminates the adversarial nature of treating workers’ compensation clients.

Chronic persistent pain syndromes can be treated effectively to restore an individual to the mainstream of living without the stigma of pain or chemical dependency or addiction.

It is my belief that chronic persistent pain syndromes can be treated effectively to restore an individual to the mainstream of living without the stigma of pain or addiction.