Chronic Pain : Monitoring of Injured Workers on Pain Meds Inadequate

John Fauber

Nearly 1 in 12 injured workers who were prescribed narcotic painkillers still were on the drugs three to six months later, according to a new report on worker's compensation claims.

The report also found that drug testing and psychological evaluation, two measures designed to reduce abuse of the drugs, were not being done most of the time.

The study, which looked at 300,000 worker's compensation claims in 21 states, including Wisconsin, highlights how doctors often don't follow treatment recommendations for long-term monitoring of injured workers who receive opioid pain medications.

It comes at a time when doctors and regulators are reassessing the use of narcotic painkillers as a long-term treatment for chronic pain.

"These results ring true for me," said Mark Sullivan, a professor of psychiatry and behavioral sciences at the University of Washington in Seattle.

He said implementation of the recommendations for opioid therapy among primary care doctors is very spotty.

Sullivan, who was not involved in the study, said it is difficult to implement drug testing and psychological evaluation safeguards in a busy primary care practice unless doctors are given support from their clinics.

The study also highlights a serious problem with long-term use of opioids to treat chronic pain, said Andrew Kolodny, a New York psychiatrist and addiction specialist who was not involved in the study. Often, the drugs don't help in improving pain or day-to-day function long-term, yet patients stay on the drugs.

"There are workers who get these pills and go home and spend the whole day on the sofa," said Kolodny, president of Physicians for Responsible Opioid Prescribing. "Most addiction experts would call that addiction."

The report, which was done by the Workers Compensation Research Institute, also looked at 1.1 million prescriptions filled through March 31, 2011. The claims involved work injuries that did not include surgery.

The study addresses the serious issue of how often doctors follow treatment recommendations for monitoring workers who are put on long-term opioid therapy, Richard Victor, executive director of the institute, said in a statement. It should help public officials, employers and others understand how to help workers while reducing costs and avoiding risks to patients, he said.

Wisconsin fared better than most of the 21 states in the report. About 4% of injured workers were identified as long-term users of opioids, compared with a median of 7%. However, the percentage of long-term opioid users in Wisconsin increased from 3% to 4% from 2009 to 2011.

Among the report's other findings, nationally:

Only about 24% (up from 14%) of workers who were on narcotic painkillers long-term got at least one drug test. Drug tests are done to monitor use of narcotics in hopes of preventing misuse of the medications.

Only 4% to 7% of injured workers who received the drugs long-term also got psychological evaluation, which can help reduce narcotic use and screen out people who would not be good candidates for opioid therapy because of past substance abuse or psychological problems.

"It (psychological evaluation) continues to be abysmal and is, in fact, slipping," said Michael Gavin, of Prium Medical Cost Management Services in Duluth, Ga.

Gavin also noted that the report did not measure another important issue -- how much opioids improve the long-term function of injured workers.

Too often workers say their pain is improved, but they show no improvement in performing the activities of daily living or returning to work. Conversely, they may say they aren't improved enough to return to work or perform other activities, yet they able to get out of the house and drive to a doctor's appointment to get a new prescription, he said.

"A lot of times we see opioid script after opioid script after opioid script without function improvement," he said. "We want people getting better. If opioids aren't providing functional improvement, then they are providing more harm than good."

(c)2012 the Milwaukee Journal Sentinel

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