Chronic Pain Management in Workers Compensation Claims

 

A Physical Injury at Work Often Results in a Chronic Pain Condition that Affects Both Your Body and Mind. Find Out How to Treat and Manage Your Chronic Pain through Workers Compensation.

 

Chronic pain is a major problem for injured workers.

 

It is also a difficult one to solve.

 

Managing chronic pain is challenging in the best of circumstances. When you add the stress and uncertainty that comes with filing a workers compensation claim, managing your pain may seem like an impossible task.

 

But help is here.

 

The purpose of this article is to help you and other injured workers understand and deal with chronic pain from a work injury. And, if possible, help you avoid or eliminate chronic pain altogether by showing you how to get the medical treatment you need from your employer and its workers compensation insurance carrier.

 

If you have any questions about chronic pain and workers comp, or are looking for a top-rated workers comp attorney to help you get the medical care and money you deserve, call me: 804-251-1620 or 757-810-5614. Come see why other attorneys and past clients have voted me one of the Best Lawyers in America for workers comp. And how I can help you get the benefits you are owed or negotiate a fair workers compensation settlement.

 

What is Pain?

 

Merriam-Webster’s Dictionary defines pain as:

 

  • a localized or generalized unpleasant bodily sensation or complex of sensations that causes mild to severe physical discomfort and emotional distress and typically results from bodily disorder (such as injury or disease)

 

  • a basic bodily sensation that is induced by a noxious stimulus, is received by naked nerve endings, is associated with actual or potential tissue damage, is characterized by physical discomfort (such as pricking, throbbing, or aching), and typically leads to evasive action

 

  • mental or emotional distress or suffering 

 

Whatever the exact definition, medical experts in the pain management field recognize that pain is not just a physical experience. It is also an emotional one. And unless you treat both the physical and mental causes of pain, you are at risk of suffering from chronic pain after a work injury.

 

What is Chronic Pain?

 

I use the term “chronic pain” throughout this article.

 

Chronic pain is defined as: Pain that has continued on a daily or weekly basis for a period of one month or longer after your work injury or surgery for the work injury. And that interferes with your daily life activities, ability to work, and quality of life.

 

Symptoms of chronic pain syndrome from a work injury include: burning pain; throbbing pain; swelling; stiffness; skin discoloration; and, sensitivity to hot and cold temperatures.

 

Unlike acute pain, which can alert you to situations where your body is in danger, chronic pain serves no purpose. You do not need continuing pain to let you know that you are hurt.

 

Many of my clients experience pain on a daily basis because of their work injuries. This chronic pain often causes additional stress, depression, anxiety, and fear, which worsen the pain further.

 

How Do You Deal with Chronic Pain from a Work Injury?

 

Having represented hundreds of injured workers in Virginia who have suffered or continue to suffer from chronic pain after a work-related accident, I am familiar with the treatment options for chronic pain offered by health care providers. And how to get pain management and treatment approved through workers comp.

 

Your workers comp doctor may recommend the following pain management options:

 

Medications for Chronic Pain

 

1. Non Steroidal Anti Inflammatory Drugs (NSAIDs) and Acetaminophen. This category of medications includes Tylenol, Ibuprofen, Aspirin, Naproxen, and Celebrex. They work by reducing inflammation (swelling) and relieving pain from muscle aches and stiffness. Some of these medications are available over the counter. Others requires a prescription from a doctor. Using NSAIDs for a long period or in high doses is not without risk. Doing so increases the potential risk of heart attack, stroke, and bleeding stomach ulcers.

 

2. Topical Pain Relievers. You may use ointments, creams, lotions, sprays, and patches to treat your chronic pain. Many of these medications are applied to the skin directly, right on top of the painful area. Others, such as Fentanyl patches, may be placed elsewhere on the body and still work. As with NSAIDs, some topical pain relievers are available over the counter, while others require a prescription.

 

3. Muscle Relaxants. You may experience muscle spasms after your work injury. Sometimes these muscle spasms can be seen on diagnostic testing. To treat your muscle spasms, doctors may prescribe muscle relaxants such as Robaxin, Flexeril, Soma, or Baclofen.

 

4. Opiods (Narcotics). These painkillers are available by prescription only. Common opioid drugs include: Codeine; Fentanyl; Hydrocodone; Hydrocodone/Acetaminophen (Lorcet, Lortab, Vicodin, Norco); Methadone; Meperidine (Demerol); and, Hydromorphone (Dilaudid). Opioid pain medications account for a large percentage of workers compensation drug claim costs each year. And studies have linked them to side effects such as drowsiness, nausea, and constipation, addiction, and even overdose causing death. If your doctor prescribes an opioid or narcotic and you are hesitant to take it because of fear of dependence on the drug, ask your attorney to seek a second opinion in your workers comp case.

 

5. Anti-Depressants. Studies show that anti-depressants such as Amitriptyline, Bupropion, Duloxetine, and Sertraline can help with neuropathic pain.

 

6. Anti-Seizure Medications. Anti-seizure drugs, also known as anticonvulsants, may help with shooting or burning nerve pain. Common anti-seizure medications prescribed for injured workers with neuropathic pain include Neurontin and Lyrica.

 

Physical Therapy

 

Almost all of you will undergo physical therapy for your work injury.

 

Physical therapy uses exercises, joint mobilization, stretching, electrotherapy, and shockwave modalities to treat chronic pain, cartilage damage, arthritis and degenerative disc disease aggravated by a work injury, and soft tissue injuries.

 

Physical therapy can increase your flexibility, helping you avoid re-injury on the job.

 

Transcutaneous Electrical Nerve Stimulation Therapy (TENS Unit)

 

A TENS unit uses electrical stimulation to reduce pain.

 

TENS units work by delivering electrical impulses through electrodes that are attached to pads placed on your skin.

 

You put the pads on the areas of your body that hurt and turn the machine on.

 

Chiropractic Treatment and Massage

 

Chiropractic treatment is often recommended for neck and back pain when you are not a surgical candidate for your work injury.

 

It involves manual manipulations of your underlying bones and vertebrae, along with massage of your soft tissues to reduce stress and tension by increasing blood flow.

 

Trigger Point Injections

 

Trigger point injections are used to treat areas of muscle that continue to spasm and do not relax after a work injury. Muscle spasms are often painful and uncomfortable.

 

When you undergo trigger point injections, the health care provider will inject a local anesthetic into a trigger point in your muscle tissue. This often provides a limited period of relief.

 

Trigger point injections are often used to treat muscle injuries, such as lumbar strains. They are also used to treat headaches from a head injury, neck injury, whiplash, or post concussion syndrome.

 

Epidural Steroid Injections (ESIs)

 

If you suffer a joint injury, such as knee injury, torn ACL, hip injury, ankle injury, or rotator cuff tear, or a back injury, your doctor may recommend that you undergo an epidural steroid injection. This is a common treatment for chronic pain from spinal cord injuries resulting in a herniated disc or spinal stenosis.

 

An epidural steroid injection involves injecting an anti-inflammatory into the area surrounding your pain. The goal is to relieve pain and reduce swelling of the irritated nerve.

 

You cannot receive steroid injections indefinitely. Often your doctor will provide no more than three injections per year.

 

Facet Joint Injections

 

Those of you experiencing chronic pain from a work-related back or neck injury may undergo a lumbar facet joint block.

 

These injections into the small joints located along the side of each of your vertebrae can decrease pain and increase range of motion of the neck, back, legs, and arms.

 

Facet joint injections are performed using an x-ray for guidance.

 

Lumbar Sympathetic Nerve Blocks

 

You may undergo a lumbar sympathetic nerve block if you are experiencing pain radiating from your lower back to leg and foot. Usually this treatment is rendered after you are diagnosed with chronic regional pain syndrome/reflex sympathetic dystrophy.

 

The doctor will use an x-ray to inject numbing medication near the part of your spine where the ganglion is located.

 

Stellate Ganglion Blocks

 

Doctors often use stellate ganglion blocks to confirm a diagnosis of chronic regional pain syndrome of the arm or hand.

 

Spinal Cord Stimulators and Intrathecal Drug Delivery Systems

 

If physical therapy and prescription medication do not relieve your chronic pain, but you are not a surgical candidate, you may be a candidate for a spinal cord stimulation implant or .intrathecal drug delivery implant.

 

A spinal cord stimulator consists of a medical device that uses low-level electrical signals to block pain signals from reaching the brain. The spinal cord stimulator device is surgically placed in your body and sends an electric current to your spinal cord. When the device is turned on, it stimulates the nerves in the area where you feel pain. You have a remote control that you can use to adjust the amount of medication you receive at any one time. Your pain is reduced because this electrical stimulation changes and masks the pain signals in your body.

 

Spinal cord stimulators require maintenance throughout your life. This is expensive and increases the settlement value of your claim.

 

Usually I see spinal cord stimulators recommended for clients who have been diagnosed with chronic regional pain syndrome or who have suffered crush injuries or undergone multiple unsuccessful back surgeries, including a spinal fusion surgery,

 

I recommend obtaining a second opinion before undergoing implantation of a spinal cord stimulator. Complications are common because of the hardware in your body.

 

Similarly, an intrathecal drug delivery system – also called an infusion pain pump or spinal drug delivery system – may be used to receive morphine or a muscle relaxant directly to your spinal cord at dosages that are a fraction of those required with pills.

 

Cognitive Behavioral Therapy (CBT)

 

Some pain management experts believe that all injured workers experiencing chronic pain would benefit from psychological intervention.

 

This may not mean long-term treatment with a psychologist or psychiatrist. Rather, it may mean a few sessions where you learn skills to cope with chronic pain.

 

Many mental health programs to help injured workers deal with chronic pain are based on cognitive behavioral therapy (CBT). CBT is a short-term psychotherapy treatment that provides you with the information and skills necessary to take control of your pain management treatment. Its purpose is to change your patterns of thinking so that you are not focused on your chronic pain.

 

Psychological Treatment

 

If your chronic pain causes feelings of anger, hopelessness, or sadness that affect your energy levels, motivation, and relationships with others, you may need psychological treatment.

 

Psychological treatment for chronic pain from a work injury includes not only the cognitive behavioral therapy explained above, but also individual psychotherapy and group therapy. It may include prescription medication, including antidepressants and anti-anxiety medication.

 

Medical Marijuana

 

Many medical providers are hesitant to to recommend medical marijuana for chronic pain from a work injury because though it is legal in many states, marijuana is still illegal and considered a Schedule I drug under federal law.

 

That being said, some injured workers experiencing chronic pain report relief from the use of cannabidiol (CBD), an extract found in the hemp plant. Various studies have found that CBD helps with insomnia, anxiety, and chronic pain.

 

Acupuncture

 

Acupuncture is a type of alternative medicine in which needles are inserted into your body. It is thought to increase the release of endorphins, which are chemicals that block pain signals within your central nervous system.

 

Workers compensation covers palliative care, which is medical treatment that improves your symptoms temporarily but not permanently. You can, therefore, receive acupuncture treatment through workers comp.

 

Why Do Patients Treating Through Workers Comp Have Worse Outcomes than Patients Treating for the Same Problem Who are Not Involved in Workers Comp?

 

Studies have shown that patients receiving medical treatment through workers compensation have poorer outcomes than patients receiving treatment in a non-litigation environment.

 

Many doctors are aware of these studies. Several surgeons, relying on these studies, have refused to perform a reasonable, necessary, and causally related surgery on my clients until after the parties negotiated a workers compensation settlement. Instead they referred my clients to surgeons who would operate even though the patient was involved in work comp litigation.

 

But why do workers comp patients have worse outcomes than other patients?

 

Employers, workers compensation insurance companies, and third party claims administrators (TPAs) argue that injured employees report greater pain because doing so may result in additional financial compensation. In other words, many employers and insurers think that injured workers report pain only for financial gain and that employees are committing a form of workers comp fraud.

 

But that is a simplistic – and self-serving – view. In my experience the actions of the employer and insurer, along with certain procedural aspects of the workers compensation system, explain why so many work injuries result in chronic pain. Workers comp insurers often drag out medical care, frustrating both injured employees and doctors who treat injured workers.

 

For example:

 

  • Many insurance companies will not pay for medical treatment until after they conduct an initial investigation of the workplace accident. This can take anywhere from a few days to several months. Unless you have private health insurance, you may not receive medical care for your work injury until the investigation is completed. This delay in treatment increases your risk of suffering chronic pain.

 

 

  • If your claim is accepted or you win at hearing, and the Commission enters an Award Order, you may still experience delays in getting the medical treatment you need. Often insurance carriers require extensive documentation anytime a new treatment is recommended, even if your authorized treating doctor whom you chose from the offered panel of physicians makes the request. This documentation is then reviewed by internal nurse case managers or doctors before the treatment is approved. At best, the insurer approves the treatment, in which case your recovery has been slowed down by several weeks increasing the chance of chronic pain. At worst, the insurer will issue a medical treatment denial stating that the recommended pain management treatment is not reasonable and necessary. This will require additional litigation where you must meet your burden of proof, and prolong your recovery even longer. This process may be repeated many times while you are trying to recover from your work injury.

 

  • Even if the insurer knows it should pay for medical treatment recommended for your work injury, it may delay approval, hoping you give up. This way it can save money.

 

  • Insurance carriers often try to take advantage of any optimism you show at medical appointments. If you tell the doctor you are feeling “ok” or “normal,” the claims adjuster or defense counsel may try to pressure your doctor into releasing you back to work before you are ready. Rather than realizing that “ok” or “normal” for you is a day filled with pain, the insurer will argue that “normal” means no pain at all. So as an injured worker, you must report each and every symptom to your health care providers. Or you risk losing out on on many types of workers comp benefits, such as temporary total disability, temporary partial disability, and permanent partial disability payments.

 

  • A work injury often causes psychological stress, which worsens pain. There are many reasons for this. Not only the pain itself, but also a loss of identity when you stop working, financial stress, and a decrease in your physical or mental abilities can cause increased psychological stress. This makes it more difficult to recover from your injury. If you are experiencing increased stress from your pain, workers comp may pay for treatment for depression and PTSD.

 

  • Both the work injury and the litigation process can make you feel hopeless. When you have a workers compensation claim, you lose some control over your life. People that are strangers – claims adjusters, defense attorneys, vocational rehabilitation counselors, health care providers, and IME doctors – are making decisions that affect your health and finances. And the employer may stop your benefits at any moment for a reason you find baseless. This loss of control can make it difficult to recover from work injury – physically and psychologically.

 

With all the hurdles put in front of injured workers trying to receive adequate medical treatment for chronic pain, it is no surprise that outcomes are worse.

 

An Experienced Attorney to Help You Navigate the Workers Comp Medical Maze and Get Treatment for Chronic Pain

 

If your medical providers recommend a form of medical care and treatment to decrease your pain from a work injury or surgery, your employer and its insurance company should pay for it.

 

But because pain management is expensive, the insurer may deny treatment recommended for your chronic pain, forcing you into litigation. Often, insurers argue that recommended treatment is duplicative or palliative, and should be denied.

 

You do not have to accept the insurers decision. And should fight back.

 

That is where I come in. Voted one of the best lawyers for Virginia workers compensation, my goal is to find the best doctors for you so that you can reduce – or eliminate – chronic pain from your work injury. And then to help you obtain the best possible financial recovery, which may include not only your work comp claim but also a Social Security Disability or third party claim based on negligence and tort law.

 

Call now for a free consult: 804-251-1620 or 757-810-5614. Let’s put together a pain management team to help you deal with your chronic pain issues after a work injury.

Corey Pollard
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