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Measuring opioid effectiveness requires more than scale of 1 to 10: Doctor

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LAS VEGAS — The impact of opioids should be measured regularly, but it's not sufficient to ask injured workers to subjectively evaluate their pain and functional improvement, Dr. Kurt Hegmann said at this week's Disability Management Employer Coalition's conference in Las Vegas.

During a session Tuesday titled “Opioids: A Big Buzzkill in Workers' Comp and Disability,” Dr. Hegmann, director of the Rocky Mountain Center for Occupational and Environmental Health at the University of Utah in Salt Lake City, said it's been more than 20 years since he asked a patient to rate his or her pain on a scale of 1 to 10.

Because of the negative impact opioids can have on injured workers, and the fact that such drugs do little — if anything — to improve function, comprehensive history and physical examinations and regular monitoring are important, Dr. Hegmann said.

However, subjective questionnaires and “pain rating scales are not the way to go,” Dr. Hegmann said. “The way to go with patients is (to ask), 'How's it going?' 'What are you able to do?'” and other quantifiable, function-based questions.

Functions that can be measured, such as grip strength, walking distance and aerobic capacity, can help determine the impact of opioids, he said, adding that if functional benefits aren't apparent, opioids should be discontinued.

Use should also be discontinued if there's no resolution of pain, signs of noncompliance, aberrant drug screening results, or use of sedating medications like benzodiazepines or alcohol, Dr. Hegmann said, calling opioid use “the greatest epidemic of our lifetime.”