As the workers compensation industry steps away from opioid prescribing for pain management, it is counting on a menu of alternative therapies to help injured workers grappling with chronic pain that require the patient to do much more than take a pill.

Many of the therapies, including physical therapy, chiropractic care, yoga and moderate exercise, can be beneficial for patients, but often come with a side effect of temporary pain as the patient gets accustomed to movement. Other mindful therapies, such as cognitive behavioral therapy and meditation, can be met with skepticism if the injured worker has never heard of them being used to manage pain, according to experts.

And then there’s the issue of immediate relief, a hallmark of pain medications and lacking in alternative therapies that promise relief over time, according to Jean Brajuha, vice president of operations for Owings Mills, Maryland-based Restore Rehabilitation, which provides nurse case managers for injured workers navigating the road to recovery.

“People want immediate relief and they have been used to pain products to treat; they want that instant gratification,” she said, adding that it’s common for an injured worker to skip a scheduled physical therapy session if they deemed the last one too painful.

The patient compliance problem is worse for older claims, according to Beth Wood, Kansas City, Missouri-based vice president and senior claims costs control consultant for Lockton Cos.

“If you are looking at alternative therapies and you are dealing with a person whose perception is that the (workers comp) system has failed them, they tend to not be motivated,” she said.

Legal issues also pose challenges, said Darrell Brown, Long Beach, Californiabased chief claims officer and executive vice president for Sedgwick Claims Management Services Inc. “If you have an injured worker who has an attorney, there are limits to what you can do,” he said. “We would have to work with the attorney and the physician (to urge the workers to try alternative therapies.)”

The treating physician who doesn’t buy into alternatives and won’t suggest them to a patient is another roadblock, according to Jeffrey White, Towson, Maryland-based senior vice president and product manager of workers compensation for Gallagher Bassett Services Inc.

“I think one of the most challenging things is the limited ability to impact provider practices,” he said. “I think what’s exciting about today is there’s more research that’s coming out on using cognitive behavioral therapy to reshape the mind (when dealing with pain). But how do you get a physician with misaligned incentives, related to dispensing (drugs), to help?” 

Ultimately, experts say, the answer is in the advocacy approach: working with patients one-on-one through the recovery process and motivating the injured worker to get better.

“We have to explain all the benefits,” said Mr. Brown.

“The best approach is when there is a partnership between the injured worker, the employer and the physician,” he said.

“The reality is at some point… we have given them advanced notice that we can no longer authorize (medicine). (We spend) a lot more time on this especially since the opioid crisis. We have other resources and we have to say, ‘we would really like to try this… if that doesn’t work, let’s brainstorm something that might work.’”

The injured worker is the “wild card,” he added.

“This is the root of the issue; there is not a lot you can do if the individual doesn’t want to help themselves,” said Mr. White.

“You have to develop trust and have conversations,” said Ms. Wood, adding that the employer can also help motivate the injured worker. “When it comes to alternative therapies and motivating the worker, the relationship between the employee and the employer is paramount. Our model builds rapport with the employee, and when you have that going on, the employee is motivated for recovery and discussing alternative treatments.”

After motivation, there’s coaching, according to Ms. Brajuha, whose company stresses the importance of follow-up phone calls to a worker who went to physical therapy, for example, or a check-in call to a person who missed an appointment. Under the company’s business model, nurse care managers are notified if an appointment is missed, she said.

“We might be talking to them two times a week or more,” she said. “They worry they are going to get further hurt or that something doesn’t feel the way they think it should because they just don’t know. A lot of it comes down to constant communication and support.”

The key is regular communication, said Ms. Wood.

“It’s a simple, careful conversation about the fact that what that physical therapist is going to ask that injured worker to do may hurt, but it isn’t designed to be harmful,” she said. “That’s true with any modality and you have to say, ‘this may hurt, but it is not designed to be harmful.’”