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Yoga, acupuncture may help workers avoid opioids

But few comp payers cover alternative therapies

Yoga, acupuncture may help workers avoid opioids

Workers compensation payers have resisted covering complementary and alternative medicine, but such treatments can lessen injured workers' pain and improve their function while decreasing the use of powerful opioids.

Therapies such as dietary supplements, chiropractic treatment, acupuncture and yoga, either alone or in conjunction with painkillers, were used by about one-third of U.S. adults in 2012, according to the Department of Health and Human Services. Sources said that number has likely increased since 2012, but state workers comp systems differ on whether to pay for such treatments.

“There's a small but significant percentage of injured workers that are interested in complementary and alternative treatment,” said Dr. Robert Goldberg, San Francisco-based chief medical officer at Healthesystems, a medical cost management firm and pharmacy benefit manager.

Dietary supplements, deep-breathing exercises and yoga/tai chi/qi gong were the top three complementary approaches used in 2012, according to the latest HHS data available.

“In California, it's probably more commonly sought or requested than in other states,” Dr. Goldberg said. “People in California are generally more inclined to look for nontraditional complementary nonpharmacologic treatment.”

Other states would be more likely to cover certain complementary and alternative treatments if more studies proving their efficacy were available rather than just anecdotal evidence, sources said.

Unlike California, acupuncture isn't covered under comp in Washington state, said Dr. Gary Franklin, medical director of the Washington State Department of Labor and Industries, the state's monopoly workers comp insurer.

“We're looking at the evidence right now,” he said. We are open to reconsidering it based on good evidence.”

“If workers comp insurers want doctors to use less opioids, they're going to have to cover alternatives to opioids that are effective,” Dr. Franklin said.

Chiropractic treatment is one “highly mainstream” alternative the state does allow, and injured workers who see a chiropractor at the beginning of a case are less likely to go on long-term disability, he said.

“For the most part, chiropractors are responsible, and they don't prescribe opioids,” Dr. Franklin said. “They have been extremely effective.”

Given that cognitive behavioral therapy, which most states now cover, once was considered an alternative treatment, it's clear the industry is open to new therapies.

Medical technology company NeuroMetrix Inc. is counting on that. Its Quell device, approved by the U.S. Food and Drug Administration, is worn on the upper calf and emits vibrations that stimulate the wearer's nerves to decrease the perception of pain, said Dr. Shai Gozani, CEO of the Waltham, Massachusetts-based firm.

The device, available since June, with an upgraded model put out March 1, has yet to make its way into the workers comp industry, but “we're starting to get interest from insurers and self-insured employers,” Dr. Gozani said.

“Every now and then, we'll get some things that are approved that are not supported,” such as aromatherapy, said Dr. Joel E. Mata, San Diego-based medical director of third-party administrator and managed care services provider CorVel Corp. “So long as the person can demonstrate an increased ability to function objectively, then it seems fair that the person should continue to have authorization for continual treatment, up to a reasonable amount.”

Dr. Mata said activity-based treatments such as yoga are more likely to be covered under comp since occupational health guidelines tend to support active treatments over passive treatments, such as massage therapy, that provide only temporary relief.

Despite evidence that yoga is a successful pain management tool for some, not all workers comp professionals see the value in covering it, said Mark Pew, senior vice president at Duluth, Georgia-based medical management company Prium.

In addition, “a gym membership isn't a bad investment,” since it gets an injured worker moving and encourages socialization, which “is a key point they lose when they don't go to work everyday,” Mr. Pew said.

Massage therapy might still be beneficial periodically if it helps loosen tight muscles, Mr. Pew said, but payers could argue that “rigorous stretching exercises or a more active lifestyle might do the same thing.”

If alternative treatments increase function and quality of life, decrease prescription drug reliance and help someone to achieve “true management of pain, not sedation ... whatever the modality is, whatever works, that's what we should pay for,” Mr. Pew said.

“What that means is that (workers comp payers) might need to experiment with different things,” he added.