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Medical providers in the workers compensation sector have successfully reduced their reliance on opioids to help injured workers manage their pain, and some are experimenting with technologies such as virtual reality as an alternative to medication.
The U.S. Food and Drug Administration approved the first virtual reality device for treating chronic pain in 2020, but many barriers remain to the widespread use of such technologies in the comp sector, experts say.
At least a half dozen studies have been released in the past year evaluating the medical use of virtual reality. Among the topics addressed is the use of headsets and video games to treat such issues as combat-related post-traumatic stress disorder, mood disorders and anxiety.
In 2020, CorVel Corp. began using virtual reality to treat a handful of patients with chronic pain, combining technology from Las Vegas-based Harvard MedTech LLC, which produces VR tech for in-home use, with weekly goal setting and coaching calls.
Historically, treating chronic pain patients has been approached pharmacologically, said Karen Thomas, Washington-based director of case management innovation at CorVel.
“It’s ‘take a pill, have a procedure’ — our customers and even injured workers themselves are really hungry for alternative treatments and therapies,” she said. “The acceptance of these types of alternative treatments is growing. Customers (are) embracing a bio-psycho-social model to health care critical to getting their injured workers recovered more quickly.”
The technology, which is essentially a headset delivered to injured workers’ homes, enables them to immerse themselves in a virtual reality to provide a meditative or escapist experience that helps to “transform the way in which pain and symptoms of trauma are alleviated,” said Pat McCutcheon, chief sales officer at Harvard MedTech. “Think of it as rewiring the brain.”
“The goal setting begins day one, which is really critical with our … injured worker population,” Ms. Thomas said. “It puts the onus of care and recovery on the lap of that injured worker. They’re owning their recovery.”
The Montgomery County Self-Insurance Program, a member-based program in Virginia that handles workers compensation for county employees including police, firefighters, paramedics, teachers and maintenance workers, recently tried using VR with a group of workers to manage their chronic pain, according to Pearl Monroe, Fairfax, Virginia-based vice president of MC Innovations LLC, a managed care consulting group and program manager of the self-insurance program.
“We were dealing with the fallout from the opiate crisis and trying to find other alternatives than using the very basic, more traditional type of care,” she said.
The self-insurer identified about 10 injured workers who had been using medications for years to treat their chronic pain — many taking high doses of morphine medical equivalents — as potential candidates for VR, Ms. Monroe said.
While some had anxiety about changing their routine of pain medication, the VR allowed them to be engaged in the process of managing their pain vs. having someone direct them to take a prescription “or god forbid have surgery again,” she said. “The idea here is they’re part of the solution, they can see their progress, they can see their results.”
And with the expense of opioids, Ms. Monroe said medical costs for workers who used the VR or a combination of reduced prescriptions with the therapy dropped “anywhere from $1,200 to $1,400 a month.” Since there is no fee schedule, the VR is billed via a direct fee arrangement.
While the workers comp industry is interested in using such technology, it has not fully embraced it because currently there is no defined way to bill for the services, said Dr. Teresa Bartlett, senior medical officer at Sedgwick Claims Management Services Inc.
“There is no billing code so it requires going off the grid to pay for this technology,” she said.
Another issue is the lack of solid data to back the treatment, said Dorothy Riviere, Overland Park, Kansas-based chief clinical officer at Bardavon Health Innovations LLC, which analyzes workers compensation treatment data to improve clinical outcomes.
“If you think about VR, I do think there is a great opportunity there,” she said. “With 100 million people having chronic pain each year, new ideas are always a good alternative.”
However, more data of its use in the workers comp sector is needed to “understand the impact of VR not just on pain, but also on the ability of that intervention to improve a person’s function” and the ability to return to the workplace, Ms. Riviere said.
Payers also want to clearly see the value in the treatment, and it’s also challenging for health care providers to use such innovative treatments on injured workers if they’re not assured of payment, she said.
“As technology continues to advance rapidly, if the cost continues to come down, and it’s being used more widely in the commercial health space … then I think you’re going to see more adoption potential,” Ms. Riviere said.
With health care professionals suffering from post-traumatic stress disorder from being on the front lines of the COVID-19 pandemic, virtual reality is also being tested as a potential treatment.
“VR types of gaming technology are being used a lot more in rehabilitation settings and in the treatment of things like phobias and PTSD,” said Dan LeGoff, clinical advisor at St. Petersburg, Florida-based workers compensation behavioral health provider Ascellus Health Inc.
In PTSD, treatment involves keeping the individual relaxed while being exposed to stimuli, Mr. LeGoff said. For instance, if someone is injured in a fire and subsequently has anxiety about being near fire, VR can expose that person to the experience while in a safe environment, such as their home or office, he said.
The Montgomery County Self-Insurance Program is looking at using VR to treat the anxiety and stress of workers, including treatment of concussions, said Pearl Monroe, Fairfax, Virginia-based director and program manager for the self insurer.
“Definitely that’s an avenue we are going to be working on,” she said. “When you’re dealing with a concussion, for example, there’s always an anxiety or sort of stress level that is tied to that. We see that (VR) can complement that treatment.”
Ascellus is also using VR-type technology to help doctors and nurses dealing with COVID-19 brain fog. “They have a hard time going back to work if they don’t feel sharp; they worry about making mistakes,” Mr. LeGoff said. “For those people, we really want to make sure we give them close scrutiny.”
The VR-type games played by the workers provide feedback that determines their fitness for duty and tracks their progress and outcomes, he said.