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Editorial: Results mixed on opioid alternatives


Finding effective, safe therapies to treat pain and help injured workers return to work remains a major concern for the workers compensation sector.

While advances are being made, there are still limited alternatives to opioids, which were prescribed widely starting in the 1990s, but over the past 10 years were used far less frequently as problems with addiction and dependency were recognized. 

In workers comp, the drugs were a scourge for many injured workers, sedating their bodily systems and impairing their cognition for prolonged periods, preventing them from returning to work. 

As we report here, though, various studies show that opioid scripts in comp have fallen dramatically over the past five years and more, and the notoriety of the drugs, not to mention the multibillion-dollar liability settlements, will likely mean that their use will decrease further.

But like many other substances or materials that were once used widely but are now banned or restricted — the fire-resistant properties of asbestos, for example, made it an extremely useful material in construction and other industries before its lethal toxicity became apparent — the benefits of opioids are real.

One of the reasons why their use became so widespread was because they were very good at what was said on the packet — they relieved pain. And, so far, other options are limited, as chronic pain continues to be an issue in treating injured workers.

Other drugs that are now being used to treat pain come with their own side effects and risks, which is why physicians and pain relief experts are looking to alternatives that do not involve medication.

The results, though, are mixed. For example, in a recent study published by the Journal of the American Medical Association that compared treatment of lower back pain in veterans treated with medication and those treated with cognitive behavioral therapy sessions, the drugs won. The CBT treatment was still determined to be effective in reducing pain but not as effective as the medication.

The study’s authors concluded both pharmacological and behavioral approaches were reasonable options for chronic pain.

While the study had a relatively narrow scope, it illustrates difficulties involved in managing pain — popping a pill is a quick and easy way to get relief, but slower, ostensibly less-effective therapies might be the wisest choice in the long run, especially if they get patients healthy and back to work quicker.

Workers comp insurers and physicians have already made progress moving toward a more nuanced and laborious approach to pain management, but there remains some way to go. Pharmaceuticals, including some powerful drugs, clearly still have a vital role to play, but other treatments such as CBT, physical therapy and massage therapy are being tried and tested. Methodical, clear-eyed analysis of all the options is critical for the industry to avoid another rush to an easy but fatally flawed approach to managing pain.