Treat pain, don't manage it for best outcomes, physician advises

Medication is not the best answer to treating injured workers with soft tissue injuries, according to a member of the American Board of Pain Medicine. A holistic system to treat the claimant can help the patient be pain free, get him back to work earlier, and save upward of $100,000 per injured worker.

"I believe emphatically by following a strict systematic approach every injured worker who has asoft tissue injury can return to work without having to have surgery or use narcotics," said Dr. Pattanam Srinivasan.

The secret, he says, is pain treatment, not pain management. "When a worker gets injured multiple things get injured. Soft tissue gets inflamed," he said. "In order for the worker to get complete relief of pain and to have normal functioning, all the areas inflamed need to be treated."

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As the clinical director for the Indiana-based Advanced Interventional Pain Center, Srinivasan believes many physicians focus only on specific areas of the patient in pain and consequently only treat one area. "There's incomplete treatment with workers being referred to one specialist or another," he said. "Each one treats one area. There's no comprehensive treatment of all areas with the pain."

The interventional pain treatment system he uses begins with a 15-20 minute head-to-toe exam to determine all the sources of pain. "Is it the muscle? Is it the nerve? Is it the bone? Is it the joint?" he asks. "Then we have a treatment plan for him."

Each inflamed area is injected with a small dose of medication. After two or three treatments, he says the pain is gone and he moves on to the next area of pain. "It's all within a period of six to eight weeks and the patient is completely pain free. This is the principle behind this treatment."

The treatment works best if the injured worker avoids smoking since the medications injected clear the inflammation and open up the small blood vessels in the area being treated. "The opened up blood vessels shut down if the injured worker continues to smoke preventing long-term pain relief," he said. "So smoking cessation is a key requirement of our treatments."

Srinivasan says the system works because it addresses and alleviates all the sources of pain. In a typical workers' comp situation, an employee with a herniated disc would undergo surgery which would relieve the pain only in that area. "Once the anesthesia wears off, the pain comes back," he explained. "Invariably, they get some narcotics after the surgery. The whole picture gets kind of confused as to what is causing the relief at that point: the surgery, the anesthesia or the narcotics meds."

Identifying the areas of pain and resolving them without surgery or narcotics can reap tremendous savings for the workers' comp system, he said. An injured worker with back pain might undergo $130,000 in surgery plus another $30,000 of physical therapy and still be in pain.

"If they come to my pain center for treatment, it's three or four sessions and costs $9,000 or less," he said. "So that's a big difference."

Read more at the WorkersComp Forum homepage.

November 1, 2010

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