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By MATTHEW BRODSKY, senior editor/Web editor of Risk & InsuranceŽ

Perhaps as much as 30 percent of the U.S. population suffers from chronic pain of one sort or another. One in eight workers loses five hours of productive time per week because of his or her pain. In the 2001-2002 period, employers lost as much as $61.2 billion because of this reduced productivity and lost workdays due to pain.

Surely the schedule of Dr. David Deitz, vice president and national medical director at Liberty Mutual, has been made far more hectic due to all of the talks and webinars he's given on chronic pain, such as the one he gave Thursday morning at the 19th Annual National Workers' Compensation and Disability ConferenceŽ & Expo in Las Vegas.

There, he was preaching to the choir about: how opioids are not very recommended for dealing with most pains an injured worker would feel, though they are widely, and ever more so, prescribed; how an association is apparent between opioid use and poor claims outcomes; how spinal fusions are performed in many cases for pain cases; and the "enormous and unrelenting" cost growth for workers' comp payers despite their questionable efficacy.

Often when the topic of chronic pain comes up, listeners are left with more questions than answers. Yet Deitz did his best to provide possible solutions to the problem, instead of just framing its frightening enormity.

Tops here were perhaps his description of what employers and workers' comp claims payers should seek in a quality pain management program. Liberty Mutual expends a lot of energy finding such programs. As such, Deitz wasn't able to specifically name any of these top programs that the insurer works with. But employers desperate for answers will appreciate what info he could provide.

According to Deitz, the components of a successful program include: full-time, co-located clinicians; interdisciplinary involvement; psycho-social approaches that deal with noninjury-related causes of pain; detoxification; the aim to reduce long-term disability and return workers to their jobs and productive lifestyles; a liaison among all stakeholders; outcome tracking; and the willingness to work with adjusters.

"This is not one-size fits all," Deitz said about chronic pain treatment programs. "This really needs to work for everybody."

When it does, it works. Liberty Mutual has nearly 400 graduates from its pain programs and sees an average monthly medical savings from each grad of $500 per month. (The control group sees average medical cost increases of 30 percent.)

Deitz is the first to warn, though, that even after you find a good pain program, the process isn't easy. It requires vigilance by case managers. The risk always exists that a patient will relapse, or that a treating physician will place him or her right back on opioids as soon as they leave the program. The employer or the claims adjusters might not believe in the program.

As more and more evidence builds of the success of interdisciplinary chronic pain management programs, perhaps it might become easier to get buy-in from stakeholders. It can still be a problem. One audience member asked Deitz how he could overcome this challenge.

Deitz's answer: "Welcome to my world."

November 11, 2010

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