Program teaches long-term claimants to transform their lives despite the pain

An injured worker who had spent most of a six-year period in a recliner taking methadone daily after a spine fusion now walks several miles a day, taught his son to fly fish, and returned to work. Another, a stressed-out invalid for most of a decade, had a medication tab upward of $10,000 a year and is now feeling optimistic, reducing her medications, and walking every day for exercise. A third was bed-bound for 10 years and prescribed 400 mg of morphine equivalents daily, but now does her own housework and shopping, exercises at the gym daily, and is largely pain-free.

The stories of "Frank," "Irene," and "Patty" are the first of what a group of experts hope will be many long-term, high-cost claimants in the workers' comp system who become productive members of society again. These three were in the first graduating class of the Maze-Masters program.

The program is not a miracle cure nor is it for everyone. In fact, the three were the only ones in the first batch of 24 referred injured workers who passed the extensive screening process.

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Lessons learned from ADA case lead to disability management program (02/27/12)

"They passed all the hurdles," said Dr. Jennifer Christian. "They demonstrated that they were qualified for and determined to get value out of the program. All three completed it successfully and have had their lives transformed."

Christian, the president of Webility Corporation and well-known for her commitment to improving outcomes of workers' compensation injuries, developed Maze-Masters to create a way to help individuals who've had poor recoveries that have created high-cost claims. It is aimed at helping those lost in the maze of the workers' comp/disability systems.

Program basics. Despite Christian's medical background, the program is nonmedical. It is described as an evidence-based, structured, and outcome-focused self-help program that serves as a supplement to traditional medical care and "does not interfere with claims or medical management."

Candidates are not promised success or that their pain will disappear. Instead, they are told that relief is possible right now "whether or not your medical condition will ever change" and that Maze-Masters will help them create the best life possible "under the circumstances."

Candidates receive a letter telling them they will learn, practice, and then master techniques to:

Get relief from your symptoms, especially pain, and soothe yourself.
Cope with the impact of your condition on your life situation.
Safely and slowly rebuild your ability to do what you want and get back into the swing of things.
Create a more satisfying and fulfilling everyday life.

Participants are sent a variety of resources -- books, CDs, DVDs, and websites -- and assigned specific projects tailored to their specific needs. The guides use "an educational and coaching model to tackle biopsychosocial issues."

Success is defined as completing the program and creating noticeable positive life changes accompanied by a decrease in claim costs within a 12-month period.

The graduates. Frank, a former groundskeeper, was told by his treating physician "don't even bother applying for a job" after a back fusion failed to relieve his pain. Part of his program involved speaking with a physician-educator about the natural history of back pain, realistic expectations for functional recovery after back surgery, and what he could do in the way of work. At the end of the conversation, Frank said "my doctor put a little cap over my future and my hopes, and you have just taken off that cap."

Frank began walking outside and took a sedentary job to support his family during a time of economic need. "He was thrilled to discover he can work," Christian said.

Irene had been a custodian when she was injured. When she entered Maze-Masters she was on hydrocodone and Lyrica, Christian said. After learning about chronic pain and how to handle it better, Irene started walking for exercise and put together "a toolbox of techniques to soothe herself," Christian said. "She is now reducing her hydrocodone steadily on a weekly basis and has found a part-time job at her church."

Patty was a cafeteria worker when a workplace back injury and unsuccessful treatment rendered her bed-bound for 10 years. She was using hydrocodone, dilaudid, and a Fentanyl patch. In the most dramatic of the cases, Patty's pain disappeared entirely after she agreed to a detoxification program. "This is an example of opiate hyperalgesia or 'rebound' in which the narcotics were actually causing her pain," according to Christian. "She called me to ask if I had any resources for life after chronic pain. So we found some for her."

The key to the program is persuading candidates to try it. Christian described her conversation with one long-term injured worker. "He said, 'I don't want to work on the quality of my life until I get rid of my pain.'"

"I said, 'Keith, it's been 15 years. What is the quality of your life?'"

"Keith" is now among the latest group of participants in the early phase of the program.

Read more at the WorkersComp Forum homepage.

November 26, 2012

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