Each year millions of claims are submitted by workers who may have suffered a work-related injury or illness. The Bureau of Labor Statistics reported 2.8 million nonfatal workplace injuries and illnesses reported by private injury employers in 2019 alone. Of that figure, 888,220 nonfatal injuries and illnesses caused a private industry worker to miss at least one day of work, with 80% of injuries or illness being sprains, strains, tears, soreness, bruises, contusions, cuts, lacerations, punctures, and fractures – all, very likely, causing some degree of pain[i]. Ten to twenty percent of individuals who enter the workers’ compensation system due to physical trauma develop chronic pain from either the severity of the initial injury or the injury’s progression. [ii] Chronic pain, one of the most common reasons adults seek medical care, has been linked to restrictions in mobility and daily activities, dependence on opioids, anxiety, and depression, and poor perceived health or reduced quality of life.[iii] This month’s INSIGHTS article explores pain, including pain management options, and how they may be used during an individual’s workers’ compensation rehabilitation.
The experience of pain from one individual to another is entirely unique. As one may imagine, pain is subjective and intertwined with two complementary aspects: a feeling of pain in a particular part of the body, and the other, an attempt to relieve or terminate the pain[iv]. Determining the best options for treating a worker’s pain is guided by understanding the source and history of the pain, the intensity, the duration, aggravating and relieving conditions, and the structures, or parts of the body, involved in causing the pain. Pain management is aimed at identifying the source of the problem and defining the optimal plan of treatment[v].
Options for pain management include:
- Interventional procedures
- Medication management
- Physical therapy or chiropractic therapy
- Psychological counseling and support
- Alternative therapies
- Referral to pain management specialists[vi]
Interventional pain procedures
Interventional pain management aims to relieve, reduce, or manage pain and improve a patient’s overall quality of life through minimally invasive techniques specifically designed to diagnose and treat painful conditions. As nurse case managers, facilitation of timely testing and ensuring the completion of treatments and procedures helps develop a clear picture of how the individual’s pain is being managed and its effectiveness in relieving or reducing the underlying pain. The nurse case manager’s assessment skills are crucial in detailing pre-and post-procedure status, documentation of symptoms, the anticipated impact in everyday life, and the longevity of response. This knowledge helps the health care provider determine the treatment’s long-term effectiveness and the resulting pain relief.
[i] Brown, Jeff – BLS. (2016). Employer-Reported Workplace Injuries and Illnesses — 2015. https://www.bls.gov/news.release/pdf/osh.pdf
[ii] MPR. (2015, September 10). Prescribing Pain Medications for Workers’ Compensation Patients – MPR. MPR. https://www.empr.com/home/mpr-first-report/painweek-2015/prescribing-pain-medications-for-workers-compensation-patients/
[iii] Dahlhamer, J., Lucas, J., Zelaya, C., Nahin, R., Mackey, S., DeBar, L., Kerns, R., Von Korff, M., Porter, L., & Helmick, C. (2018). Prevalence of Chronic Pain and High-Impact Chronic Pain Among Adults — United States, 2016. MMWR. Morbidity and Mortality Weekly Report, 67(36), 1001–1006. https://doi.org/10.15585/mmwr.mm6736a2
[iv] Institute of Medicine (US) Committee on Pain, Disability, and Chronic Illness Behavior, Osterweis, M., Kleinman, A., & Mechanic, D. (2020). The Anatomy and Physiology of Pain. Nih.Gov; National Academies Press (US). https://www.ncbi.nlm.nih.gov/books/NBK219252/#:~:text=At%20least%20four%20physiological%20mechanisms,primarily%20central%20nervous%20system%20mechanisms.
[v] Standiford Helm II, MD. (2016, September 6). Pain Management. MedicineNet; MedicineNet. https://www.medicinenet.com/pain_management/article.htm#how_is_pain_treatment_guided
[vi] DO, T. (2019). Interventional Pain Management: A Comprehensive Approach to Chronic Pain. SpineUniverse. https://www.spineuniverse.com/treatments/pain-management/interventional-pain-management-comprehensive-approach-chronic-pain