Gary M. Franklin, medical director of the Washington State Department of Labor and Industries and director of the Occupational Epidemiology and Health Outcomes Program at the University of Washington, extols the values of what he calls a more “multivariable approach” to treatment.

Employing a broad range of pain-management options other than narcotics, Franklin suggests, can help prevent relatively minor injuries from ballooning into cost outliers as patients become dependent on painkillers.

Other medical professionals with a focus on Workers' Comp agree with him.

“Cognitive therapy should absolutely be used in any treatment plan, as should correct posture, mindfulness and concentration,” says Kathryn Mueller, medical director of the Colorado Division of Workers' Compensation and a professor in the Department of Emergency Medicine at the University of Colorado's Anschutz Medical Campus.

Mueller believes both medical and psychological therapies have a place in treating injured employees and getting them back to work.

“Treatments are segmented, but they shouldn't be,” she says, speaking in her role as university professor, not as a state official. “You don't see chronic-pain clinics with a treating doctor and a psychologist in the same place as a way to treat the thought processes contributing to chronic pain.”

BE MINDFUL OF MEDITATION

Specifically, one pain-program component being endorsed by some Workers' Comp experts is meditation, which has been practiced in some cultures for millennia.

When used as part of a multidisciplinary approach tailored to individual cases, this ancient practice can help injured workers manage pain better than drug use alone and can help in preventing possible medication dependency, some scientists and medical professionals say.

Research speaks to the benefits of meditation in pain management; in lowering hypertension; and in eliminating anxiety and depression, “versus reaching for pharmaceuticals for a 'quick fix,'” says Maria Perez, president and CEO of New York-based Case Management Network.

Companies hire the network's nurse team to work with patients hurt on the job. It provides same-day injury evaluation; long-term-care coordination; in-patient rehabilitation; and medication tracking and intervention in order to prevent lost work days. Perez tailors daily meditation training into patients' care strategies to help them manage pain after an incident—and to help prevent future accidents by improving coordination and alertness.

Studies by the American Psychological Association (APA) report greater pain acceptance after eight weeks of meditating for 30 minutes per day, but anecdotal evidence from practitioners shows improvement in mood and reaction to pain after just two weeks.

The APA states that even patients battling chronic pain show recovery improvement after undergoing a stress-reduction and relaxation program; and mindfulness training aids in increased pain tolerance and decreased pain ratings.

Perez points to one recent case in which a man practiced meditation techniques as part of his treatment after having a thumb amputated and saw a resulting decrease in medication use.

“He had been in and out of work intermittently after having several procedures done on part of a bone protrusion,” Perez recounts. “After applying the breathing technique he was taught, he was no longer taking oxycodone, and his pain had diminished significantly. The greatest challenge in implementing this holistic and cost-effective approach was allotting the time to develop the discipline.”

Another challenge is in identifying those patients for whom meditation would most likely be effective.

“Even though everybody could benefit from meditation, we would have to identify the triggers and outlier cases that could be most effectively treated with this type of intervention,” says Shelley Boyce, founder and CEO of MedRisk, which provides its clients (including carriers, self-insured employers and third-party administrators) with care programs and return-to-work-oriented treatment for their patients.