Early ID, Intervention Accelerates Recovery

Workers’ compensation payers could save so much money through early identification and referral of patients at risk of delayed recoveries. Unfortunately, many employers and insurers don’t refer injured workers for appropriate interventions until after they’ve spent significant dollars on unsuccessful treatments and dangerous medications.   

Patients who are in chronic pain long after the injury has healed don’t get relief from surgeries or implanted devices. They certainly don’t need cocktails of opioids, benzodiazepines and other medications. What they do need are techniques to be able to control their pain and get back to their lives; brief, time limited interventions in which they learn steps that enable them to decrease their pain response and increase their activity level. In short, they need to know how to cope with their pain. Cognitive behavioral therapy (CBT) offers the best help for them.

One of the CBT programs we offer, for example, is called COPE with Pain; COPE stands for Control Over Pain Effects. It integrates behavioral medicine care with treating medical physicians to help patients avoid or recover from chronic pain or drug dependence, reduce disability from chronic pain, resolve their opioid dependence, and accelerate their recovery. It is serviced through a national panel of health providers in psychology.

While CBT is highly effective for people with delayed recoveries, the sooner the injured worker is referred, the fewer the number of sessions typically required. On average, a patient referred to the our program within 6 months of the date of injury needs just 4 sessions; those referred 6 months to 2 years after the injury require 9 sessions; and those referred more than 2 years from the date of injury may need up to 14 sessions to get the true benefits.

One catastrophically injured worker who’s going through CBT will tell his story during an upcoming conference. SEAK (Skills, Education, Achievement, Knowledge) is holding its 37th Annual National Workers’ Compensation and Occupational Medicine Conference, July 18-20, 2017, in Hyannis, Mass. Headlining the session will be Lauren Danahy, a registered nurse and principal at Willamette Nurse Consultant Group. She has had 21 years of diverse nursing experience that began after completing a six year service obligation in the U.S. Army Military Police Corps.

During a recent conversation, Lauren expressed her thoughts about early referrals for catastrophically injured workers. “When you get a cat file, the most important thing is to make contact as soon as possible. The earlier the referral, the better,” she said. “A lot of employers and insurers try to wait and see, and that can be very expensive down the road. It’s much more cost effective to engage case managers and have them engage immediately with the family.”

CBT Candidates

So who are these patients who can benefit most from interventions? The list is long, and includes those who have:

• Failed conservative care; they have guarding behavior. Physical therapy has not worked for them.  
• Subjective complaints that outweigh medically objective findings.
• Medically unexplained symptoms.
• Chronic pain, generalized pain, migrating pain, or central sensitization pain.
• No functional improvement.

Other factors may be involved as well; such as a history of substance abuse or childhood abuse; depression, anxiety or personality disorders; catastrophic thinking; compliance issues with the prescribed medical treatment, behavioral issues — insomnia, obesity or smoking — and catastrophic injuries.

Assessing injured workers is the first step in determining if they are at risk for delayed recoveries. That process involves having the psychologist and injured worker discuss his pain and current medical care, and respond to a simple questionnaire that explore the person’s pain, stressors and supports, the effect on his mood, his lifestyle and attitudes toward his pain and his healthcare.

The Interventions

Injured workers in chronic pain may never be completely ‘cured’ of the pain, but working with a highly trained, skilled health psychologist they can learn to intervene in the cycle of stress-pain-stress. Working on some of the stressors with the pain clinical specialist can teach the injured worker to cope with other problems in his life as well.

CBT is different from other psychotherapies, such as psychodynamic therapy. More traditional therapy tries to uncover the patient’s deeper motivations for feelings and behavior; whereas CBT helps train the patient’s mind to think and perceive in different ways to help alleviate suffering. CBT is a collaborative effort between the therapist and client, it is based on stoic philosophy, it is based on an educational model and it is structured and directive.

The COPE program generally involves 1 visit per week for 4 – 12 weeks. It teaches the injured worker about the mind and body connection to managing chronic pain.

Two important aspects of COPE and other CBT programs are practice and homework. The injured worker is learning techniques to manage his pain and it’s vital that he engage in what he learns. The pain psychologist is a support system to navigate him through the ups and downs.

Conclusion

No one should have to live in excruciating pain that controls his life. With short, interventional CBT programs such as COPE with Pain, injured workers can return to doing the things they did before the pain started, and, often, payers can have their workers back on the job.

Integrated Medical Case Solutions (Ascellus) is a national network of Health Providers in Psychology that delivers cognitive behavioral therapy (CBT) for chronic pain, trauma and insomnia across the country for the workers’ compensation industry.

For additional information, contact us at The Ascellus Group, or visit our website http://www.cope-with-pain.com.  Please join our LinkedIn group, at COPE with Pain.