Here, the First Report of Occupational Injury or Illness plays a critical role in establishing case containment. Pain diagrams are utilized so that the patient may visually indicate where they are symptomatic. This proves invaluable in instances where a patient will allege a much broader range of pain either in proximity to the initial injury date or remotely. Capturing the mechanism of injury, past history of injury to the involved body parts, and information about past Workers' Compensation claims is critical.
The patient should be provided basic medications where appropriate and simple interventions designed to keep the patient moving, such as six sessions of physical therapy. Additionally, unnecessary diagnostic procedures such as MRI’s and EMG-NCV studies should be avoided in the absence of ACOEM red flag indications. Finally, every effort must be made to formulate work restrictions that allow the patient to remain actively employed in a manner that is safe yet productive. If total temporary disability is applicable, the duration must be kept to a minimum. If employers do not have limited duty available, they should be advised of the risks associated with inability to accommodate work restrictions.
Employing these principles allows the great majority of injured workers to return to work at or near their pre-injury capacity.
The astute clinician treating the injured worker must be able to recognize when a patient demonstrates a failure to improve along the proper timeline. Recognizing risk factors for delayed recovery is a critical component of case containment; failure to identify and manage the injured workers’ “issues”, pre-existing co-morbidities, workplace concerns, and other warning signs of delayed recovery significantly increase the likelihood that the case will “go south.” Containment of these cases involves alerting the adjustor, discussing the concerns with any treating specialists, contacting the employer to assist with managing any work environment concerns, and if necessary, enlisting the assistance of a behavioral health professional to manage these concerns. Effective management at this level can help avoid the eventual provision of narcotics by “specialists”, unnecessary surgeries, and perpetual spiral of total disability.
Chronic pain cases account for a minority of cases in the WC system, yet they comprise the majority of cost. The costs of the endless provision of medications, surgeries and repeat surgeries, invasive procedures as well as costs of indemnity and legal management are the primary drivers of increasing expenses in the WC system. This has created a huge burden for employers.
Once the chronic pain patient is identified, effort must be made to address the patient’s chronic pain and attendant psychosocial issues where applicable. This must be done in a timely and efficient manner, as we understand that the longer cases are open, the more they will cost. Multidisciplinary care, if instituted properly with focus on minimizing medications and returning the injured worker to gainful employment, can successfully salvage these cases; these injured workers can meaningfully re-engage the workforce, ultimately regaining productivity and structure in their lives. If the end result is not a return to work, a course of adequate multidisciplinary care should result in the patient being rendered permanent and stationary, defining a reasonable course of future medical care where appropriate.