The overuse of opioid therapy in the U.S. to treat chronicpain is reaching an “epidemic” level, according to the AmericanCollege of Occupational and Environmental Medicine.

When dealing with workplace injuries, reliance on narcotics todeal with pain is a road riddled with rising Workers' Compensationcosts for employers and insurers. And for employees, the use ofnarcotics poses the potential for addiction and long delays in aproductive return to work.

For example, a 2008 report by the California Workers'Compensation Institute, based on a study that tracked 166,000Workers' Comp claims over the course of three years, linked the useof opioid painkillers to long disability periods and high treatmentcosts.

As a solution, some Workers' Comp experts are encouraging a moreholistic approach to pain management, one that combines or evenreplaces lab-produced medications with the healing power of thehuman mind.

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

Employing a broad range of pain-management options other thannarcotics, Franklin suggests, can help prevent relatively minorinjuries from ballooning into cost outliers as patients becomedependent on painkillers.

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

“Cognitive therapy should absolutely be used in anytreatment plan, as should correct posture, mindfulness andconcentration,” says Kathryn Mueller, medical director of theColorado Division of Workers' Compensation and a professor in theDepartment of Emergency Medicine at the University of Colorado'sAnschutz Medical Campus.

Mueller believes both medical and psychological therapies have aplace in treating injured employees and getting them back towork.

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

BE MINDFUL OF MEDITATION

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

When used as part of a multidisciplinary approach tailored toindividual cases, this ancient practice can help injured workersmanage pain better than drug use alone and can help in preventingpossible medication dependency, some scientists and medicalprofessionals say.

Research speaks to the benefits of meditation in painmanagement; in lowering hypertension; and in eliminating anxietyand depression, “versus reaching for pharmaceuticals for a 'quickfix,'” says Maria Perez, president and CEO of New York-based CaseManagement Network.

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

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

The APA states that even patients battling chronic pain showrecovery improvement after undergoing a stress-reduction andrelaxation program; and mindfulness training aids in increased paintolerance and decreased pain ratings.

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

“He had been in and out of work intermittently after havingseveral procedures done on part of a bone protrusion,” Perezrecounts. “After applying the breathing technique he was taught, hewas no longer taking oxycodone, and his pain had diminishedsignificantly. The greatest challenge in implementing this holisticand cost-effective approach was allotting the time to develop thediscipline.”

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

“Even though everybody could benefit from meditation, we wouldhave to identify the triggers and outlier cases that could be mosteffectively treated with this type of intervention,” says ShelleyBoyce, founder and CEO of MedRisk, which provides its clients(including carriers, self-insured employers and third-partyadministrators) with care programs and return-to-work-orientedtreatment for their patients.