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Musculoskeletal disorders in comp highlight prescribed changes



Musculoskeletal disorders can be treated more effectively through medications and therapies other than opioids, according to new research showing that injuries that make up the bulk of workers' compensation claims can avoid dangerous drug remedies.

On Thursday, McMaster University in Hamilton, Ontario, published research funded by Itasca, the Illinois-based National Security Council, which reviewed 13 studies involving more than 13 million participants with musculoskeletal disorders (MSDs), and found that treatment of these patients with non -steroidal anti-inflammatory drugs, commonly known as NSAIDs, were more effective than treating the pain with opioids.

"Anytime you can try other (non-opioid) pain relief methods first, it's better," said Jenny Burke, senior director of impaired practice at NSC. "This research tells us that these over-the-counter medications can treat pain effectively."

Common drugs including aspirin and ibuprofen are considered NSAIDs.

The Department of Labor & # 39 ;s Bureau of Labor Statistics describes MSDs as musculoskeletal systems and connective tissue diseases and disorders often caused by overexertion or repetitive motion. The agency estimated that as much as 30% of comp injuries fall into this category.

At the same time, the latest data for 201

9 show that opioid prescribing continues to decline in workers' comps, and the shift toward alternatives is increasing, according to Raji Chadarevian, head of medical regulation and informatics at Boca Raton, Florida-based National Compensation Insurance Council.

The proportion of all workers applying for opioids decreased from 55% in 2012 to 34% in 2018, according to the credit rating agency, and alternative treatments are up, Chadarevian noted. From 2012 to 2018, there was a 131% increase in the use of massage to treat chronic pain, a 26% increase in the use of orthotics and a 15% increase in the use of physiotherapy, according to the NCCI.

Frontline physicians and those handling comp claims also see the change.

Eight years ago, "every patient I saw was on four drugs a day and four Soma a day," says Dr. Steven Feinberg, pain expert and founder of Palo Alto, California-based Feinberg Medical Group. "Someone was in pain, you started them on a low-dose opioid. We are so critical of what we did then, but the reality is that it was the norm."

Even at that time, it was difficult to get insurers and employers to approve alternatives In California, non-drug treatments continue to grow, including alternative therapies such as acupuncture, which are now being incorporated into government workers to treat guidelines, he said.

"This is a very interesting area – Thai Chi, yoga. , mindfulness … and old standbys like heat and cold. "It's also cheap," said Dr. Feinberg about treating work-related MSDs.

Coventry Workers Comp Services has also seen an increase in the use of opioid alternatives, says Nikki Wilson, Omaha, Nebraska-based pharmacy product director. for the Care and Cost Management Program Provider.

"In 2019, 25% of injured workers had an opioid filling, which is lower than in previous years," she said. "I could not tell you if this is specific to muscle and skeletal disorders, but it really plays out. "

Mrs. Wilson has also seen a greater willingness on the part of payers to provide alternative therapies, such as physiotherapy.

" I think there is a change in attitude and more openness when it comes to to adopt alternative therapies that are low-risk and potentially beneficial, "says Wilson.

In the McMaster University study, the researchers analyzed the effectiveness of pain therapy for a group of participants with non-low yggslager that included workers who received workers compensation, veterans and patients with group health with higher amount of substance use. disturbances.

They found that NSAIDs, both in local and oral forms, followed by acetaminophen, provided the most "attractive benefit-to-harm ratio for patients with acute pain from musculoskeletal back injuries" and that no opioid provided more benefits than NSAIDs in their research.

"Our results show that opioids fail to achieve significant benefits beyond alternative interventions with less harm," said Jason Busse, chief investigator and associate professor at McMaster's Department of Health Research, Evidence and Impact. "These results provide compelling reasons to avoid prescribing opioids in the setting of acute, non-low back, musculoskeletal injury."

Ms. Burke hopes that research will continue to support the movement away from using opioids to treat diseases such as MSDs.

"It's still important."

However, the medical community can go too far, said Dr. Feinberg and noted that there are times when a worker with a severe fracture in the arm and in terrible pain can not get a low opioid dose for a short period.

"We are equally concerned that a physician does not want to prescribe opioids because he is afraid of and patients who may need them and cannot get them," he said. "It's hard to find a balance."

Another area of ​​concern is the pandemic, as the American population is more prone to abuse due to the mental health damage associated with COVID-19, Burke said.

Experts say that the uptick in opioid use during the pandemic and current prescriptive behavior must continue to be evaluated, with an emphasis on switching to alternative therapies.

More than 40 states have reported increases in opioid-related deaths during the pandemic, according to the American Medical Association. The national institutes of environmental health sciences said that the pandemic has a negative effect on opioid use due to social isolation, work-related stress, work-related ergonomics and the different effects of COVID-19 on societies.

More insurance and work compensation news about the coronavirus crisis here . Catalog

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