Back pain is a huge issue in workers comp – not only due to cost, but also because the range of treatment options is seemingly as broad as the number of claimants.
WCRI’s presentation this morning focused specifically on lower back pain and treatment thereof by PT and surgery. Chiropractic was not studied (procedure or specialist based?). The data are embargoed, but here’s what the panelists had to say.
The panelists were commenting on preliminary data shared by WCRI. The data (in general) indicated that the vast majority of patients were initially treated with active physical medicine (PT/chiro); relatively few went right to surgery or pain injections, and a few more cases resolved themselves. Of those cases that started with PM, a slight minority resolved with no further care, with the lion’s share of the remainder getting injections and the rest headed for surgery.
The range of treatment options includes surgery, oral drugs, injected drugs, chiropractic, acupuncture, physical therapy, and combinations of all. And all of these are commonly used in the treatment of back pain – with little discernable difference in terms of outcomes.
Three physicians were on the panel, each with a different perspective. They discussed the whys and shoulds of the different types of care. David Deitz MD (Liberty Mutual Medical Director) noted the dramatic increase in pain management injections that has occurred over the last few years, despite the lack of evidence supporting their efficacy. A physiatrist (Margaret Anderson of Aspirus) also noted the inherent issues with self-referrals among physicians who direct the care and also perform the injections.
However, Dr. Anderson described the positive impact of pain injections on claimants as potentially significant – even though the issue may resolve itself, the injection can dramatically reduce pain, thereby enabling the patient to return to work while the healing process takes place.
Dean Hashimoto, MD (Partners HealthCare) is an actively practicing physician in a low-utilizing practice. Dr. Hashimoto opined that based on the data presented by WCRI, there are too many surgeries, and too many injections for these conditions. Remember, WCRI specifically excluded ‘red flag’ cases that might well benefit from surgery or more aggressive treatment.
Here’s an item from Dr. Deitz that really surprised me – there is a strong correlation between smoking and herniated discs – and that appears to be the only significant controllable risk factor, or perhaps more accurately, the most controllable risk factor (you can’t pick your parents). This may be related to the damage to the peripheral vascular system caused by smoking, or it may not.
Are they for real. smoking causes herniated disks.(ha ha ha) it seems that everyone is jumping on the sue the cigarette companies band wagon. do they really expect people to believe this. cause the last time I checked herniated disks are usually caused by some sort of trauma. I know that mine was caused by lifting a 1500 lbs crowd gate over my head, not by my smoking. before the injury I had an extremely strong back even though I smoke. the correlation they are seeing is just coincidental. probably due to the fact that the majority of smokers in this country work low paying physical jobs where injuries of this nature r more common than the injuries to white collar workers who can actually afford the price of the stop smoking programs and drugs. If smoking actually affected people in the way that many claim the human population would have been wiped out by these diseases years ago!!!