How Should Workers’ Comp Approach Pain Management During COVID-19?
Workers’ comp care managers and clinicians know that managing chronic pain takes a fairly hands-on approach.
Injured workers suffering from the condition often try several different treatments before finding one that effectively reduces their pain, or they may be on lifelong medication, such as opioids, that need to be managed by a professional, lest they can lead to addiction.
As COVID-19 limits access to care, some of the treatments chronic pain patients rely on may be unavailable. Clinics are shutting down, prescriptions are becoming more difficult to access and elective procedures that could help relieve pain are being delayed.
“We believe pain management is critically important during this point and time. We have a number of injured workers in the claims system that need us to help them with access to care,” said Kimberly George, SVP of corporate development, M&A and healthcare for Sedgwick.
During a recent webinar, George and co-moderator Mark Walls, vice president, communications and strategic analysis, at Safety National, spoke about managing chronic pain during COVID-19 with Beth Darnall PhD, pain psychologist and associate professor in the department of anesthesiology, perioperative and pain management at Stanford Health Care, and Steven P. Stanos, DO, who is medical director of Pain Medicine Services and director of Occupational Medicine Services for Seattle’s Swedish Medical System.
They discussed the ways in which COVID-19 is preventing injured workers with chronic pain from receiving treatment and suggested some possible ways to continue care during the pandemic.
Lack of Access to Pain Medication
Since the virus started forcing business closures, some chronic pain patients have had trouble accessing the medications they need to manage their pain.
While pharmacies remain open, some doctors’ offices have closed down due to a lack of patients. For injured workers under the care of physicians who require an in-person visit to refill a prescription, this means that they can’t access the treatment they need.
Beth Darnall, pain psychologist and associate professor, Stanford Health Care
Even if the office remains open, some injured workers with chronic pain may avoid going in because they fear contracting coronavirus.
“We’ve really seen across different states that patients have had difficulty accessing their medications,” Darnall said.
“What COVID has done is brought to the surface yet again the vulnerability of our patients who require opioid medications to address their pain.”
The disruption caused by COVID-19 is also creating psychological problems for people with chronic pain, as many may become anxious about continuity of care during the virus.
“All of these new stresses are compounding both the mental and physical issues that they may have,” Darnall said.
“These are people who on a daily basis are working to achieve stabilization in their lives… Now with everything disrupted it’s really led to multiple complications for individuals who are already vulnerable, who already have multiple medical comorbidities, may have mental health challenges.”
Video Visits Are Essential for Continuity of Care
For some injured workers with chronic pain, telemedicine has stepped up to ensure that they are receiving continuity of care. Both Darnall and Stanos say that virtual and phone visits have helped them continue care with their patients.
“[Telemedicine] in and of itself made a huge difference, both to the treating physicians and to the patients who would have safe access to care,” Darnall said.
“Many of our patients are just happy to speak to somebody and they’re very appreciative of a phone visit,” Stanos added.
Steven P. Stanos, medical director of Pain Medicine Services, director of Occupational Medicine Services, Swedish Medical System
Stanos noted that these virtual visits have allowed him to check up on his patients to see how their day-to-day environments are influencing their pain. Given that many people are working from home now, they may be less active which could increase their pain levels.
“When I talk to patients… I really first focus on what are you doing, what’s your situation?” he said. “[From that], I get a good idea about how active they are during the day [and] what activities are they actually struggling with, and less focus on the pain.”
While these resources can help continue care for injured workers with chronic pain, Stanos emphasized that they’re useless if patients don’t know that they’re available.
“We’ve been doing phone visits and virtual visits and what I’ve noticed is that communication is so important,” Stanos said.
“Most patients weren’t even aware that we were able to do phone visits or virtual visits and … weren’t even aware that they could still be in contact with their clinic.”
Phone and video visits can also allow clinics to keep in touch with patients who may be at a higher risk for addiction.
“Many of those patients [that struggled with opioids] had poor coping, high anxiety, many of those things that could get exacerbated during a pandemic,” Stanos said. “It’s really important to be watching those patients closely.”
Workers’ compensation programs treating injured workers with chronic pain shouldn’t just rely on physicians to complete these well checks.
George noted that claims teams and service providers can also check in with chronic pain patients to see how they’re doing during this time. That way, they can see if the effects of COVID-19 are exacerbating claims, and they can step in and help injured workers who are struggling during this time of social distancing.