This week I want to share two articles about treatment options for both mental and physical pain. The first article is about a new study showing how virtual reality could help those suffering from PTSD. The second article is about a case that examines how long a payor is responsible for paying for opioids in a workers’ compensation case. As you can imagine, there is an intersection between these two stories as the workers’ compensation industry – and society in general – are trying to figure out how to properly treat pain. Below you’ll find these articles and my thoughts on their implications.
Disclaimer: The views and opinions expressed below are those of Mark Pew, Senior Vice President of Product Development and Marketing, and do not necessarily reflect the views of Preferred Medical.
A new study from NHS Wales has concluded that virtual reality could help veterans suffering from PTSD. This study tested 42 veterans and involved walking on a treadmill while interacting with images they chose that represent their traumatic experiences (in other words, reliving the experience). The sessions are guided by a therapist and the goal is to eliminate the often ineffective coping strategy many people suffering with PTSD use—cognitive avoidance. Further testing will still be needed to determine who this therapy will most help but it underscores the increasing evidence that virtual reality is not just for gamers.
I have come to the conclusion that Virtual Reality is real. And this randomized controlled trial (the gold standard) study helps demonstrate that. “Veterans who received this treatment reported a 19% greater reduction in PTSD symptoms after 12 weeks, compared to veterans who had not yet been exposed to 3MDR (multi-modular motion-assisted memory desensitization and reconsolidation).” It is important to note that “all those who took part in the study (42 total) had not recovered with conventional forms of treatment” so this was not a first-line therapy but used after other treatments have failed. That grants hope to those where more “mainstream” options did not work for them. Implications for people in Chronic Pain? Massive. The purpose for this particular treatment is to confront the traumatic experience with the assistance of a therapist. The aim is to “eliminate cognitive avoidance—a coping strategy that can contribute to the worsening of PTSD symptoms” so it combines virtual and “real” reality to help that person move on in their lives. There are other applications of virtual reality that address other conditions – the options are only limited by creativity. The common assumption among them all is that the brain is wonderfully equipped to manage more than we give it credit for. Sometimes external guidance is required to help the individual harness the power they already have between their ears.
This article focuses on a case regarding a payor’s obligation to provide continuing opioid treatment for a workers’ compensation claim. This case looks at a situation where a man taking Percocet was paying for his medication himself and wanted the payor to reimburse his medication expenses. This bears the question of how long should a payor be required to cover the cost of opioids. However, what the correct answer is has a lot of disagreement. But there does seem to be common agreement that prescribing (and paying for) opioids long-term without any validation they’re providing value (i.e. benefits exceed the risks, increased function) doesn’t make a lot of sense.
Very interesting court decision in New Jersey about the duration of time a payer is obligated to pay for a Workers Comp injured worker’s opioids. Attorneys will enjoy the details of Martin v. Newark Public Schools. For us non-attorneys, here’s the bottom line—”There must be proof that the opioid medications are providing curative relief and proof that the continued use of opioids is improving the function of the injured worker.” If they are…Pay. If they’re not…Figure something else out. Sound familiar? Hat tip to Keith Lavin. This post elicited several interesting comments, the content of which was obviously influenced by their individual perspective:
- From Carlos Giron (pain management physician): “Referring to a Pain specialist after 6 years of opioid treatment is about 6 years too late. Much of this situation could have been averted by earlier involvement of a Pain Management provider with workers’ compensation experience.”
- From Rochelle Odell (Pain News Network columnist): “It was interesting. It was unfortunate his physican for six years appeared to keep his Percocet dose the same over the years. In addition, his physician should have referred him sooner for a pain management consult. The patient told his physician the Percocet only helped a little. Did his physician ever raise his Percocet dose? Had his physician ever recommended he be switched to a different opioid? It would be more interesting to see the physician notes during that six-year time frame. Otherwise one is forced to believe at face value what the final decision was.”
- From Rosemary McKenzie-Ferguson (Craig’s Table): “I can speak as a person who has a prescription medication addiction even though it is now 22yrs since I took the last lot of opioid based medication, the addiction is still in place. I had no idea where my physical injury pain stopped and where my addiction started. I had the conversation with my treating doctor who told me that I would never cope with the amount of pain I was in without the prescription medication. It took many months of plain old-fashioned hard work to get through the hell of withdrawal- trust me Hollywood has not made a movie that comes close to any of that journey. What did help was getting my head clear of medication and being able to determine the real level of physical pain due to my workplace incident and allowing the time required for my body to actually repair itself as best it could. I acknowledge that there are days even now when my pain levels are off the scale, then there are days when I can dance the night away. The ever-present challenge is to be honest with myself and work with whatever is happening. I had to face the reality that my body was never going to fully recover but that need never stop me from being me.”
- From Paul Meleedy (claims director): “Judge seems to be following guidelines in the NJ-2017 opioid law enacted. Unfortunately, law that was silent on workers compensation policies but definitely having a positive impact as its message flows into the workers comp arena. Now the hard part, weaning the claimant off the drug properly.”
To read everything on my mind this past week, please visit me on LinkedIn at https://www.linkedin.com/pulse/marks-musings-october-13-mark-rxprofessor-pew/.
Until Next Week,