CMSA Today - Issue 8, 2014 - (Page 12)

Chronic Pain Conditions Improving Outcomes Injured Workers with Low Back Pain BY JANET S. COULTER, RN, MSN, MS, CCM O ver 1.5 billion people have chronic pain conditions in the world today. The Institute of Medicine of the National Academies estimates that 100 million people in the United States suffer from chronic pain. This is more than the combined number of Americans with diabetes, heart disease, and cancer. According to National Institute of Health statistics, the most frequent complaints about chronic pain include low back pain (LBP), severe headaches or migraines, and neck pain. Additionally, the Centers for Disease Control found that 51.5 percent of adults reported a chronic musculoskeletal condition, which is twice the rate of chronic heart or respiratory conditions. LBP is the world's most debilitating condition and is an increasingly prevalent and costly issue in the United States. Furthermore, nearly 80 percent of the general population will experience LBP at some point in their lives, meaning four out of five people will have intermittent recurrent back pain. In the United States, direct and indirect costs to treat LBP have been estimated to be $90 billion annually. This has increased steadily over the last few decades, mainly due to the high economic cost of injured workers who are off work for more than six months. The third most common reason Americans seek medical attention is musculoskeletal conditions. A U.S. Department of Health study showed that managing musculoskeletal sprain or strain injuries - including lost wages - costs an average of $850 billion annually, making it the largest workers' compensation expense. For employers, the economic strain is very significant. Of all claims under workers' compensation, 80 percent are musculoskeletal sprain or strain injuries with low back injury consuming more than 33 percent of every workers' compensation dollar. According to the U.S. Department of Labor, back pain causes more than 314 million bed days and 187 million lost work days a year. Furthermore, LBP is the biggest cause of work absenteeism. The total annual costs of LBP in the United States - including lost wages and reduced productivity - is more than $100 billion. Additionally, employers lose 5.9 hours of productivity per week from those suffering from musculoskeletal pain who continue to be on the job. Musculoskeletal injury is clearly a primary threat to employers' risk programs. Although LBP is extremely common, in 85 percent of cases, it is next to impossible to say why a person is experiencing back pain. Symptoms and severity vary greatly, mainly due to the intricate structure of interconnected and overlapping tendons, muscles, and soft 12 CMSA TODAY Issue 8 * 2014 tissues with highly sensitive nerves and nerve roots traveling from the lower back to the legs and feet. Back injuries often occur sporadically rather than all at once. Ninety percent of back pain is uncomplicated and can be part of the normal aging process. Additionally, there are several possible causes for LBP. Most cases of LBP can be linked to muscle strain, injury, overuse, or a specific diagnosis or condition such as herniated disc or degenerative disc disease. Furthermore, LBP can be caused by the same vascular mechanism that causes angina. Atherosclerosis can obstruct branching arteries of the abdominal aorta including the four paired lumbar arteries and the middle sacral artery that feed the lumbar spine. This diminished blood flow could result in various back problems. Other causes of LBP include: sacroiliac joint dysfunction, spinal tumors, fibromyalgia, piriformis syndrome, lumbar herniated disc, lumbar spinal stenosis, degenerative disc disease, and osteoarthritis isthmic spondylolisthesis. Smoking and high serum cholesterol levels have consistent associations with disc disease and LBP. Adults under 60 years old are more likely to experience LBP from the disc space itself or from back muscle strain or soft tissue strain. Adults over 60 years old are more likely to have pain related to joint degeneration or a compression fracture. Most episodes of LBP are self-limiting and the injured worker heals within one to three weeks. Out of these cases, 50 percent of injured workers will experience relief within two weeks, while 90 percent will experience relief within three months. Sometimes doing nothing can be as or more effective than treating the injury with conventional treatments. TREATMENT Treatment is usually based on the specific training of the health care provider. For example, pain management physicians use injection therapy; chiropractor physicians employ manipulation; physical therapists apply general exercises; and surgeons recommend surgery. The first step in determining treatment is to determine a diagnosis followed by implementation of the most effective care strategies delivered by the correct provider type. Self care is very important as well as reinjury-prevention interventions. However, treatment can also be ineffective and costly. About 80 percent of all workers' compensation dollars are allocated to musculosketal injuries. These costs are impacted by inappropriate and over-utilization of services that lengthen the duration of the claim and increase medical costs and time away from work. This can eventually lead to disability and a negative outcome. IMPROVING RETURN TO WORK OUTCOMES Case management of the injured worker with LBP can be challenging. Case managers can positively impact the outcome of these injuries and facilitate an early, successful return to work (RTW); however, there are many variables that influence outcomes. The case manager must first enlist active participation of the injured worker and employer. Other case management interventions that can improve RTW outcomes for injured workers with LBP are managing costs, implementing employer

Table of Contents for the Digital Edition of CMSA Today - Issue 8, 2014

Workers’ Compensation Case Management: Up Close & Personal
Association News
CMSA Corporate Partners
Improving Outcomes
The Impact of the Aging Workforce
Inside the Mind of a Traumatic Brain Injury Case Manager
Index of Advertisers

CMSA Today - Issue 8, 2014