Dangers of Tramadol Recognized

July 23, 2014

Recently, the DEA made the decision to reclassify Tramadol as a schedule IV controlled substance and the decision will officially go into effect on August 18th. Tramadol is an opioid analgesic and aside from its generic form it can also be found in brand names such as Ultram, ConZip and Ryzolt.

This is considerably important news for a number of reasons. First, Tramadol is one of the last commonly prescribed opioids to not be scheduled by the DEA. It has long been used by physicians as a “substitute” for other opioids perceived to be more dangerous. The prevailing thought has been that tramadol has a better safety profile and is not associated with dependence or other negative side effects as much as its headline grabbing brethren such as Oxycontin. In work comp and really in health care in general, it has been this type of thinking that has led to the frequent prescribing of Tramadol as a first line treatment even prior to recommending an NSAID.

The DEA however, has now realized that the data shows something different entirely. And because Tramadol was not scheduled upon FDA approval, it had been closely monitored since it hit the market in 1995 … that is until the steering committee tasked with monitoring dissipated in 2005 due to lack of response to their findings. And what they found was that Tramadol had a high incidence report as related to emergency room visits, a high potential for abuse and astonishingly atypical withdrawal symptoms both when the drug was titrated and stopped abruptly. There were 16,000 emergency room visits related to Tramadol in 2010 yet still 40 million prescriptions made it out of doctors’ offices in 2012.

It is unfortunate that it has taken the DEA this long to do what 10 states have already found necessary (states have the right to schedule differently than the feds), but at the very least this action has brought increased awareness to the dangers of all opioids – not just the typical headline grabbers. And to their credit, throughout their process the DEA was faced with pushback from a number of interest groups citing the potential for a new black-market to emerge, fear of criminal action by prescribing physicians and even the complaint that there is a never ending practice of drug-scheduling (give me a break); but through it all they held firm and got this done.

Chronic Pain Can Be Managed With Alternative Therapies

July 10, 2014

Traumatic injuries and opioid therapy can alter the pain pathways in the central nervous system, and this process is called neuroremodeling. This can cause unwanted or undesirable reactions to pain and negatively impact the recovery process. There are several approaches to reversing the neuroremodeling, some of these alternative treatments include cognitive behavior therapy and opioid tapering.
A patient cannot overcome chronic pain when their mind is at odds with their body, and so psychological therapy can be an effective way to reverse the body’s perception of pain. Cognitive behavior therapy uses teaching strategies to enable patients to control their perception of pain, and to overcome the feeling of defeat about an injury.   Through CBT, patients learn to cope with existing pain using relaxation, distraction, imagery and self-hypnosis.

Chronic pain affects the whole person… mind, body and spirit.  As such, pain management alternatives must consider more than just the physical.

“In some patients, opioid therapy administered to reduce pain has the opposite effect and the patient experiences an increased feeling of pain. This effect is called opioid-induced hyperalgesia (OIH). OIH is an example of neuroremodeling that occurs to the specialized receptors in the body that respond to opioids. The cause is unknown, but sometimes a normal perception of pain can be restored by discontinuing opioid therapy through a medically supervised program. The assistance of a comprehensive pain management center experienced in opioid tapering may be necessary.”

Many are resistant to standard detoxification programs, noting that most are cost-prohibitive, and many times the patient returns to old habits.  While this may occur in some cases,  greater attention is being given in treatment guidelines, especially when opioids are involved, to recommend alternative pain management strategies like CBT in an effort to heal the whole person.  Leveraging the patient’s individual strengths while building compensatory strategies to offset weaknesses, long term success can be achieved. 
                     
What’s the old saying…..

 “Give a man fish and he will have food today.  Teach a man to fish and he will have food for a lifetime.”

Are we, as an industry,  willing to spend the time, money and effort to teach?

Managing Costs Of The Aging Workforce In Workers’ Comp Claims

Problems arise in the workplace with aging employees, especially when the work involved requires physical stamina. The same can be said for those employees with pre-existing medical conditions, like diabetes or asthma. One way to manage the occurrence of workers’ compensation claims is to provide a number of alternatives for employees, measures that will act as preventative care.

Some companies determine the definition of aging by setting a certain age limit, depending on the type of work it can be as early as 35. While it has been shown that there are no greater instances of workers’ compensation claims in older workers, the cost of claims from aging workers is significant to companies. Implementing wellness programs that provide incentives for healthy behavior is one way to counter the aging or ailing of your workforce. Marsh has released a Risk Management Research Briefing that shows ways in which employers can counter the workers’ compensation costs for an aging workforce.

The cost to employers when older workers are injured can be much higher than when younger employees are injured. Obesity and other comorbidities common to older employees could also extend recovery times. But you can take action to reduce the frequency of injuries and help your employees remain fit and better able to recover following an injury.

In light of  our current challenges with MSAs, and the struggle we see with CMS acceptance in cases where co-morbidities and obesity complicate treatment and settlement, this article brings to light some interesting points.  Accidents in the elderly may be inevitable, but proactive steps taken now to create a healthier workforce at any age may result in significantly less severe accidents.  For Medicare beneficiaries, the financial ramifications could be significant.