Recent Developments: Opioids and Chronic Pain; New Study Shows that Opioids May Prolong and Even Cause Chronic Pain
June 17, 2016
Workers’ Compensation carriers are well-aware of the diminishing effectiveness of opioids for treating pain over time. A new study out of Colorado University-Boulder explains why and suggests that opioid use not only prolongs chronic pain, but may actually cause chronic pain.
The study was published May 30, 2016 in the Proceedings of the National Academy of Science. Interestingly, the study focused on the treatment of sciatic pain (a common work injury) in rats with morphine.
The rats that did not get morphine recovered about four to five weeks after the sciatic nerve injury. However, the rats that received morphine had a doubling of their chronic pain, and it took them ten to eleven weeks to recover from the same injury.
The lead author, Dr. Peter Grace explained why this paradoxical result happened. Pain is processed by glial cells in the brain. The glial cells of the rats that were treated with morphine went into overdrive, resulting in spinal cord inflammation and increased pain. The morphine made the “pain neurons go wild.” This meant worse and longer lasting pain. He surmised that the brain treated the morphine as a foreign substance that needed to be eliminated, triggering an immune response that increases the perception of pain.
The study concluded that instead of treating pain, opioids prolong pain after injury and may actually cause chronic pain.
One takeaway from this for workers’ compensation carriers would be the need to ensure that injured workers are not prescribed opioids at the first presentation of pain. The easiest way to achieve this is the effective use of the panel system, as panel providers are much less likely to prescribe opioids than doctors selected by claimants. Panel lists must exist and be accessible not only to workers, but to the supervisors and managers that injured workers report their injuries to. If Claimants do not automatically get an opioid at the first manifestation of pain, the potential for development of chronic pain and addiction is diminished.
Once a Claimant is outside the panel system, the next tool would be use of Nurse Case Managers to prevent/limit the use of opioids, and recommend the use of non-narcotic medications. This is especially true in cases where opioids are used following surgery, to ensure that they are phased out as soon as possible and not renewed.
The need for for extra-careful monitoring of cases where opioids are prescribed is clear, as the use of opioids may prolong recovery and increase costs on not only the medical side, but wage loss side as well. Carriers should take an aggressive approach to URs when these drugs are used. Red flags should be the increasing of dosage of a prescribed opioid and the addition of new opioids. Prescribers of narcotics will learn quickly which carriers are aggressive about opioid use and this may even affect their prescribing decisions if every escalation of opioid use is met with challenge.