Diagnosing chronic pain using evidence-based medicine will improve outcomes and reduce worker compensation costs

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Low back injuries are the most costly musculoskeletal condition in US workers’ compensation claims, representing 20–25% of all costs. The use of magnetic resonance imaging and computed tomography scans has increased substantially to diagnose and dictate treatment for chronic low back pain. Medical imaging drives up the cost of claims, yet outcomes for injured workers have not improved.      

In chronic pain cases, medical imaging findings are often red herrings—a diagnosis made based on poor science or inaccurate criteria. False certainty is created, and the search for the actual problem ends. The real source of pain and distress usually lies elsewhere, but treatment options—usually pain medication—are aimed at the abnormality showing in the spinal imaging.

 

Medical imaging can also result in over-diagnosis, when a physician labels a condition more serious than it truly is, attributing a usually benign condition to more serious causes than the scientific data and situation warrant. A clear example is diagnosing a condition that requires major surgery when the patient actually has a problem that needs a less hazardous and more helpful form of care.

“Opioids remain the de facto treatment for most workers with chronic pain,” said Rosenblum. “Yet comprehensive reviews of medical literature show chronic pain is frequently caused by the brain itself, making traditional treatment ineffective. We are following and assessing new, innovative models in diagnostic technology that may ensure more accurate diagnosis and treatment.”

From a claims perspective, Rosenblum believes intervening early in the claim, within 2–4 weeks, will allow a claims specialist to engage with the treating physician and encourage them to comply with medical treatment guidelines.

“Diagnosing patients’ complaints based more on evidence-based medicine and less on imaging studies, where not recommended, will make a substantial impact on the cost of claims,” said Rosenblum. “Most importantly, it will avoid many cases of unnecessary disability for working Americans.”

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