What’s Going on with Pain? NCCI’s Sinclair Looks at the Post-Opioid Landscape

Orlando, FL (WorkersCompensation.com) -- By now, it's well-known that a major contributing factor to the opioid crisis has been pain management practices, but as the past 10 to 15 years have seen a decline in opioids, what's popping up in their place to help injured workers manage pain from on-the-job injuries?

At NCCI's AIS on Wednesday, Jon Sinclair took a look at the current state of pain and how treating it impacts the workers' compensation industry.

Fewer Opioids Pushes Other Drugs Down

If you we're just thinking hypothetically, you'd be forgiven if you'd conclude that as opioids make their way to patients less and less, other drugs would see an increase in utilization.

That hasn't been the case, and Sinclair reported decreasing drug utilization numbers across drug classes.

Why is that?

"Opioids' side effects are often treated with additional drugs, so other drugs are no longer needed," Sinclair reported. "We've seen a 15% drop since 2012."

Other factors have driven the use of drugs downward, as well.

"Best practices now put more focus on individual results and early pain resolution," Sinclair said. "Plus, public perception of drugs has changed, and it's possible that people will tolerate more pain before taking pills."

Have Costs Dropped?

Since 2012, the use of opioids has declined nearly 75%, but pain management cost per claim has been relatively flat.

Sinclair attributed that trend to:

+ Increased use of topicals, particularly high-priced prescribing of private label options that could be replaced by over-the-counter options like Icy Hot or Ben Gay.

+ Increased utilization of physical therapy.

+ Increases in the cost of surgery.

"The timing of pain treatments makes a difference," Sinclair said. "Pain resolution is typically provided early, but drug costs often stretch beyond the first two years."

The Future

While GLP1s and other weight-loss treatments aren't directly a part of treating workers' compensation injuries, their utilization may have consequences for insurers and employers.

"Reduced obesity in the general population could lead to healthier workers," Sinclair reported.

And how about cannabis? Is that trend taking effect?

According to Sinclair, not yet.

"There's little evidence regarding cannabis right now, and that route is best considered complementary to other approaches and handled on a case-by-case basis," Sinclair said.

But one hot new drug shows promise: Journavx.

"What makes Journavx so promising is that it interrupts the path of pain signaling before it gets to the brain," Sinclair said. "So, there's a low risk of addiction because there's no euphoria feeling and the medication works outside of the brain."

The downside for now is the cost.

"Journavx is 30 times the cost of Vicodin," Sinclair said. "But it comes with significant benefits from what we're seeing early on."

With Journavx or any other new option, Sinclair stressed that the future of pain care will depend on how new advancements fit into the pain management framework in workers' compensation.

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