Why myMatrixx Believes Early Engagement in Behavioral Health Leads to Better Workers' Comp Outcomes

There is growing evidence to support the idea that chronic pain and mental health are highly intertwined — and this has huge implications for the treatment of injured workers. While the conventional wisdom in workers’ comp has been to avoid taking on mental or behavioral health claims due to their tendency to become long-term cases, it may be time to reconsider. It is becoming clearer that many injured workers dealing with years- or decades-long chronic pain also have untreated mental health conditions.

In all but the most severe cases, workplace injuries should generally be short-term problems. For example, a worker has a fall and suffers from a broken leg on the job. While this is a painful and serious injury, treatment is typically straightforward. There is a cast, sometimes medication is needed and the patient is incapacitated for a period of time. Eventually however, the bone heals, the cast comes off, the worker goes through rehab and the need for medication subsides. This type of case should have a return to work time of approximately six to eight weeks.

So what separates this type of claim from chronic pain sufferers who have ongoing pharmacological needs and other cascading issues for months and years? The answer lies in what is known as the bidirectional relationship between chronic pain and mental health. People who have mental health conditions like depression and anxiety are more likely to develop chronic pain, while those with chronic pain are also more likely to develop a mental health condition. By identifying and engaging behavioral health concerns early in the life of an injury, workers who are at a higher risk for developing chronic pain have a better chance of successfully managing pain and achieving positive outcomes, including return to work.

Evidence for a bidirectional relationship between chronic pain and mental health conditions

Chronic pain and mental health conditions have such an entangled relationship because the two sensations share pathways in the brain. There are multiple imaging studies that show the same region of the brain that is responsible for processing pain, or nociceptive stimuli, is also responsible for processing emotional stimuli.[1] This means that the presence of pain can overload these circuits and make it less able to properly process emotions. Likewise, the development of a mental health condition can similarly burden this part of the brain and make people less mentally able to contextualize pain.  

Data has been able to confirm that patients with chronic pain are at an increased risk of developing mental health condition, including depression, anxiety and substance abuse. Highlighting depression specifically, one study found the estimated current or 12-month prevalence of depression or mood disorders exceeds 50% in individuals with fibromyalgia, TMJ, chronic spinal pain and chronic abdominal pain. It was also estimated that depression exceeds 20% in patients with arthritis, migraine headaches and pelvic pain. Essentially in all chronic pain types, the risk of a depressive disorder and less severe forms of the illness is increased.

What may be even more interesting is the evidence that pain-free patients with diagnosed mental health conditions are at a higher risk of developing chronic pain. A study of 118,533 participants found that patients diagnosed with depression were three times more likely to develop chronic back pain than individuals without depression.[2] Overall, according to statistics from the Anxiety and Depression Association of America, people with mental health conditions are twice as likely to have a coexisting chronic condition.

Ignoring behavioral health can become a decades-long problem

While these findings do have implications that can make certain workers’ compensation claims more complex, responding to them appropriately offers a potential for timely claim resolution and cost containment. If there is a newly injured worker with an underlying mental health condition, employers and payers that are aware of the risk factors for chronic pain and substance abuse and have measures in place to respond to them can limit the possibility of a years- or even decades-long claim. To use the broken leg example from above, if that injured worker had an underlying mental health concern and developed a chronic pain disorder, it could turn a six week claim into one that lasts years and involves multiple prescriptions.  

Conversely, workers who suffer injuries that lead to chronic pain may also find themselves with a newly elevated risk of developing a behavioral health conditions, including depression, anxiety and insomnia. This can be compounded by the conditions that seriously injured workers have to contend with, such as lack of productive activity, isolation and immobility, which can put them even further at risk for behavioral health concerns.

Early intervention and effective therapies for pain relief and mental health

By engaging with behavioral health early, particularly in cases that have been open for two years or less, injured workers who are at the highest risk of developing long-term chronic pain can be identified and receive appropriate treatments. Even across the general workforce population behavioral health care is important, as it is estimated that mental health conditions contribute to 16 million missed work days per year in the U.S.³ Cognitive behavioral therapy, or CBT, is one treatment in particular that is backed by evidence and has been successful in helping with chronic pain, anxiety and insomnia. This treatment approach involves specific techniques and strategies that help patients identify mental health symptoms and triggers and take behavioral steps to counter them. Methods such as CBT can be integrated into broader behavioral health programs that provide predictive modeling and comprehensive patient education to address and improve mental health among workers.

The job of any pharmacy program in workers’ compensation should be to help an injured worker reach treatment goals and get back to work. Medication is often a key part of treatment, but it can also be an obstacle. In the case of chronic pain, especially when there is an intersection with a mental health condition, it can be all too common for prescription cascades to occur with no clear strategy for getting patients off of medications. It should be noted that psychotropic drugs, including antidepressants and sleep aids, along with pain medication are more often than not intended for short term use. By combining a measured pharmacology program and clinical oversight with early behavioral health intervention, injured workers and employers can enjoy the best chance of positive outcomes.

By Michael Nguyen

Michael Nguyen is the Director of Clinical Pharmacy for myMatrixx, an Express Scripts Company, with over 11 years of experience managing pharmacy benefits for workers’ compensation patients. Michael earned a Doctor of Pharmacy degree from Mercer University College of Pharmacy and Health Sciences and is passionate about using his clinical knowledge and expertise to help injured workers with their medication needs. Together with the clinical team, Michael is driven to deliver on myMatrixx’s clinical value proposition by engaging in the strategy, creation and maintenance of clinical pharmacy programs that are designed to facilitate the safe, effective and fiscally responsible use of medication therapies for injured patients. 

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