A Proposed Solution to the High Cost of Opioid Abuse

Through collaboration, safety professionals and physical therapists can achieve optimal results with both prevention and post-injury management.

• By Deborah Lechner
• Apr 01, 2017

The use of opioids has grown exponentially in the United States in recent years—in 2012, there were enough opioid painkillers prescribed for every American to have one bottle (almost 260 million), according to the Centers for Disease Control and Prevention. Opioids can be highly addictive due to tolerance that builds up quickly, leading to dependence and, in some cases, overdose—the primary cause of accidental death in the United States, according to the American Society of Addiction Medicine.

The loss of human life is certainly the most significant consequence of opioid abuse. However, there is also a high financial cost to both injured workers abusing opioids and their employers. A recent study published in the Journal of Occupational and Environmental Medicine found that health care costs for workers with workers’ compensation and short-term disability claims were substantially higher for those with diagnosed opioid abuse.

Many people do not realize that taking opioids after an injury does nothing to address the underlying problem. Think of an opioid as a band-aid solution: It covers up the issue by blocking the feeling of pain, while the primary problem or cause of pain persists.

The good news is that there is an extremely effective alternative treatment for musculoskeletal injuries that does not involve opioids. This alternative treatment directly addresses the underlying cause(s) of pain and prevents it from becoming worse or returning in the future. The underlying causes of musculoskeletal pain usually involve stiff joints and tight or weak muscles, or compressed nerves and blood vessels. The primary causes of these injuries are overexertion, repetitive movements, or sustained awkward posture.

You might be wondering about this "alternative treatment"—it is quite simple. It addresses the underlying cause of the pain or injury with physical therapy instead of prescription medications. The earlier the underlying problem is addressed, the better. Research shows that employees treated within three to four days of injury are significantly less likely to end up in long-term disability than those for whom treatment is delayed for several weeks.

Physical Therapy as an Alternative Treatment
Physical therapy can improve patient outcomes through techniques that specifically address the involved tissue, including:

• Joint mobilization and manipulation stretches the joint capsule (tissue surrounding the joint) and ligaments surrounding the joint, allowing the joint to move more freely.
• Deep tissue massage, unlike a general massage that one would receive from a massage therapist, specifically targets painful nodules in the muscle.
• Injury-specific strengthening is directed toward muscles that are weak and creating imbalances around the joint.
• Injury-specific stretching incorporates techniques that take advantage of the normal functions of the nervous system.
• Application of heat and cold is done through a variety of modalities including hot and cold packs and ultrasound.
• New innovative treatments, such as dry needling (inserting fine wire needles into muscle trigger points) and cold laser, are used to decrease muscle spasm and pain.

Unfortunately, there are many misperceptions that exist about physical therapy, including feelings that it:

• Costs too much
• Hurts
• Can be done independent of a professional
• Can be bypassed with rest
• Is worth the pain to avoid

However, visiting a physical therapist early can save an employee up to 60 percent on medical bills, and most insurance plans cover at least some part of treatment. Chronic conditions can also be improved by physical therapy. Physical therapists are trained to work within an individual’s pain tolerance and make safe, incremental gains. If rest alone worked, no one would use opioids or need surgery. The reality is, most musculoskeletal problems do not go away when ignored, they get worse. If someone hears an engine rattle in her car, she does not expect that issue to correct itself; the human body is no different.

Safety professionals play an important role in identifying musculoskeletal injuries that would benefit from physical therapy. Safety professionals and physical therapists also work together to implement feasible ergonomic changes that will decrease stress on the injured body part and allow the employee to continue working in some capacity during recovery or to return to work in a transitional duty capacity.

If an injury occurs in the workplace, the employee should receive the appropriate physical therapy intervention as soon as possible. Did you know that many musculoskeletal injuries can be treated in as little as three to four physical therapy visits, if the employee is seen with 24 to 48 hours after injury? Unfortunately, most employees do not have immediate access to physical therapy. Instead, this common scenario unfolds: An employee gets injured on the job site and goes to a doctor in the community. The doctor puts the injured employee on an opioid pain medication and bedrest, then restricted duty, and a few weeks or months later, he finally ends up in physical therapy because he is still experiencing pain. The problem? The underlying causes were never addressed and, because of the delay, the initial issue worsens and becomes much harder to treat.

Early Prevention
Workplace musculoskeletal injuries are often caused or worsened by repetitive motions or static positions that are ergonomically incorrect and create muscle and joint stress and imbalance. Employees often overwork some muscles and underwork others, so some muscles become weak while others become tight. Imbalances in the neck and back, for example, can cause alignment issues in the small joints of the spine, causing a variety of painful conditions.

Preventing injuries from happening in the first place is even better than early treatment. Injury prevention via work site prevention programs have been shown to be an effective way to prevent injury on the job. Work site prevention programs utilize a variety of methods, including but not limited to ergonomics, employee training, stretch breaks, or job-specific exercises and job rotation. However, a relatively new injury prevention strategy that includes work site "first aid" for musculoskeletal discomforts—before they deteriorate into full injuries and pain—seems to be taking hold in many industrial settings.

Non-Recordable Versus Recordable Techniques
The Occupational Safety and Health Administration (OSHA)-approved prevention techniques that can be used for non-recordable discomfort are strictly defined and include:

• Hot and cold therapy: Hot and cold therapy consists of compresses, soaking and non-prescription skin creams for pain relief. According to OSHA, regardless of the frequency of application, hot and cold therapy is considered first aid and therefore a non-recordable case. Hot therapy addresses the discomfort by increasing blood flow to the affected area, bringing nutrients and oxygen, whereas cold therapy decreases circulation in order to reduce inflammation and discomfort.
• Massage: Massage is another effective first aid intervention. It works by using pressure to release tension in muscles and joints, resulting in increased flexibility and mobility of muscles, tendons, and joints and decreased muscle restrictions and spasms. Massage helps to free adhesions, break down scar tissue, and decrease inflammation. Massage improves muscle tone and balance, reducing the physical stress placed on bones and joints. It increases blood circulation and promotes rapid removal of toxins from the muscle, which reduces fatigue and soreness.
• Application of non-rigid support: According to OHSA 29 CFR 1904.7, first aid treatment includes “any non-rigid means of support, such as elastic bandages, wraps, non-rigid back belts, etc.” In the early stages of discomfort, non-rigid support can go a long way toward preventing a joint or muscle injury. In July 2015, OSHA clarified that the "use of kinesiology tape and other types of elastic taping is included within the definition of first aid treatment" and is not considered medical treatment. Athletic or kinesiology taping is the process of applying tape directly to the skin in order to maintain a stable position of bones and muscles during athletic activity. Taping reduces pain and aids recovery by restricting the motion of the injured joint, compressing the soft tissues to reduce swelling, and supporting the anatomical structure involved in the discomfort. Taping may also help employees recover from overuse and muscle imbalances.

According to OSHA, exercise is a medical treatment and does not qualify as first aid if it is prescribed after an injury has occurred. Therefore, it is important for employers to proactively develop company-wide exercises that are job-specific (e.g., stretch breaks, movement breaks, or warm-ups before work and during work) to prevent injuries. If an employee experiencing muscular discomfort is reminded of previously recommended job-specific exercises, they are not considered medical treatment and thus are non-recordable.

Safety plays an important role in encouraging employees to self-identify early, before a discomfort becomes an injury. As with post-injury recovery, the employee must work together with physical therapists to develop ergonomic interventions that minimize muscular stress so that any potential issues do not develop into injuries.

As you can see, there are many alternatives to prescribing dangerous opioids to employees. The first and best line of defense against injury is to implement a workplace injury prevention program, including work site first aid interventions. If an employee gets injured on the job despite the prevention efforts, early physical therapy that directly treats the underlying cause of the pain is much more effective than a drug that merely blocks the brain’s perception of pain. Through collaboration, safety professionals and physical therapists can achieve optimal results with both prevention and post-injury management—creating a solution that does not include opioids.

This article originally appeared in the April 2017 issue of Occupational Health & Safety.