Clinical Pain Management

Interdisciplinary Care with a Patient Centered Approach

A Proactive Team Approach Improves Patient Recovery

Chronic pain has developed into a healthcare epidemic affecting almost 1 in 4 Americans. The prescription costs commonly used to treat chronic pain now represent 21% of medical spend. While treating physicians are fast to write a prescription as a quick fix, the inappropriate management and use of medical interventions illustrate how the traditional, reactionary biomedical model of care is failing injured workers. By not addressing the psychosocial elements that may impede recovery, injured workers are not receiving the quality care they need.Pain Managemnet Graphic

CorVel has developed a multidisciplinary solution to address both physiological and psychological treatments required for a patient to receive the most appropriate care and ultimately return to work. Using a combination of wellness intervention through peer to peer review, medication review, and cognitive behavioral therapy, in addition to physical therapy and physician case management, CorVel provides patients with quality holistic care.

We successfully provide quality care and return employees to work by utilizing a dedicated team that works to identify functional restoration issues and overcome barriers to return to work. This team approach to the treatment plan encourages a comprehensive pain management program that addresses the complex nature of these cases, which may include physiological impediments to pain reduction and recovery. The following case illustrates a CorVel patient's experience with this program.

Case Synopsis

A female worker in the service industry slipped and fell at her place of employment suffering an elbow and head injury. She was seen by an orthopedist and a neurologist and lost time was reported at the onset of the injury. Her recommended treatment plan was physical therapy and conservative pain management via non- narcotics following the casting of her fractured right elbow. The Patients treating neurologist also ordered an MRI due to reported head trauma experienced during the fall, however her imaging results came back free of any neurological damage. All parties agreed on the treatment plan and a conservative return to work date was set.

As medical bills were being processed the claim was flagged by CorVel's clinical modeling system, a proprietary set of rules that identify indicators such as narcotics usage, length of use and certain drug combinations. It revealed that the patient was being prescribed opiate based narcotics as well as benzodiazepines such as Xanax generally used to treat anxiety disorders from a physician outside the network.

Due to potentially inappropriate drug usage this case was selected for further evaluation. The Medication Review Report concluded that the patient was seeking anti-anxiety medications to treat depression and anxiety caused from headaches that she was experiencing due to her head injury. The narcotics prescribed were reportedly due to extreme elbow joint pain. Through this process, CorVel reached out to the patient and new information came to light as to why she strayed from her original treatment plan. She stated that she did not feel comfortable working with the previous treating physicians so she sought care elsewhere. She also did not feel that the recommended treatment plan addressed the head pain, and anxiety/depression issues she was suffering from nor did she think that any physical therapy was necessary to her recovery and she stopped attending after two visits.

The interdisciplinary team immediately began working with CorVel's pain management physician to determine a new treatment plan that was conducive to resolving the pain concerns, both emotional and physical, the patient was experiencing. Through a new in network physician, a wellness program was ordered in conjunction with physical therapy and medically necessary medications.