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Pain Management in the Workplace: A Low-Cost Solution to a High-Priced Problem
by George DeVries

Chronic pain may be the most costly health problem in America. It affects more than 70 million people a year and results in more adult disability than any other condition, according to the National Pain Foundation. Chronic pain has serious economic consequences in addition to the devastating personal consequences. The National Institutes of Health (NIH) has estimated that employeesÕ chronic pain costs employers $100 billion a year in direct medical expenses, lost workdays, reduced productivity, compensation payments, and legal charges.

Chronic pain in the workplace is likely to increase as the population ages and more older workers stay on the job. Older workers are more likely to have arthritis, joint pain, shingles, diabetes, cancer, and other painful or debilitating conditions. Brokers and insurers must help employers minimize the impact of pain through new pain management therapies, low-cost health coverage that addresses pain management, and employee education about alternative treatments.

Decades of Inadequate Pain Management
Inadequate pain management has been a serious problem for decades. A 1999 survey conducted for the American Pain Society revealed that only 25% of chronic pain sufferers received adequate pain treatment. Part of the problem is our limited scientific understanding of the physiological and psychological mechanisms of pain. There is no one-size-fits-all solution since each personÕs level of pain differs based on several factors, such as age, gender, social support network, cultural background, physiological differences, and psychological state.

What is predictable is that pain that goes untreated or is treated inadequately will affect a workersÕ productivity. It will lead to more absenteeism, more doctor visits, and higher insurance premiums. Chronic headache, back pain, arthritis, and musculoskeletal disorders cost employers $61 billion per year in lost productive time, according to a 2003 study published in The Journal of the American Medical Association. Workers suffering from headaches lost an average of 3.5 hours of productive time per week, and those with arthritis or back pain lost 5.2 hours.

Remedying Pain in the Workplace
Chronic pain in the workplace falls largely under the radar in corporate America, despite the recent attention to pain and its costs. The exception is in labor-intensive industries. Employee benefit managers estimated that only 20% of employees suffered from chronic pain. In contrast, 68% of employees said they suffered from some pain on the job, according to a 1996 survey by Louis Harris and Associates Inc.

Chronic pain rose 38% among U.S. workers since 1996, according to a recent Harris Interactive survey. There was a 27% increase in the number of employees who called in sick for five or more days a year due to pain. Yet, only 22% of wellness programs included a component for preventing or living with chronic pain.

Pain Medications: A Prescription for Failure?
The first solutions usually offered to pain sufferers are common pain relievers, such as aspirin and acetaminophen, or opioids, such as codeine or fentanyl. These drugs can provide a relatively inexpensive and temporary solution. However, only 41% of those taking over-the-counter medications found them effective. Only 58% taking prescription drugs found them fairly effective, according to a 2003 study by Hart Research Associates.

Complications of simple non-steroidal anti-inflammatory drugs can include serious stomach ulcers, bleeding, and even death. It costs more than $2 billion a year to treat these complications, according to a study in the New England Journal of Medicine.

The more potent prescription drugs can cause lethargy, dizziness, and other problems with mental clarity. This increases number of times employees show up for work when they are in too much pain or too distracted to be productive. These drugs can even increase the number of on-the-job accidents.

Non-compliance can be a significant issue in managing pain with medication. Many people are concerned about side effects, the potential to become addicted, and the financial and physical effects of taking medications over a long period. Non-compliance can lead to more physician visits, hospitalizations, or claims for workers' compensation and disability.

Alternative Solutions in Pain Management
More and more physicians are advocating complementary therapies alongside traditional medicine. Centers for integrative and complementary medicine have been springing up in hospitals, holistic health centers, and provider networks nationwide. A study done for the American Chronic Pain Association revealed that nearly all respondents living with pain have turned to complementary and alternative medicine, such as acupuncture, massage therapy, chiropractic therapy, meditation, and biofeedback. They sought this treatment in addition to their medications or as a replacement.

The National Center for Complementary and Alternative Medicine, under NIH, has been funding an increasing number of studies on complementary and alternative medicine pain treatments. A landmark NIH study in 2004 revealed that acupuncture provides pain relief and improves function for people with osteoarthritis of the knee and is an effective complement to standard care. Participants receiving acupuncture showed a significant increase in function by week eight and a significant decrease in pain by week 14 compared to those in sham and control groups. Those who got acupuncture for the full length of the study had a 40% decrease in pain and a nearly 40% improvement in function, compared to baseline assessments.

Therapeutic massage has long-lasting benefits for persistent low back pain sufferers, according to study published in the April 2001 issue of Archives of Internal Medicine.

Mind-body therapies are effective in treating chronic low back pain and headaches as well as pain and function problems caused by chemotherapy, according to an extensive 2003 review published in The Journal of the American Board of Family Practice. In addition, biofeedback has been proven helpful in treating about 150 medical conditions, including migraines, arthritis, and fibromyalgia, according to the Mayo Clinic.

Employees with chiropractic health insurance benefits had 41% fewer hospitalizations for back pain, 32% fewer back surgeries, 37% fewer CT/MRI scans for back problems, and a 23% fewer x-rays, according to a study in the Archives of Internal Medicine. It cost 28% less per episode to treat back pain for employees with chiropractic health benefits compared to those without coverage.

Setting up a Comprehensive Pain Management Program for Your Groups
Multi-faceted pain prevention and management programs can help employers reduce pain-related healthcare costs. Effective programs should include a number of options including the following:

¥ Injury Prevention: Programs should include interviews with employees. They should also include a review of jobs, equipment, or processes that contribute to workplace injuries, such as repetitive motion and back injuries. Solutions may include modifying equipment or job processes, adding safety equipment, such as back braces and ergonomically designed equipment, and implementing training programs to prevent injuries.

¥ Pain Awareness: Pain awareness programs educate employees about how chronic pain reduces productivity and increases employee absenteeism and healthcare costs. These programs can also provide education on pain treatment options and the pros and cons of different therapies.

¥ Complementary Health Benefits: Complementary health benefits can provide an important substitute to prescription and over-the-counter drugs, surgery, hospitalization, and costly physician visits. This safe, clinically conservative option reduces absenteeism, lowers the number of times employees show up when they are too sick to be productive, and lowers costs for employers and employees.

Brokers can add CAM benefits to any health plan, just as they would add on dental or vision care, for about 1% to 2% of the groupÕs total healthcare premium. Flexible arrangements allow employers to purchase products on a contributory or non-contributory basis or an employee pay-all supplement.

Employees with health savings accounts will also appreciate being able to stretch their healthcare dollars by paying for these lower-cost services with pre-tax cash. They will also appreciate that the employer is providing an enlightened and holistic approach to pain management.

The demand for comprehensive and cost effective pain management solutions is only going to grow as AmericaÕs aging workforce re-evaluates how to spend their golden years. For many, retirement at age 60 or 65 wonÕt be an option. Brokers who can help employers evaluate the cost of pain in the workplace and offer a range of cost-effective solutions will become most valuable players in health cost management.

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George DeVries is chairman, president, and CEO of American Specialty Health Inc. in San Diego. The company is a provider of complementary health benefit plans covering chiropractic care, acupuncture, massage therapy, dietetic counseling, naturopathy, mental imaging, and relaxation benefits. ASH also provides personal health improvement programs, such as smoking cessation, weight management, and fitness improvement through its Healthy roads for Living program. For more information, visit www.ashcompanies.com, or email George at GeorgeD@ashn.com.