Treatment Options for Injured Workers with Chronic Pain
We have represented hundreds of workers in Georgia who have suffered or continue to suffer from chronic pain after on-the-job accidents. Chronic pain can develop after failed orthopedic surgeries, after crush injuries and when injured workers have been diagnosed with Complex Regional Pain Syndrome “CRPS”. While it is always very challenging to treat chronic pain, fortunately there are currently a variety of treatment options.
Medications for Chronic Pain:
- Oral Nom-Steroidal Anti-Inflammatory Drugs and Acetaminophen: There are many different types of non-steroidal anti-inflammatory medications (NSAIDs). Some of them (such as ibuprofen) may be obtained over-the-counter. NSAIDs can be very effective for acute muscular and bone pain as well as some types of chronic pain syndromes. When taken for an extended period of time or in large doses, NSAIDs may cause gastric ulcers.
- Topical Medications: A variety of medications such as ointments, creams and patches can be applied directly to the skin and are very effective for pain control. Some patches are placed on top of the painful area where the active drug, such as lidocaine, is released. Fentanyl patches, however, can be placed at a location far from the painful area. While some of these topical medications are available over the-counter (OTC), others may require a prescription.
- Anticonvulsants (Anti-seizure) medications: These medications such as Neurontin and Lyrica can be very helpful for certain symptoms of nerve pain such as burning or shooting pain.
- Muscle Relaxants: These medications are most often used in an setting where an injured worker is experiencing muscle spasms shortly after an accident on-the-job. The most common side effect seen with these medications is drowsiness.
- Opioids: Opioid medications are under extreme scrutiny due to the staggering increase in drug overdose deaths for the past 20 years. They should be prescribed with a short-term prescription and at the lowest effective dose, only when other forms of pain management treatment have failed to be effective. For pain that is present all day and night, a long acting opioid is usually recommended. One of the dangers of opioids is that they tend to be less effective or require higher doses for nerve type pain. One of the most frequent side effects of opioid use is constipation. Drowsiness and nausea are other side effects which may be difficult to treat and may require changing to another drug. Most importantly, tolerance to opioids occurs after prolonged exposure. This results in a progressive decrease in the opioid’s effectiveness. Physical dependence is usually seen in the form of drug withdrawal after an opioid has been abruptly stopped or rapidly reduced.
Transcutaneous Electro-Nerve Stimulator (TENS) Units: These units utilize pads that are placed on the skin of workers who suffer from chronic pain. They provide stimulation around the area of pain and may help to reduce some types of pain symptoms.
Interventional techniques: The vast majority of injections utilized for the diagnosis or treatment of chronic pain are performed on an outpatient basis. They include:
- Epidural Steroid injections: These injections are performed in the neck or back. An anti-inflammatory steroid (with or without a local anesthetic) is injected into the epidural space close to the inflamed area that is causing the pain. They may be done under x-ray guidance. ESIs are generally effective for relieving pain involving the back and leg, or the neck and arm/hand. Common side effects include soreness of the back or neck at the point where the needle enters the skin.
- Topical Medications: A variety of medications such as ointments, creams and patches can be applied directly to the skin and are very effective for pain control. Some patches are placed Facet Joint Injections: Facet injections can be administered into the joints of someone who is suffering from chronic pain after a work injury. The injections are designed to provide relief of neck and back pain and allow increased movement of the neck and back. They are also frequently employed to relieve burning pain in the arms or legs due to CRPS. Facet joint injections are always performed under x-ray guidance. Common side effects include soreness in the neck or back when the needle was inserted. A needle is placed in the neck or back and advanced to the level of the joint under x-ray visualization. Contrast dye is used if the needle is put within the joint, and sometimes used if the injection is designed to numb the nerves to the joint. This block is often used for diagnostic purposes and a more long lasting injection may be indicated if a chronic pain sufferer has significant pain relief from the injection.
- Lumbar Sympathetic Nerve Blocks: These blocks are performed for pain in the leg that is thought to be caused by Complex Regional Pain Syndrome Type 1 “CRPS 1”. The injection is administered from the back, in the lower part of the back. A needle is placed, usually under x-ray guidance, just to the side and approaching the front part of the spine where the ganglion is located. If the procedure is performed without x-ray guidance, a small amount of contrast dye is injected to make sure the needle is in the right spot. After the doctor is satisfied that the dye is in the right place, numbing medicine is injected and then the needle is removed.
- Stellate Ganglion Blocks: We often see these injections performed either to confirm a diagnosis of Complex Regional Pain Syndrome “CRPS” of the arm or hand or to treat pain in the affected area. Stellate ganglion blocks can also be used to help to improve blood flow to the hand or arm. The injections can be performed with or without x-ray guidance.
Accupuncture is currently being studied to assess its effectiveness in controlling chronic pain. Early results appear to be promising.
Exercises performed under the direction of a physical therapist can also provide some temporary relief to individuals who suffer from chronic pain.
If you or a loved one suffers from chronic pain, we can help you navigate the Georgia workers’ compensation medical maze. It is our job to find the right doctors to treat you. Call for a free consultation with our experienced attorneys today.