Friday, March 2, 2012

CA: On the Compensability of Pain

David DePaolo’s post this morning on the recently released opinion by the CA 4th DCA is a critical read for anyone struggling with CA claims in which opioids are being used for somataform disorders (or physical symptoms that suggest a general medical condition but cannot be fully explained by that condition – more on this in a moment). 
I wanted to follow up on David’s question and supposition: “How many work comp cases allege fibromyalgia, or some other pain that is not reasonably explained by physical findings? I believe there is actually quite a large population of those cases in the system.”
David’s right – there are a lot.  Granted, when PRIUM looks at a case, it’s usually because there’s an issue that’s been identified (so we have a bit of selection bias), but we see some sort of unexplained pain disorder in about 30-40% of the cases in which we intervene.  The most common diagnoses we see in this area are chronic regional pain syndrome (CRPS) and fibromyalgia. 
This is a material issue in dealing with the drug regimen for these patients.  Co-morbid conditions are always a challenge, but those that are deemed psychiatric in nature are by far the most challenging.  Often, physicians are left practicing defensive medicine against a source of pain they cannot easily identify – and the most popular tool to fight this fight is a prescription narcotic (or a cocktail of narcotics and other medications).  
The CA decision could completely reset the way we think about these cases.  David’s explanation is very thorough, but in summary, the ruling states “that physical symptoms that are the product of psychological injury are not compensable if they are the product of lawful, nondiscriminatory, good faith personnel actions.”
I wonder, though, if this is opening Pandora’s box… or, contrary to mythical lure, somehow managing to put some things back in the box?  Those of us on the front lines in the fight against prescription drug over-utilization tend to view the myth from a different perspective. 
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