The Perils of Pain Management

Back in the good old days when I first started doing Connecticut worker's comp law, musculoskeletal and low back claims used to be fairly straightforward. One was injured, they saw their orthopedist and either they did a short course of physical therapy or they were a surgical candidate and they had their problem corrected surgically. The claimant would be out of works maybe six to eight weeks and move on. A few months after that, they would get a PPD rating and we could either get that paid or settle the case.

Now, there is a new and unholy place. It is the place of pain management, or as it is called in some places, physiatry. These areas of medicine have become great profit centers for doctors and hospitals. A claimant gets hurt on the job, sees the orthopedist, and if they are deemed to not be a surgical candidate, the doc sends them to an affiliated "pain management" or "physiatry" or "rehabilitative medicine" physician---frequently found in their own practice--- for treatment. This is, in the case of the worker's comp client, the same as being lead into a dead end alley. Now, rather than than a six to eight week stint of recuperation, the client is likely looking at months and months of "pain management"...typically manifested by epidural steroid injections and things of that nature. It creates a cycle of dependency in the mind of the claimant that, in my opinion, does not improve their outcome medically, or bring their legal matter to a head.

Clients are kept at T, or worse, TP, for weeks or more commonly months on end, doing job searches and not doing much else during the 4 week intervals in their visits to pain management. The lawyers dont get reports from these docs, the insurance companies hate paying indemnity for these long periods, and the whole case just gets bogged down. These sojourns have not, in my anecdotal experience improved results. To the contrary---they seem to make claimants more and more anxious.

In this economy, people want to work. When a claimant is told by their pain management doc that they cant work---or more commonly---can only do light duty---it creates a tremendous impediment to that all important concept of closure. People languish in pain management. Their case drags on longer that it should. Their FMLA expires. They lose their job. It is a bad, bad situation.

Back in the old days, the notion of green penicillin was the great elixir. Closure and a decent monetary benefit got the claimant back to work and brought closure to the case. Now, with pain management, the green penicillin is hard to come by and closure takes a lot longer than it should.