Tuesday, February 16, 2016

Pain in Mental Health

In just a couple of weeks Boston will host the annual Workers' Compensation Research Institute's conference. Lots of interesting research presentations on things that workers' compensation wonks love to cavort about.

A lot of the conference this year is medical in nature: fee schedules, outcomes, utilization review, jurisdictional issues on medical control and treatment...

We'll find out, predictably I think, that states with fee schedules cost less than those without. We'll probably learn that rewarding system vendors based on measurable outcomes, rather than on the services provided, generates better results and system savings. We'll learn that there are differences between jurisdictions that some may, or may not, exploit to their benefit or detriment.

Missing in the grand scheme, though, is this industry's unwillingness to accept that mental health is just as important to controlling costs, to achieving good outcomes, to minimizing disability, as any external, artificial controls dictated by law or regulation.

A lot of jurisdictions have laws that minimize employer liability for psychological or psychiatric issues, whether or not caused by work. Treatment is segregated - body parts are treated as though independent of the rest of the body, or the mind.

There is one commonality among all injuries, whether industrial or not: pain.

The reason someone seeks medical care is because something is causing pain. It might be the flu making one's head hurt with coughing, sneezing, running sinuses, achy back... It might be some trauma, a wound or fractured bone.

It might be that the boss yelled or was mean-spirited.

That's all pain. Pain isn't felt by the appendage, or the organ. Pain is an interpretation of signals from nerves that is processed by the brain. The purpose of pain is to send a message - stop doing what it is that causes the pain.

It's really pretty simple. Pain is in the head. It is real because our minds say it is.

Some of the most interesting breakthrough research is about how the mind can challenge pain, alter its character, change the outcome.

Becky Curtis, our 2015 Comp Laude Injured Worker award winner, can tell you all about how the mind can change the perception of pain.

Michael Coupland, a vociferous proponent of cognitive behavioral therapy, has the data and statistics on pain perception and altering outcomes to demonstrate the power of the mind over pain.

Senator Patrick Kennedy, talking about his battle with addictions, notes that the social stigma against mental health has stymied medicine's ability to take care of the whole person. We take statins to forego the possibility of a heart attack or stroke. We support biennial dental care to stem tooth decay. We promote exercise to stave off obesity and stimulate our muscles.

Yet, we eschew mental health services ... until it's too late. It's easier to dispense a pill than it is to dispense good psychology.

We know the path to wellness, to productivity, to return to society, is through the mind.

The Journal of Occupational and Environmental Medicine, in this month's issue, looks at wellness programs and why one company's program is a success, and another's a failure. The conclusion - it's about the whole person, an integrated approach.

What happens in workers' compensation treatment (and, frankly, in much of general health medicine) is a focus on the symptom, but not the problem. We treat the broken bone, the laceration, the low back pain, with physical modalities and drugs.

Throw a psych ICD code into the mix, though, and all hell breaks loose. We are conditioned to treat mental health as a negative, as that person's problem and not part of the claim.

But it's irrefutable that the mind controls the body, and controls one's perception of pain.

I have a high tolerance for pain. My threshold is miles higher than my wife's. Maybe it's because I've been a daredevil all of my life, jumping off roofs, skying a table top on my motorcycle, leaping off cliffs on a bicycle - all those crashes, all those broken bones and organs... I heal and move on to the next adventure.

Others don't have the same tolerance. They may become slaves to their injuries - instead of having an injury, they ARE the injury...
We can't help everybody. There are some that can not be redeemed, their issues too deep; complications interfere with desired outcome.

But most can be helped. Most can be brought back into productivity and well being; if mental health services are implemented earlier in the claim. Much earlier in the claim - like right at the very beginning of the very first treatment implementation.

The trite phrase, "prevention is the best medicine," applies. Identify early-on mental obstacles to return to health, deal with them head on. Don't worry about assuming someone's psychological disability - the fact is that's already happened by virtue of the workers' compensation claim!

When workers' compensation's culture changes to recognize the realities of mental health on successful outcomes, then the conversations at WCRI's annual conference will be less about controlling medical costs, and more about what to do with all the money that's saved on claims...

No comments:

Post a Comment