The National Council on Compensation Insurance (NCCI) published a new report on interstate variations in pain management trends.

According to NCCI, pain management represented 30% of workers’ comp medical costs in 2023. Pain management (PnM) paid per claim increased on average by 1% per year, with the largest increase at 5.3% in Louisiana and the largest decrease at 3.0% in Alaska.

While opioid use has declined, overall pain management spending increased in most states between 2012-2023. Though prescription drug costs fell an average of 2.8% per year, due to reduced opioid utilization, total pain management cost rose as treatment patterns shifted.

The report identifies topical medications as an emerging cost driver, driven by high prices rather than utilization levels comparable to opioids. Topical costs varied widely by state, ranging from roughly $10 to $630, with Hawaii reporting nearly three times the average cost. Physician dispensed topicals accounted for more than 50% of topical payments on average, compared to 17% for other pain management drugs.

Opioids and topicals, on average, make up 40% of drug costs per PnM claim for all study-states combined. This means that due to the higher price of topicals, even small upticks in utilization can result in significant increases in costs.

The report further notes that states with topical-specific regulations, stricter physician dispensing limits, and drug formularies reported some of the lowest topical costs.

The costs of treating pain through physical medicine and major surgery have increased across almost all states. This increase, however, has been partially mitigated by a sharp decline in drug costs.