In July, the Canadian Medical Association Journal (CMAJ) published a systematic review and meta-analysis of anticonvulsant treatments for low-back pain and lumbar radicular pain. Anticonvulsants such as gabapentin and pregabalin are commonly used in workers’ comp to treat pain as an alternative to opioids, and the study found moderate-to-high quality evidence that these anticonvulsants were ineffective for low-back pain and lumbar radicular pain.
In response, WorkCompCentral, an online news service focused on workers’ comp, published an article that explored the implications of the study, asking industry leaders for their expertise.
Among the experts consulted, Healthesystems’ Chief Medical Officer, Robert Goldberg, MD, FACOEM, spoke to WorkCompCentral, stating that because these drugs are effective in treating diabetic neuropathic (nerve-related) pain, the workers’ comp industry looked to these drugs as an alternative to opioids, hoping they would be effective in treating nerve-related conditions common in injured workers. However, Dr. Goldberg pointed out that little evidence exists for their effectiveness in treating back-related conditions, stating that workers’ comp guidelines are generally neutral to these medications, recommending a trial treatment if other medications fail.
In other news, Risk & Insurance, a publication focused on risk management and commercial insurance, explored the risks opioid prescriptions pose to inpatients, a population less prominent than the more common outpatients taking opioids dispensed by retail pharmacies.
Risk & Insurance spoke to clinical experts on the matter, including Healthesystems’ VP of Clinical Services, Silvia Sacalis, PharmD, BS. Dr. Sacalis explained that the risk factors related to prescribing opioids for inpatients include anxiety, depression, and pain disorders. Furthermore, post-surgical patients may be unconscious due to anesthesia, increasing opioid risks such as respiratory depression, which can be fatal. Dr. Sacalis spoke of other potential risks, explaining how prescription drug monitoring programs could help prevent some of those risks.