Is there a way to silence pain early, before it becomes a lifelong affliction? The question has taken a back seat to efforts to treat pain, but research is starting to point the way.
Travelers, an insurance company that covers worker’s compensation cases, has developed a statistical method for predicting the likelihood of developing chronic pain and a program for intervening with those at risk.
Dr. Adam Seidner, Travelers’ national medical director, said four main factors enter into the Travelers Early Severity Predictor, a statistical model the insurer is seeking to patent: the medications used; the patient’s mental health; the patient’s musculoskeletal health; and the presence of other medical conditions, such as vascular disease or diabetes.
In the first year of applying the model, about 9,000 of the 20,000 injured workers were identified as being at high risk for pain that will not go away.
The brain and nervous system undergo changes when pain starts to become chronic, Seidner explained. “We’d like to be proactive and prevent folks from going down the chronic-pain cascade,” he said.
Travelers contacts the patients’ physicians and suggests interventions that might help prevent long-term suffering — such as psychologists who specialize in pain, pharmacists who can evaluate medication, and physical therapists who help improve conditioning.
Seidner said Travelers is already seeing positive results, with use of opioids and surgery declining, and medical costs going down by as much as 50 percent.
Chronic pain can often result from surgery as well, and anesthesiologists are starting to develop new approaches to prevent it, said Dr. Paul J. Christo, associate professor of anesthesiology and critical care medicine at Johns Hopkins Medicine and host of a show about pain on Sirius XM radio.
Using nerve blocks and epidurals during surgery can prevent pain from raging out of control afterward, he said. “Anesthesiologists are placing catheters along nerve bundles, and they’re leaving catheters in to provide continuous pain relief,” he said. With pain controlled after surgery, patients are better able to participate in physical therapy. Multiple medications — not necessarily opioids — can tackle pain in different ways simultaneously, he said.
But Christo acknowledges more research is needed to understand which patients are at risk for chronic pain and which interventions work best.
Felice J. Freyer
Felice J. Freyer can be reached at email@example.com.