Tag Archives: CBT

Alternatives to Opioids for Pain Management

One of the areas of focus on Out Front Ideas with Kimberly and Mark has been addressing chronic pain without opioids. The workers’ compensation industry’s approach to chronic pain has historically been trying drugs and other medical procedures first. Then, if the pain has not subsided or has worsened, we look for psychological factors. If we truly want to help injured workers in pain and prevent opioid abuse and other unnecessary measures, we need to reverse that protocol. To learn more, we spoke with two of the nation’s most highly respected pain management experts, who gave us great insights into the experience of pain, how it can be best treated and non-pharmaceutical ways to treat pain.

Beth Darnell is a clinical associate professor in the division of pain management at Stanford; a clinical pain psychologist at the Stanford Pain Management Center; an NIH-funded scientist doing research on psychological treatment for chronic pain; one of the co-chairs of the Pain Psychology Task Force at the American Academy of Pain Medicine; one of the co-authors of the 2017 Chronic Pain Guideline updates from the American College of Occupational and Environmental Medicine; and author of multiple books on the subject: “Less Pain, Fewer Pills” and “The Opioid-Free Pain Relief Kit” — both written for patients. Dr. Darnell also recently co-published a research paper on The JAMA Network titled “Patient-Centered Prescription Opioid Tapering in Community Outpatients with Chronic Pain”

Dr. Steve Stanos is the medical director of pain management services for the Swedish Medical System in Seattle and runs the pain services for five hospitals in the system; the director of Occupational Medicine Services at Swedish; the president of the American Academy of Pain Medicine; and the medical director for myMatrixx. He was also a reviewer for the CDC’s Guidelines for Opioid Management and was involved in the National Pain Strategy.

Myths and Facts

Many of us have preconceived ideas about pain — what it is and how it should be treated. Unfortunately, many of these ideas are misconceptions and have led us to where we are today.

We think of pain as solely a physical experience. But our experts explained that pain is really a negative sensory and emotional experience. Psychology is an integral part of the pain experience, and, if we ignore that, we are not adequately addressing an injured worker’s pain.

Pain is very helpful in alerting us to situations where our bodies are at risk. If you put your hand on a hot stove, for example, the pain signals your brain to remove your hand. However, that does not work well for chronic pain when the continuing pain alert does not help us. Instead, it causes us fear and stress, which can actually exacerbate the pain. Those fears and stress are what we need to address in injured workers with chronic pain.

Another misconception is that people in pain are powerless to do anything about it and are at the mercy of drugs or other medical procedures. That simply is not true. There are teachable skills patients can use to assuage their own pain. These are learned skills.

See also: Is There an Answer to Opioid Crisis?  

We need to help injured workers understand and deal with the psychology of their pain experience up front, instead of waiting until the claim deteriorates. Medical providers, payers and others involved in a claim need to be aware of that and work with the injured worker to empower him or her to reduce their fears and stress and, in doing so, reduce their pain.

That leads us to another misconception — that dealing with the psychology of pain requires a specialist for extended sessions. Actually, non-behavioral health individuals can teach valuable skills to help cope with pain.

Again, this should be done early in the claim process for the best outcomes. The best predictor of outcomes in a pain program is early intervention with psychosocial factors. We need to have an early emphasis on behavioral health.

Yet another falsehood is that using drugs and medical procedures first is better for the patient because it does not assume he or she has any psychological issues. Instead, we are missing the elephant in the room, and, when the injured worker is finally sent for psychological intervention, it can be demoralizing. It sends a message to the injured worker that he or she is a failure and that the pain is all in his or her head. It does a terrible disservice to the injured worker.

We asked our experts whether all patients in chronic pain need psychological intervention. The answer was, yes, anyone in chronic pain can benefit from some level of behavioral intervention. That does not mean long-term, expensive, one-on-one treatments with a trained psychologist. Again, there are teachable skills to deal with chronic pain. The focus is on changing behavior.

Non-Pharma Pain Treatments

There are a variety of programs to help people deal with pain, many of which are based on cognitive behavioral therapy (CBT). This short-term treatment is goal-oriented and takes a practical approach to problem solving by changing patterns of thinking and behavior. Doing so helps change the way patients feel.

CBT is considered the gold standard of psychological treatment for chronic pain. It teaches concrete information and skills with action plans to move forward. It helps in creating care pathways that promote organized and efficient patient care based on evidence-based medicine. It helps patients become engaged and active in their own treatment so they rely on themselves more than the medical system.

Patients can learn the skills of behavioral health principles through classes and videos as well as by talking with therapists and others. Again, it is something anyone in pain can and should learn — not just those who are profoundly depressed or have other, more serious psychosocial issues. It is active management of pain.

Some newer treatments include mindfulness training, acceptance and commitment therapy and chronic pain self-management. These are all based somewhat on CBT, although not necessarily on pain management. Acceptance and commitment therapy trains you to stay focused in the moment so you do not react to pain. Negatively reacting to pain can be more distressing than the pain itself.

These programs teach people how to self-soothe. They also help establish meaningful goals and the steps to achieve them so people are not stuck in a passive mindset about their pain.

Functional restoration programs incorporate many of these aspects and can also be great, not only for at-risk patients already struggling with chronic pain, but also for early intervention. These programs have been around for years and typically involve physical and occupational therapy, psychology, relaxation training, exercise and vocational rehabilitation. The cost is fairly inexpensive when you compare them to unnecessary surgeries, so they can be helpful.

There are also certain medical procedures and services that have been overused in the past but can actually have a role as part of an overall pain management plan. Spinal cord stimulators and injections are among them, along with chiropractic care and spinal manipulation. These can help with function for certain patients, such as those with acute pain. But they must be integrated into an overall plan, and they are only appropriate for certain individuals.

Passive treatments, such as acupuncture and massage therapy, might be helpful for some pain patients, at least in the short term. But again, it needs to be used in conjunction with an active therapy program in which the patient is helping to manage his own pain through skills learned from CBT and other techniques.

One treatment on which both experts are hesitant to recommend at this point is medical marijuana, mostly because of its classification as a Schedule I drug under federal law. The science on it is just too sparse; there is no safety regimen around it and no protocols for when to use it, what type to use and how much could help.

“Prehab” is a relatively new term that might hold some promise. Think of rehab before the fact. It focuses on things like wellness, how to relax during the day and stress reduction techniques. The idea is to intervene with patients prior to surgery or other treatments and prevent poor outcomes. Patients who have fear avoidance or catastrophic thinking can be taught skills so they are better able to deal with their pain and stress later on.

Education programs are key in helping pain patients to avoid overuse of medications and services. Because so many do not understand pain or how to control it, they may seek multiple treatments to eliminate the pain.

Opioid Guidelines

The 2017 revisions to the ACOEM Chronic Pain Guidelines, released in May 2017, included an extensive section on behavioral health, the role of psychology and recommendations to integrate psychological principles in chronic pain.

The CDC’s guidelines for managing opioids have been invaluable in the attention they have brought to the opioid issue since they were released last year. However there has been some confusion and pushback, especially on the recommendations that deal with the morphine equivalent dose. The CDC recommends providers avoid or carefully justify prescriptions of more than 90 MED. Some payers have incorrectly interpreted that to mean physicians cannot prescribe above the 90 MED.

Another controversial recommendation says providers should only prescribe opioids for the duration of expected pain, typically between three and seven days. But some providers have been mistakenly told they can only prescribe the drugs for a specific number of days.

See also: Misconception That Leads to Opioids  

The Future

Both experts say a shift from fee-for-service to outcomes-based care could be a huge benefit because it would allow for a more holistic approach, including the integration of behavioral health. Putting behavioral health efforts on the front end of the claim is one of the biggest changes that they believe would help chronic pain patients. This would be a game changer in the workers’ compensation system and would cost more up front, but the speakers believe it would pay off in dividends.

Precision medicine is an emerging field that the speakers say could provide great promise for treating injured workers with chronic pain. It involves deep phenotyping patients on the front end and at each point of care. It includes an array of psychosocial variables and assessments to determine the specific needs of each patient for targeted interventions. It moves beyond the one-size-fits-all approach.

Technological advancements will allow for more and better treatment, such as apps and videos that reinforce behavioral health techniques. Telemedicine is a way to help keep patients engaged. Telehealth can allow for virtual face-to-face meetings between patients and psychologists. Virtual reality also holds promise as a way to help decrease pain levels during treatments.

Clearly there is much that the industry can do to reap better outcomes for our injured workers and, in turn, their employers. However, we need new ways of thinking; a change in the way we have been doing things. All stakeholders need to truly understand pain and what we can do to address it better and faster.

How to Identify Psychosocial Risks

We know that early intervention is critical to prevent delayed recoveries for injured workers. One of the challenges has been to identify those at higher risk of poor outcomes.

Fortunately, we have the tools to determine which patients are more likely to develop chronic pain and languish in a disability mindset. The process is fairly simple and backed by strong, research-based evidence. With increased awareness among payers, providers and other industry stakeholders, we can prevent creeping catastrophic claims, help injured workers regain function quicker and significantly reduce workers’ compensation costs.

Reasons for Getting Stuck

Psychosocial risk factors used to be little more than a buzz term among workers’ compensation professionals. While those of us who’ve worked extensively with chronic pain patients understood that psychological issues can easily derail a workers’ compensation claim, the research that proves this to be true has become widespread only in recent years.

In fact, some of the most recent research says that psychological factors can be more of a predictor of poor outcomes than the underlying medical conditions. We now know for certain that the biomedical model of disease does not hold true for everyone, and the biopsychosocial model of illness must be considered.

Where the first is based on the idea that a physical ailment can be cured through medical solutions, the second acknowledges that some people have an underlying psychobiological dysfunction that has clinically significant distress or disability. They are the injured workers who can greatly benefit from early identification and intervention.

Inadequate coping skills and a lack of knowledge of what is causing their pain can drive delayed recoveries and overuse of treatments and medications. Chronic pain is the final common pathway of this delayed recovery.

See also: A Biopsychosocial Approach to Recovery  

Research validated through meta analyses, prospective studies and control group studies shows that injured workers with delayed recoveries typically have:

  • Catastrophic thinking
  • A history of anxiety or depression
  • Anger and perceived injustice about their plight
  • An external locus of control
  • Minimal resilience

They may also have fear avoidance, meaning they engage in little to no physical activity out of fear they will injure themselves more and experience increased pain.

There are myriad reasons why some people have these issues. The cause could be childhood and life experiences, their relationship and interactions with their environments, issues in the workplace or home or other reasons altogether. It’s important that we identify injured workers with these issues as soon as possible after their injuries.

Pain Screening Questionnaires

One of the most effective ways to pinpoint injured workers with psychological issues is through specially designed, self-administered questionnaires. The one we use to identify patients at risk of developing chronic pain and disability is the Pain Screening Questionnaire (PSQ).

The PSQ was developed by a Swedish professor of clinical psychology and is used in many countries. It has been shown through studies to accurately predict time loss, medical spending and function — but not pain.

The PSQ takes about five minutes to complete and consists of 21 questions that focus on the injured worker’s:

  • Pain attitudes, beliefs and perceptions
  • Catastrophizing
  • Perception of work
  • Mood/affect
  • Behavioral response to pain
  • Activities of daily living

The injured worker is asked to rate on a scale of 1 to 10 things such as, “How would you rate the pain you have had during the past week?”; “In your view, how large is the risk that your current pain may become permanent?”; and “An increase in pain is an indication that I should stop what I’m doing until the pain decreases.”

Depending on the score, the injured worker is categorized as low risk, moderate risk, high risk, or very high risk. Those on the lower end of the scale are most appropriately managed through take-home educational materials on chronic pain. Moderate-risk injured workers are good prospects for a self-managed workbook style intervention. High- and very-high-risk injured workers should be referred for additional assessment and an intervention program, such as cognitive behavioral therapy (CBT).

See also: Impact on Mental Health in Work Comp  

In a program of early identification and intervention, Albertson’s Safeway found 12% of injured workers scored high. Those affected were referred to CBT. After an average of just six CBT sessions, a large percentage of them were able to return to work. Because of the results, primary treating physicians who work with Albertson’s injured workers have been referring them to the program earlier in the claims process.

Conclusion

It is estimated that 10% of workers’ compensation claims consume at least 80% of medical and indemnity resources. The vast majority of these are injured workers with delayed recoveries due to psychosocial risk factors.

With solid science backing up the successful identification and interventions of these employees, we can prevent needless disability and substantially reduce workers’ compensation costs.

Claims Advocacy’s Biggest Opportunity

We know the single greatest roadblock to timely work injury recovery and controlling claim costs. And it’s not overpriced care, or doubtful medical provider quality or even litigation. It is the negative impact of personal expectations, behaviors and predicaments that can come with the injured worker or can grow out of work injury.

This suite of roadblocks is classified as “psychosocial” issues – issues that claims leaders now rank as the No. 1 barrier to successful claim outcomes, according to Rising Medical Solutions’ 2016 Workers’ Compensation Benchmarking Study survey.

Psychosocial roadblocks drive up claim costs far more than catastrophic claims, mostly due to delayed recovery, and claims executives told us they occur regardless of the nature of injury. In other words, one cannot predict from medical data the presence of a psychosocial issue; one has to listen to the injured worker with a fresh mind.

See also: Power of ‘Claims Advocacy’  

It’s likely no coincidence that, while the industry has progressively paid more attention to psychosocial issues this past decade, there’s also been a shift toward advocacy-based claims models over adversarial, compliance- and task-based processing styles. Simply put, advocacy models – which treat the worker as a whole person – are better equipped to control or eliminate psychosocial factors during recovery. According to the 2016 Benchmarking Study survey, claims advocacy and greater training in communication and soft skills, like empathy, are associated with higher-performing claims organizations.

Psychosocial – What It Is, What It Is Not

The Hartford’s medical director, Dr. Marcos Iglesias, says that the “psych” part does not mean psychiatric issues, such as schizophrenia, personality disorders or major depressive disorders. Instead, he points out, “We are talking about behavioral issues, the way we think, feel and act. An example is fear of physical movement, as it may worsen one’s impairment or cause pain, or fear of judgment by coworkers.”

The Hartford’s text mining has found the presence of “fear” in claim notes was predictive of poor outcomes. Similar findings were recently cited by both Lockton (“Leading with Empathy: How Data Analytics Uncovered Claimants’ Fears”) and the Workers’ Compensation Research Institute (“Predictors of Worker Outcomes”).

Emotional distress, such as catastrophic reaction to pain and activity avoidance, is predictive of poor outcomes. Other conditions, behaviors and predicaments include obesity, hard feelings about coworkers, troubled home life, the lack of temporary modified work assignments, limited English proficiency and – most commonly noted – poor coping skills. Additionally, being out of work can lead to increased rates of smoking, alcohol abuse, illicit drug use, risky sexual behavior and suicide.

When peeling back the psychosocial onion, one can see how adversarial, compliance- and task-driven claim styles are 1) ill-suited for addressing fears, beliefs, perceptions and poor coping skills and 2) less likely to effectively address these roadblocks due to the disruption they pose to workflows and task timelines.

Screening and the One Big Question

Albertsons, with more than 285,000 employees in retail food and related businesses, screens injured workers for psychosocial comorbidities. To ensure workers are comfortable and honest, the company enlists a third-party telephonic triage firm to perform screenings. “It’s voluntary and confidential in details, with only a summary score shared with claims adjusters and case managers,” says Denise Algire, the company’s director of risk initiatives and national medical director.

At The Hartford, Iglesias says claims adjusters ask one very important question of the injured worker, “Jim, when do you expect to return to work?” Any answer of less than 10 days indicates that the worker has good coping skills and that the risk of delayed recovery is low. That kind of answer is a positive flag for timely recovery. If the worker answers with a longer duration, the adjuster explores why the worker believes recovery will be more difficult. For example, the injured worker may identify a barrier of which the adjuster is unaware: His car may have been totaled in an accident. This lack of transportation, and not the injury, may be the return-to-work barrier.

It Takes a Village

Trecia Sigle, Nationwide Insurance’s new associate vice president of workers’ compensation claims, is building a specialized team to address psychosocial roadblocks. Nationwide’s intake process will consist of a combination of manual scoring and predictive modeling, and then adjusters will refer certain workers to specialists with the “right skill set.”

Albertsons invites screened injured workers to receive specialist intervention, usually performed by a network of psychologists who provide health coaching consistent with cognitive behavioral therapy (CBT) principles. This intervention method is short in duration and focuses on active problem-solving with the patient. The Hartford also transfers cases with important psychosocial issues to a specialist team, selected for their listening, empathy, communication skills and past claims experience.

Emotional Intelligence – Can It Be Learned?

Industry professionals are of mixed minds about how and if frontline claims adjusters can improve their interpersonal skills – sometimes called “emotional intelligence” – through training. These soft skills include customer service, communication, critical thinking, active listening and empathy. Experts interviewed agree that some claims adjusters have innately better soft skills. But they also concur that training and coaching can only enhance these skills among claims staff.

See also: The 2 Types of Claims Managers  

Pamela Highsmith-Johnson, national director of case management at CNA, says the insurer introduced a “trusted adviser” training program for all employees who come into contact with injured workers. Small groups use role-playing and share ideas. An online training component is also included.

Advocacy – The Missing Link to Recovery

Could it be that advocacy – treating the injured worker as a whole person and customer at the center of a claim – is the “missing link” for many existing claim practices to work, or work better? Whether for psychosocial issues or other barriers, organizations like The Hartford, Nationwide, CNA and Albertsons are paving the road to a more effective approach for overcoming pervasive barriers to recovery. Participants in the 2016 Workers’ Compensation Benchmarking Study confirm that higher-performing claims organizations are taking this road.

The coming 2017 study will continue to survey claims leaders on advocacy topics. A copy of that report may be pre-ordered here.

In Opioid Guidelines We Trust?

A common recommendation to combat the current opioid epidemic is to provide physicians with opioid prescribing guidelines. Opioid guidelines synthesize the available research to inform judicious prescribing behaviors and safe dosages when opioids are needed. Given the seriousness of the opioid epidemic, it is not surprising that multiple organizations currently produce opioid prescribing guidelines. Opioid guidelines are based on evaluations of the research, but the guidelines themselves need to be evaluated critically, as well.

Guideline Evaluation

Fortunately, there are multiple standards currently available to evaluate guidelines, including AGREE (Appraisal of Guidelines, Research and Evaluation), IOM (Institute of Medicine), GRADE (Grading of Recommendations Assessment, Development and Evaluation) and AMSTAR (A Measurement Tool to Assess Systematic Reviews). For example, the AGREE consortium’s latest standard (AGREE II) provides a 23-point checklist covering six domains: scope and purpose, stakeholder involvement, rigor of development, clarity of presentation, applicability and editorial independence. While some AGREE II domains are obvious criteria including “rigor of development” and “editorial independence,” other domains such as “applicability” are less obvious but important.

See also: Who’s Going to Pay for the Opioid Crisis?  

For example, one part of “applicability” is about providing advice or tools for translating recommendations into practice. This point is important considering opioid prescribing guidelines will only work if practitioners can integrate use of the guidelines into their workflow and can apply them effectively to the appropriate individuals. Most chronic opioid users’ first exposure to opioids is through a physician’s prescription, and physicians’ opioid-prescribing patterns have been shown to be associated with opioid abuse and deaths. Therefore, preventing unnecessary first exposure to opioids is crucial.

Guideline standards have shown that not all opioid treatment guidelines are of equal quality. For example, Nuckols et al. (2014) assessed 13 opioid guidelines using the AGREE II and AMSTAR instruments. The authors found AGREE II scores ranged from 3.00 to 6.20 on a 1 to 7 scale, and AMSTAR ratings ranged from poor to high. Four of the guidelines were “recommended against using … because of limited confidence in development methods, lack of evidence summaries or concerns about readability.” This research proves that the quality of opioid guidelines does vary.

The National Guidelines Clearinghouse (www.guideline.gov) is a publicly available resource that provides summaries of guidelines that comply with IOM standards. Although not all guidelines are available free on the National Guidelines Clearinghouse website, it could be a good starting point for finding organizations with guidelines that adhere to a guideline standard.

Jim Smith’s Story

Jim Smith’s occupational injury provides a useful example of how being prescribed opioids contrary to high-quality treatment recommendations may lead to serious health and economic consequences. Jim is a 38-year-old construction worker who suffered an extremely painful lower back strain while attempting to lift a heavy box. Against most guidelines’ recommendations, he was treated from the start with a long-acting opioid, on which he became first dependent and then addicted, taking increasingly higher doses. Even on doses exceeding most guidelines’ recommendations, Jim still suffered from pain and limited mobility. In addition, he began to require supplemental medication to treat the side effects of his opioid use, such as constipation. He subsequently underwent surgery on his lumbar spine, which did not provide him relief from his pain, and he ended up a chronic user of opioids, permanently disabled and housebound.

If Jim had been treated according to any of the current, high-quality opioid treatment guidelines, he would not have received a prescription for an opioid as an initial measure. He would have been counseled to try over-the-counter medications such as ibuprofen or acetaminophen, sent to physical therapy, prescribed exercise and perhaps offered a course in cognitive behavioral therapy (CBT). If opioids had been truly necessary in the acute phase of Jim’s injury, he would have been prescribed a limited course and then been gradually tapered off.

See also: 3 Perspectives on Opioid Crisis in WC  

Conclusion

It is very important to find guidelines that both reduce initial use of opioids and serve to guide the physician in tapering chronic opioid users off these drugs. For someone who has been on opioids for a long time, the tapering process could take many months or years, and there could be both physical and psychological complications during the taper. The process for weaning someone off chronic opioid usage will be discussed in the next article in this series.

In conclusion, users of treatment guidelines put a lot of trust into the recommendations provided. Using only opioid treatment guidelines with sound quality and content helps keep that vital trust so clinicians can continue to use guidelines in combating the prescription opioid epidemic.

A Biopsychosocial Approach to Recovery

Watching people try to recover from injury can be baffling. Some recover function quickly; others do not. Why is there so much variability with severity and duration of disability, given similar injuries or illnesses? Why do some individuals get stuck in delayed recovery?

Our medical system has tended to focus on the physical: If there is back pain, there must be something going on in the disc, vertebrae or nerve roots. That approach isn’t bad. Medicine has made a lot of progress with that tactic. But sometimes a physical cause isn’t apparent.

If we examine what else may be happening in people’s lives, what they’re thinking and what they’re feeling, we start to uncover circumstances and behaviors that may be delaying their recovery.

The Hartford is focusing on a different and promising approach that looks beyond the physical aspects (such as symptoms, physical findings, test results) and looks at the whole person as a biopsychosocial being who may have non-physical barriers that are delaying recovery. The Hartford has developed a program that offers help to assist people in getting unstuck.

Internal data analytics indicate the presence of psychosocial risk factors can account for a two- to four-fold increase in disability duration of work-related injuries.

Background

The biomedical model has served as the traditional foundation of our understanding of the body and has formed the bedrock of modern Western medicine. In essence, this model reduces illness and injury to their most basic units; the body is seen as a machine that operates on the basis of physical and chemical processes. In other words, find out what’s wrong with the body and fix it.

The biopsychosocial model seeks to amplify the biomedical model by addressing an individual holistically as a physical, psychological and social being.

The 1970s saw pioneering work in the treatment of chronic pain by using psychological — or behavioral – principles. For instance, W.E. Fordyce at the University of Washington found that helping patients with pain behave normally (that is, getting them to stop displaying pain behaviors) led to improvements in function.

In the 1980s, cognitive behavioral therapy (CBT) began to be used in treating chronic pain patients. CBT tries to change patterns of thinking or behavior that are behind a person’s difficulties all to change how they feel.

In the past 20 years, some have shown the usefulness of interventions based on specific psychosocial risk factors for pain and disability. Much of this work has been carried out in Canada, Europe, Australia and New Zealand.

See also: Better Outcomes for Chronic Pain

The medical and research literature points to social and behavioral factors — like fear, expectation of recovery, catastrophic thinking and perceived injustice — as powerful forces that can delay recovery after an injury or illness. As one example, a 2015 WCRI study showed that fear of getting fired could affect a worker’s return to work after an injury.

The Hartford Approach

Armed with an understanding of these drivers of disability, The Hartford is using its advanced data analytics and developing innovative solutions to help workers at risk regain the function they had before an injury or illness.

A patented text mining technique allows us to look for psychosocial, comorbid and other risk factors to identify, early on, individuals who demonstrate a likelihood to have a prolonged disability. By combining this early identification tool with a growing toolkit of interventions, we are finding new ways to help individuals restore their lives after an injury or illness.

One such tool is a proprietary, telephonic coaching intervention. Having identified claimants who show an elevated risk for prolonged disability, we invite them to participate in a program that matches them with a specially trained coach who helps them overcome psychosocial barriers. By equipping individuals with skills and techniques to change the way they think, feel and act, we help them develop confidence to take control of their recovery. This confidence allows them to increase function in all areas of life, including return to work.

The voluntary program, called iRECOVER(SM) uses phone calls with the coach, along with a workbook and homework assignments. It can last several weeks.

Although still in its early days, iRECOVER shows promising results: earlier return to function and return to work.

Participant feedback has been very positive. For instance, we have received emails and letters from injured workers that say:

  • “There’s light at the end of the tunnel.”
  • “I feel confident going back to work. A good part of this is due to my participation in iRECOVER.”
  • “I think what you do is probably as important as medical treatment.”
  • “iRECOVER helped me be courageous and strong.”

See also: Data Science: Methods Matter (Part 1)

Conclusion

By considering the whole patient, applying potent data analytics and developing innovative solutions, we are getting to the root of delayed recovery for many individuals. The results will benefit all concerned, especially the injured worker, who just wants life to get back to normal.