The opioid crisis in America has received significant attentionthe past few months. Multiple government and medical professionalsocieties have issued new guidelines; 37 state attorneys generalsent a letter to the nation’s health plan association encouraginghealth plans to evaluate coverage policy for non-pharmacologicsolutions for pain management; states announced new guidelines onopioid prescribing; and the president declared a public healthemergency relating to the opioid crisis.

And while it’s important and appropriate for the health careindustry and lawmakers to initiate a rapid and definitive responseto opioid overuse and abuse, it’s also important not to getdistracted from the root cause: We have a pain management crisis inthe United States. One hundred sixteen million Americans sufferfrom chronic pain, and a recent article in the Journal of theAmerican Medical Association reported that estimated directhealth care costs for musculoskeletal conditions, including pain ofthe spine, neck, hip, shoulder, knee, wrist, and elbow, amongothers, have escalated to an alarming $183.5 billion annually.These conditions are more expensive than cancer care ($115.3B) and cardiac disease care($175.1B).

Some important causes of these excessive pain care expenditures,as identified by the Institute of Medicine report “Relieving Painin America,” include:

• imprecise diagnostic evaluation and treatment planning

• low utilization rates of non-invasive, non-pharmacologic,evidence-based approaches as a first-line pain treatment

• overuse and poor management of pharmaceutical interventions

• excessive selection of patients for invasive, surgicaltreatments, and poor post-surgical support

• poor coordination of care and lack of comprehensiveinterdisciplinary approach

• inadequate attention to the bio-psycho-social aspects of painthat can impact ability to improve function.

As states and federal officials band together to changeprescribing practices of opioid pain medications, physicians,insurers, advisors and employers must step up to offer access toaffordable and evidence-based options that can help employees inpain, and also mitigate the costs of unsuccessful treatment, losttime from work, and low productivity at the job.

Here are five options that brokers and benefits administratorsshould consider when determining a strategy to deal with pain inthe workplace.

1. Assessment and education

If you haven’t done a thorough assessment of the impact of painin your workplace, here’s a good place to start. Knowing whetherpain impacts 10 percent or 80 percent of your employee populationwill help you determine the breadth and depth of the painmanagement program you need to establish. Administrators canevaluate benefit plan claims data to assess costs for pain-related treatments, and use surveys (e.g.,health assessment surveys; presenteeism surveys) to poll theemployee population and better understand how many employees areimpacted by frequent or chronic pain. Survey results can be thebasis for determining the level of education, new programimplementation, and outreach that your organization needs toestablish. Evidence-based pain education modules can be deployedvia your company web portal or newsletter, in combination withposters, fliers and other communications to steer employees to yourpain education campaign.

2. Self-care options

For those employees with low levels of acute or chronic pain,and high levels of motivation and activation, self-care optionssuch as mindful movement, relaxation training, exercise, andeducation about posture and body mechanics can be very effective inhelping to mitigate pain and/or prevent re-injury. Employees can beeducated on how to effectively engage with their physician or otherpractitioner to:

• understand the specific causes of their pain

• identify barriers to movement and how to move safely

• safely implement self-care

• recognize early warning signs of potential flare-up orre-injury

• understand medications and the appropriate application ofself-care treatments, such as heat versus ice

• practice mental imagery and stress management techniques.

Employee education and self-care training should always beconsidered the first lines of treatment in any pain management strategy. Employees needreliable and easily available information to make better decisionsabout how they treat painful conditions.

3. Conservative therapies

For workplaces with a higher percentage of employees sufferingfrom acute and chronic pain conditions, there are many additional,effective care options. These include options such as physicaltherapy, manual therapy, massage therapy, and acupuncture. Recentsystematic reviews and guidelines about the effectiveness ofphysical therapy/rehabilitation, spinal manipulation, acupuncture,and therapeutic massage for managing musculoskeletal back pain havebeen published by the Agency for Healthcare Research and Quality(AHRQ), the American College of Physicians (ACP), and others.Patients find that these therapies can often resolve their pain, orreduce it to a manageable level. Additional good news for benefitsadministrators is that many health plans and specialty benefitsadministrators offer affordable, employer-sponsored coverage forthese therapies.

4. Cognitive behavioral training

As it turns out, psychological factors (such as depression andanxiety), maladaptive coping strategies (such as fear avoidance orcatastrophizing), and other psychosocial issues can have atremendous impact on functional impairment in pain patients. Sobenefits administrators need to consider pain interventions thatinclude the use of cognitive behavioral training (CBT), with thegoal of changing patterns of thinking or behavior related toperceptions about pain. CBT does this by focusing on aperson’s cognitive processes (the thoughts, images, beliefs andattitudes). CBT is beneficial for improving symptoms andfunctioning in adults with chronic musculoskeletal pain.Significant results include improvements in pain severity,pain-related interference, pain-related disability,catastrophizing, and mood. CBT has also been shown to result infewer days of work missed due to pain-related disability. CBTshould be established with definitive goals, includingtransitioning the employee to self-care, mindful movement andexercise programs.

Pain management programs that include CBT techniques provide auseful tool in their product offerings. CBT can prove to be acost-effective way of helping employees return to work as happier,more productive employees.

5. Acomprehensive pain management program

As noted earlier, one of the key drivers behind the excessivecosts of musculoskeletal pain programs has been poor coordinationof care and lack of a comprehensive interdisciplinary approach topain management. By and large, pain has been managed in specificsilos of care, with desperate patients drifting from one silo tothe next, hoping for a different result with each new type of care. Comprehensive pain management interventions offered at theworkplace may provide better outcomes when education, self-care,physical exercise, cognitive behavioral interventions, andevidence-based provider-delivered services are available, includingnon-invasive, non-pharmacologic pain solutions.

Comprehensive and coordinated pain management programs areintended to provide a structured ecosystem that surrounds theemployee with coordinated care options and educates the employeeabout how and when to choose different levels of effectiveinterventions. A coordinated system should provideindividualized education and tailored action steps to meet thecomplex needs of each person.

The goal of an effective pain management program is empoweringand activating individuals toward improved decision-making,enhanced self-management behaviors, and more effective self-carethat can improve pain control and functional capacity. Thevalue of having a coordinated and comprehensive approach to paincare should not be underestimated. Offering up the right tools atthe right time can help your affected workforce populationemotionally, intellectually and physically.

Given the high prevalence of painful health conditions and therisks associated with opioid use, providing safe and effective painmanagement options to reduce the need for opioid medications andinvasive interventions is a critical next step. Depending on theimpact of pain in your clients’ workforces, one of thesestrategies, or a comprehensive program that includes them all, canmake a difference for employees and your clients’ bottom lines.Benefits administrators should reach out to their benefits advisorsand/or health insurance providers to learn more about their optionsin providing employee access to non-invasive, non-pharmacologicpain solutions.