Psychosocial aspects of chronic pain are much better understood today than a generation ago. What healthcare organizations now know is that each person’s pain after an injury or surgery is different.

This understanding has helped the workers’ compensation industry improve its approach to working with injured workers, says Patricia Brookey, MS, CRC, CCM, LRC, senior vice president of managed care services at PMA Companies in Blue Bell, PA.

“We now have a much greater understanding of how an injured worker’s medical history and the psychosocial aspects of their personality impact chronic pain,” she says. “These factors can influence the depth and duration of the corresponding treatment plan.”

For example, a new study of people with chronic back pain found that critical life events were a strong predictor of future pain, as was physically demanding work. Another new study found that for many patients, severe pain in any body site was associated with anxiety/depression, lack of social support, unemployment, and low educational status.1,2

Patients with chronic pain are assessed more holistically now than they were in the past. The focus no longer is solely on the injury, Brookey says.

“The workers’ compensation industry’s understanding of the factors impacting chronic pain has resulted in greater acceptance of using alternative therapies to treat chronic pain,” she says. “These may include cognitive therapy, yoga, mindfulness-based stress reduction, biofeedback, acupuncture, and psychological treatments for anxiety.”

The medical industry also is more aware now of the contraindications of using opioids to treat chronic pain, Brookey notes.

“Current scientific research is questioning whether narcotics are effective for those with chronic pain,” she says. “In fact, the CDC 2016 Guidelines on chronic pain and opioids raised the red flag, stating that opioids are not the first line, nor should they be routine therapy for chronic pain patients, and — in all cases — those who are prescribed opioids require close monitoring.”

For this reason, PMA is much more aggressive in developing strategies and tools to manage opioid use and prevent dependency among injured workers, Brookey says.

“These strategies are very comprehensive, involving data analytics to identify injured workers at risk for chronic pain, early intervention strategies, and ongoing monitoring and management of opioid use,” she says.

Some pharmacy tools and strategies that can assist with monitoring and management include customized formularies for chronic pain, peer interventions, programs to combat fraud, and morphine equivalent dose programs.

“Case managers work in tandem with the pharmacy benefit managers and pharmacy intervention specialists to maximize the use of these tools in order to prevent and alleviate opioid addiction,” Brookey says.

Case management is helpful in pain management and opioid dependence cases as part of a team of experts. “Nurse case managers are key members of this team, which may also include a pharmacy nurse, claims adjuster, and pharmacy benefit management company,” Brookey says.

“The case management role has become much more specialized, requiring increased knowledge of pharmaceuticals, an understanding of the short- and long-term effects of opioids, and an awareness of the psychosocial factors impacting injured workers with chronic pain,” she adds.


  1. Wippert PM, Fliesser M, Krause M. Risk and protective factors in the clinical rehabilitation of chronic back pain. J Pain Res 2017;July 6;10:1569-1579.
  2. Dorner TE, Stein KV, Hahne J, et al. How are socio-demographic and psycho-social factors associated with the prevalence and chronicity of severe pain in 14 different body sites? A cross-sectional population-based survey. Wien Klin Wochenschr. 2017;June 20:Epub ahead of print.