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It is common knowledge that prescription drug misuse and abuse has become a significant problem in the United States. According to the Centers for Disease Control (CDC), the costs are staggering.

  •  In the United States, prescription opioid abuse costs were about $55.7 billion in 2007. Of this amount, 46% was attributable to workplace costs (e.g., lost productivity), 45% to healthcare costs (e.g., abuse treatment), and 9% to criminal justice costs.
  • Between 1998-2002, people who abused opioid analgesics cost insurers $14,054 more than the average patient.

http://www.cdc.gov/homeandrecreationalsafety/overdose/facts.htmlPrescription drug misuse and abuse impacts claims management in many ways. On the front end of the process, prescription misuse and abuse increases the risk that a person will be involved in an accident, whether work-related or not. In addition, persons with significant dependence problems may see the claims process as a manner of obtaining prescription medications to fuel their dependency. During the claims administration process, prescription drug misuse and abuse increases costs through extended (or unending) recovery periods and higher than normal pharmaceutical costs. In addition, drug seeking behavior often results in increased medical costs through emergency room and urgent care visits used to obtain medications. Finally, the value of prescription drug medications causes some persons who receive them to sell them as a means to generate income.What can claims professionals do to combat prescription drug misuse and abuse among claimants? The first place to start is with the primary treating physician. If it appears from your review of records that the patient is obtaining narcotic pain medication from multiple sources or has asked for an early refill on more than one occasion, communicate your concern directly to the physician. Most treating physicians are sensitive to narcotic use and will not tolerate drug-seeking behavior. In addition, you can encourage the physician to use her state’s Prescription Drug Monitoring Program, which will provide the physician with information regarding from whom and when patients are obtaining prescriptions for narcotics. Second, a medical record review can provide a good option for discontinuing payment of prescription pain-relievers and other drugs that may be being abused. Third, many states have dispute resolution mechanisms designed to address a carrier or employer’s contention that a particular treatment is not necessary to cure and relieve the effects of an injury or condition. This option provides an opportunity to challenge a recalcitrant physician’s decision to provide unwarranted prescription pain-relievers or other addictive drugs without the patient being a party to the claim. Fourth, drug and physician utilization reviews can be used to assess the likelihood that abuse is occurring when abuse is suspected but cannot otherwise be confirmed.The bottom line is that prescription drug misuse and abuse can be a significant claims cost driver. Taking a proactive approach of identifying potential abuse, working with treating physicians to curb abuse, and using independent medical or record reviews can provide an effective means of controlling the claims costs of prescription drug misuse and abuse. Beyond the claims environment, curbing prescription drug misuse and abuse also makes our society better and safer, which is a win-win for everyone.For more information on Medical Systems go to www.MedicalSystemsUSA.com

One of the most common concerns we hear regarding IME’s is that “the doctor didn’t explain why…”  Frequently the issue centers around the doctor’s opinion that a particular mechanism of injury did not or could not have caused the claimant’s condition.  For example, a doctor may conclude that a particular accident was not of a sufficient magnitude to have caused an acute rotator cuff tear and that the MRI findings demonstrate a wholly preexisting, degenerative process.  Most claims professionals and attorneys would be happy with this opinion, but only if the opinion did not end there.  We all want to know why the doctor reached her conclusion.One of the reasons doctors do not explain themselves in greater detail is that they live their entire professional lives interacting with other doctors and health professionals who do not require further explanation.  If an orthopedist tells a referring internist that an accident was not of a sufficient magnitude to have caused an acute tear, the internist generally will not require additional information to understand why the doctor reached that conclusion.  The orthopedist conveyed the relevant information and the internist can adjust her assessment accordingly.  Unfortunately for those of us in the medico-legal world though, medical opinions do us little good unless doctors explain why they reached them.In our rotator cuff example, the doctor likely had sound reasons for her opinions.  Perhaps the claimant did not complain of shoulder pain at the scene of the accident.  This, any orthopedist will tell you, would be highly unusual in an acute rotator cuff tear because acute tears are painful.  The tendons forming the cuff are enervated and when a complete tear occurs the nerves in and around the tendon are also torn.  This causes pain, which is the body’s natural protective mechanism to keep the person from continuing to use the joint in a way that could cause further injury and impede healing.Perhaps the claimant was a seat-belted driver whose vehicle was merely sideswiped.  The claimant did not report shoulder pain at the scene and did not hit her shoulder or have force transmitted to the shoulder through an outstretched arm.  Most orthopedists will tell you that a minor collision that does not involve direct impact to the shoulder or indirect transmittal of force through an outstretched arm cannot physically cause a rotator cuff tear.  If the shoulder is not hit or the arm is not outstretched, the rotator cuff tendon complex is essentially relaxed.  In this state it cannot be torn.  It is like a rubber band:  if you stretch a rubber band until it is taut you can break it when additional force is applied.  However, if you attempt to break a rubber band that is relaxed, nothing happens.So how can we get the doctor to explain why?  The simplest way to get an explanation is to ask for it.  We understand that certain questions need to be asked in a certain way, such as the Llewellyn questions in Wisconsin worker’s compensation cases (definite breakage, precipitation, aggravation, and acceleration beyond normal, or mere manifestation); however, tailoring causation questions to the mechanism of injury at issue will often get the doctor to answer why she reached her conclusions.  Take the rotator cuff example above:    The claimant alleges an acute rotator cuff tear arising out of a motor vehicle accident.  You have reviewed the file and just don’t think the accident could have caused a rotator cuff tear because the mechanism of injury doesn’t seem right and the MRI reports suggest the tearing was of a longstanding, degenerative nature.  In addition to the typical questions, you might want to ask the doctor a specific question regarding the MRI findings:  “The reading radiologist on the November 2nd MRI report states that there is fraying of the supraspinatus tendon that appears to be of a degenerative nature.  Please comment on whether you agree with the reading radiologist and if so what aspects of the MRI images suggest a degenerative versus an acute tear.”  You might also want to ask the doctor a specific question regarding the lack of shoulder complaints immediately after the accident:  “In her description of the accident and the development of her shoulder problems, the claimant does not mention shoulder pain immediately after the accident and first reports shoulder pain two weeks later.  What is your opinion on whether the claimant’s report of injury and the onset of shoulder pain is consistent with suffering an acute rotator cuff tear arising out of the motor vehicle accident?”We know that there are no silver bullets in obtaining independent medical examinations.  The doctors who are asked to examine claimants give an objective opinion based on the history described and the other facts available to them.  Nevertheless, targeted questions can go a long way in getting the in depth explanation behind an opinion that helps bolster the IME doctor’s credibility.  When preparing the cover letter to the IME doctor, consider whether there is anything unusual about the claimed injury.  If the mechanism of injury doesn’t seem right, point that out to the doctor and ask her to comment specifically on the mechanism of injury and why it would be unlikely to cause the alleged injury.  In many cases, you will receive a more detailed and individualized answer than you would if you only asked standardized questions.For more information on Medical Systems go to www.MedicalSystemsUSA.com

1/24/2013 in Medical Conditions
Reflex Sympathetic Dystrophy Syndrome (RSDS) is medically defined as a “rare” disorder. Yet, it has recently become a common claim following litigated injuries. Claims of this disorder are increasing faster than medical technology, making the job of claims handlers—and litigators alike—extremely difficult. Unfortunately, RSDS can be difficult to diagnose because its symptoms are mostly subjective in nature. As a result, few doctors are experienced in treating the syndrome. Doctors need to know more about RSDS to ensure proper diagnosis and treatment. Claims handlers need to be informed about RSDS to have successful claim management.DEFINITIONRSDS is a rare disorder of the sympathetic nervous system, which regulates involuntary bodily functions. It can increase heart rate and blood pressure. It can also constrict blood vessels. RSDS can also be referred to as: Algodystrophy, Algoneurodystrophy, Causalgia Syndrome (Major), Reflex Neurovascular Dystrophy, Sudeck's Atrophy, or Complex Regional Pain Syndrome. Claims handlers and doctors should be familiar with this terminology.SIGNS & SYMPTOMSUsually, RSDS clinically progresses through three stages--acute, dystrophic, and atrophic. Each stage lasts from three to six months. RSDS symptoms begin with burning pain in the arm(s), finger(s), palm(s) and/or shoulder(s). The skin over the affected area(s) may become swollen (edema) and inflamed. Affected skin may be extremely sensitive to touch and sensitive to hot or cold temperatures (cutaneous hypersensitivity). The affected limb(s) may perspire excessively and be warm to the touch (vasomotor instability). In some individuals, RSDS may occur in one or both legs or it may be localized to one knee or hip. TREATMENTThe most widely used therapy for the condition has been cervical or lumbar paravertebral sympathetic blockade with anesthetics such as mepivacaine or bupivacaine. The pain relief may be dramatic, with a duration outlasting the action of the anesthetic. Several regional blockade procedures have been developed using a modified Bier block. The administration of corticosteroids has also been advocated. Another therapy for this disorder is therapeutic exercise and hand conditioning. A coordinated multidisciplinary approach to treatment seems to work best.REASONS TO GET AN IME FOR RSDS CASESCausation: The exact cause of RSDS is not fully understood, although it may be associated with injury to the nerves, trauma, surgery, atherosclerotic cardiovascular disease, infection or radiation therapy. It can occur following sprain, fracture, or injury to nerves or blood vessels, particularly in the extremities. As a result, a neurologist familiar with RSDS will understand appropriate signs and symptoms and should be able to confirm the diagnosis Save Treatment Dollars: Frequently, RSDS may go undiagnosed. It can also be misdiagnosed as a painful nerve injury. Therefore, a neurologist who has had experience in diagnosing and treating the disease can save significant treatment dollars.Permanence: Diagnosis is important in determining treatment. However, in one large study, 60% of patients had continuing pain regardless of treatment. The pain may be excruciating, resulting in dramatic physical and psychological alterations. An experienced neurologist, who is familiar with RSDS, will be able to diagnose and recommend appropriate treatment.Medical Systems, Inc. offers several neurologists familiar with the diagnosis, treatment, and evaluation of RSDS. Call: 800-261-3278 to schedule.
Scheduling an IME for every "lost time" claim is a controversial approach to claims management. However, this strategy is becoming increasingly accepted by claims handlers for one very important reason: cost containment. An IME quickly identifies misuses of the system by both worker and health care provider. Another factor contributing to lack of cost containment is medical management. The claims handler often utilizes medical management services for the very reasons an IME is eventually obtained. A more cost effective approach would be to obtain an independent medical evaluation before referring to medical management services. Statistics show an IME temporizes treatment and claims are closed at a faster rate.
12/21/2012 in Treatment
In today’s competitive climate of rising costs and shrinking profit margins, an increasing number of businesses are looking for ways to ensure a healthy bottom line. The rising cost of Worker’s Compensation claims, as well as the direct and indirect cost of job-related injuries, is being closely scrutinized.One way to control costs is to develop a comprehensive approach to reducing and treating injuries, and an effective method for treating injured workers is the use of professional physical therapy services.PHYSICAL THERAPY IS A DISTINCT PROFESSIONThe physical therapy profession is a distinct entity within the allied health professions. The physical therapist is a licensed trained professional who plans and administers a physical therapy plan of care for medically referred patients in need of physical therapy services.USED TO TREAT MOVEMENT DYSFUNCTIONThe role physical therapy plays in workers’ rehabilitation is primarily in the assessment and management of movement dysfunction. Physical therapists work to restore the functional abilities of individuals who are either permanently or temporarily disabled due to illness, disease, trauma, or congenital abnormalities. In addition to their role as clinicians, physical therapists may serve as educators, consultants, and researchers.MAJOR OBJECTIVESThe major objectives of physical therapy are:• Prevention and relief of disability and pain;• Preservation or restoration of maximal functional capabilities;• Promotion of healing; and• Adaptation to temporary or permanent disability.EXERCISE AND PHYSICAL AGENTS USEDThe field of physical therapy typically uses exercise and physical agents such as heat, light, water, and massage to relieve pain caused by surgery or by chronic medical conditions, improve muscle strength and mobility, and improve basic functions (standing, walking, and grasping) in patients recovering from debilitating illness or accidents, or for those who are physically handicapped.The physical therapist selects specific rehabilitative treatments based on the patient’s individual medical condition. Heat may be applied to ease stiffening and joint pain. The heat source may be a hot bath, compresses, heat-creating lamps, or ultrasound waves which generate heat in tissues that are too deep to be reached by external heat applications. Massage is a standard physiotherapeutic technique, both for easing pain and for improving circulation. Hydrotherapy is useful in rebuilding injured or wasted muscles.The most frequent type of physical therapy treatment, however, is exercise, carefully chosen to increase joint mobility or to improve muscle strength and coordination.Patients with physical handicaps may be trained to learn or relearn elementary motor functions, such as holding a spoon or turning a doorknob, or they may be taught how to use crutches, prosthetic devices, or other mechanical aids. The work of physical therapists is often closely coordinated with that of the occupational therapist, since both fields involve training patients to improve their motor abilities.INTERDISCIPLINARY APPROACH EFFECTIVEThe physical therapist often works in tandem with other medical professionals, to more completely evaluate a patient’s condition from a medical, behavioral, functional and ergonomic perspective. This interdisciplinary approach is an effective way to clearly define the problems which are preventing an expedient or eventual return to work. Once these issues are appropriately addressed and managed, the ultimate goal of improved quality of life for the injured person, as well as reduced Worker’s Compensation costs for the employer can be realized.For more information please visit www.MedicalSystemsUSA.com

Definition:Deception is to intentionally distort the truth in order to mislead others. There are two classes of deception: concealing the truth (dissimulates or gloss over) and exhibiting false information (simulate). Malingering is intentional production of false or exaggerated symptoms motivated by external incentives, such as obtaining compensation or drugs, avoiding work or military duty, or evading criminal prosecution. Signs of Malingering:Malingering can be strongly suspected in the presence of any combination of the following occurrences:-Marked discrepancy between the claimed distress and the objective findings-Lack of cooperation during evaluation and in complying with prescribed treatment-Presence of an antisocial personality disorderMalingering often is associated with an antisocial personality disorder and a histrionic personality style. Prolonged direct observation can reveal evidence of malingering because it is difficult for the person who is malingering to maintain consistency with the false or exaggerated claims for extended periods.The person who is malingering usually lacks knowledge of the nuances of the feigned disorder. For example, someone complaining of carpal tunnel syndrome may be referred to occupational therapy, where the person who is malingering would be unable to predict the effect of true carpal tunnel syndrome on tasks in the wood shop.Prolonged interview and examination of a person suspected of a malingering disorder may induce fatigue and diminish the ability of the person who is malingering to maintain the deception. Rapid firing of questions increases the likelihood of contradictory or inconsistent responses. Asking leading questions may induce the person to endorse symptoms of a different illness. Questions about improbable symptoms may yield positive responses. However, because some of these techniques may induce similar responses in some patients with genuine psychiatric disorders, caution should be exercised in reaching a conclusion of malingering.Persons malingering psychotic disorders often exaggerate hallucinations and delusions but cannot mimic formal thought disorders. They usually cannot feign blunted affect, concrete thinking, or impaired interpersonal relatedness. They frequently assume that dense amnesia and disorientation are features of psychosis. It should be noted that these descriptions also may apply to some patients with genuine psychiatric disorders. For example, individuals with a delusional disorder can have unshakable beliefs and bizarre ideas without formal thought disorder.Physical Examination:Typically, deficits on physical examination do not follow known anatomical distributions. A patient's attitude toward the examining physician often is vague or evasive.Concerns:The time, energy, and financial commitment created by malingering individuals is an appreciable problem in health care. Whether the goal is to obtain narcotics, to obtain time off from work and/or to secure financial benefits such as disability payment, the costs to the health care delivery system have proved enormous. For more information visit www.MedicalSystemsUSA.com

11/30/2012 in Medical Conditions, Treatment
Numerous “red flags” can be found associated with increased incidences of delayed recovery following a compensable injury.1. Receipt of compensation for a past injury.2. Medical visits increased prior to accident.3. Frequently canceled medical appointments.4. Reports of having “had the feeling of impending doom” prior to the accident and/or nightmares about the accident.5. High absentee rate before the injury.6. A history of doctor “shopping”.7. Reluctance to cooperate with treatment.8. Pending litigation.9. Inconsistent or non-organic physical findings.10. History of alcoholism or drug abuse.11. Evidence indicating early dependency needs were not met (history of starting work at a very young age or by being a later born child in a large family).12. Family history of disability.13. Recently divorced or other recent crisis.14. Physical disability disproportionate to injury.15. Demonstrating concerns about ability to continue working or inadequate retirement savings in older workers.If present, these factors do not necessarily indicate a claimant will suffer from delayed recovery but suggest a higher risk, and these claims should be followed more closely.For more information please visit www.MedicalSystemsUSA.com
The reported incidence of work-related carpal tunnel syndrome has skyrocketed; however, many cases have an underlying systemic cause. A methodical investigation--including appropriate imaging studies and laboratory testing--can differentiate symptoms that are primarily occupational from those with associated medical illness or obesity. Syndrome DefinedA syndrome is a constellation of signs and symptoms useful in establishing a differential diagnosis and pointing the physician in the direction of an appropriate management plan. In the case of carpal tunnel syndrome (CTS), however, this definition is often forgotten. Indeed, clinical features suggestive of median nerve entrapment are often managed as a single entity that is assumed to have a clear, recognized etiology. Exhaustive research by George S. Phalen in the 1950s and 1960s, and others since then, has demonstrated that many common systemic conditions (e.g., diabetes mellitus, thyroid disease, rheumatoid arthritis, osteoarthritis of the wrist, gout, obesity, and even pregnancy) may provoke symptoms of hand pain, numbness, burning, or tingling with or without the additional impact of work-related trauma. Yet in today's medical climate, there is often a rush to judgment. Patients presenting with hand symptoms may be incorrectly diagnosed as having CTS caused by conditions in the workplace. Claims SkyrocketingSince 1985, when the U. S. Occupational Safety and Health Administration (OSHA) accepted that there were "traumatogens" in the workplace and demanded that repetitive motion disorders be reported, the recorded incidence of cumulative trauma disorders has skyrocketed. About 277,000 cases were reported in 1997, compared with fewer than 50,000 in 1985.CTS has been the fastest growing category, recently accounting for more than 40% of all work-related disabilities. An estimated 26,000 CTS patients in the United States undergo surgical decompression each year. Median time lost from work is about 32 days per patient, more than for any other cause, including back pain. Why so Much Lost Time?Undoubtedly, one reason why so much work time is lost is that treatment is often unsuccessful. Many patients either do not have CTS or have CTS as part of another, undiagnosed medical condition that accounts for most of the problem. The underlying condition usually is never addressed, largely because our workers' compensation system provides such powerful incentives for declaring any median nerve disorder to be job-related. In Nevada, for example, even a successfully treated case of occupational CTS may merit a permanent partial disability award of $25,000 or more. Since many patients presenting with hand symptoms are poorly paid factory or farm workers with no group health insurance, workers' compensation may represent their only hope of getting treatment. Consequently, the patient may file a claim even when the physician suspects that the real problem lies elsewhere. Patients who do not respond to basic measures such as splinting and anti-inflammatory medication ultimately may undergo decompression surgery--at considerable expense to employers and taxpayers. Causation IssuesFollowing on the work of Phalen, a number of investigators have suggested that occupation is more likely to be an aggravating factor than the primary cause of CTS.  When Peter A. Nathan and Richard C. Keniston studied cohorts of workers' compensation patients, industrial workers, and control populations in both the US and in both the United States and Japan, they found that variables such as age, obesity, wrist dimensions, and physical inactivity were stronger risk factors for CTS than workplace factors such as repetitious or forceful hand use.John R. Schottland and colleagues determined that median nerve conduction latencies were no different among poultry processing workers than among candidates applying for their same type of jobs. Nortin M. Hadler surveyed the world literature on the subject and concluded that all of the major studies describing a cause-and-effect relationship between work and CTS were seriously flawed.  These are many compelling reasons to question the validity of a CTS diagnosis being attributed to work related causes. For more information visit www.MedicalSystemsUSA.com
11/17/2012 in News
CDATA[Injured workers should know what rights they have and what limitations claims handlers have with regard to their claim of injury.  Many appropriate resources are available through the internet to assist injured workers with their Worker’s Compensation injury claim by providing information that is nonbiased and beneficial for all parties involved. The Department of Workforce Development provides information on their website which guides workers through the process.  This information is provided in a question and answer format and can be helpful to someone not familiar with the system. One can find information on filing a claim, the flow of a claim, returning to work, vocational resources available, claim denial, what to expect at a hearing, finding the employer’s worker’s compensation carrier,  and the rights and responsibilities of the injured worker. It is the best site our research has found to provide nonbiased information concerning an injured worker’s rights and responsibilities under Wisconsin Worker’s Compensation and can be found at the following address:  http://www.dwd.state.wi.us/wc/default.htm. Another good internet resource is the Wisconsin State Law Library at http://wsll.state.wi.us/topic/laborlaw/workerscomp.html.  This site contains a wealth of information on Wisconsin Worker’s Compensation geared to educate employees and employers alike in a nonbiased way through providing factual information about the Worker’s Compensation system.  It contains links to various sites, which direct to the Wisconsin Department of Workforce Development, the Wisconsin Office of the Commissioner of Insurance, and links to various Worker’s Compensation statutes and administrative codes.Workerscompensation.com provides Worker’s Compensation information, news, and contact information for employees, employers, insurers and medical providers.  On this site, rules, statutes, forms and professional help relate to workplace injuries and disabilities in the state of Wisconsin. Findlaw.com is also another resource for injured workers looking to obtain information about Worker’s Compensation.  The site provides an overview of Worker’s Compensation, benefits and returning to work, employer’s responsibilities and a frequently asked questions section. While the information provided on the site is great educational information, the goal of this website is to ultimately refer the injured worker to an attorney who can handle their case. All of these sites provide good information for an employee looking to obtain a solid education about the Wisconsin Worker’s Compensation system and their rights and responsibilities under Worker’s Compensation statutes and administrative codes. A multitude of websites are geared toward the topic of Worker’s Compensation, however many do not pertain to Wisconsin or Wisconsin law.  Additionally, it is sometimes difficult to navigate through information geared to assist employees versus information geared toward employers.  Certainly the majority of information provided on the internet for injured workers is geared to sell them a service.FOOD FOR THOUGHT:  It may be that many injured workers retain attorneys because they lack the necessary knowledge of the Worker’s Compensation system to confidently navigate themselves through the system.  Knowledge of the system and how it operates may actually serve to cost-effectively settle Worker’s Compensation claims.This knowledge can be a powerful tool in the quick resolution of claims.  It has been statistically proven that IME’s can help temper claims, closing them at a faster pace; but the knowledge in this scenario is often obtained on behalf of the employer/insurer.  It would be interesting to know what effect increased knowledge on behalf of the employee would have on the system. For more information please visit http://www.medicalsystemsusa.com
The ProblemThe incidence of low back and neck pain is pervasive throughout society and represents a major reason for time lost from work, costing the American economy billions of dollars per year between medical care, lost wages, and benefits. Most of these lost resources are utilized by a small minority of patients. Lost time due to occupational back injuries represents a challenge to the medical industry, and the insurance world to provide early, effective treatment. The proper approach is to provide cost effective care while improving the quality of patient care and facilitating a successful and quick return to activity by the patient.BackgroundMany patients with back problems seek early care with their primary care physician or medical generalist rather than enlisting the assistance of a spine specialist.  As a result, these patients are frequently treated symptomatically without the benefit of a defined algorithm for effective testing and treating. Studies such as MRI’s are frequently ordered when unnecessary, and patients can go weeks or months before a proper diagnosis is derived and appropriate treatment initiated.This approach is counterproductive in an industrial setting where the injured worker has a propensity for further injury and extended lost time from work, without effective care.GoalsThe goal for treatment in work related spinal injuries is to provide early intervention that identifies an accurate working diagnosis and is coupled with effective treatment modalities.  The evaluation of the patient must involve the use of established algorithms ordering tests only when necessary and avoiding wasteful testing that is not medically necessary, and does not alter the course of early treatment. Early control of pain along with effective mobilization of the patient through aggressive physical therapy provides the most effective means to quickly return patients to the work place.The ultimate goal is to return the patient to their previous level of function in society. Although it is not always possible to provide 100% resolution of the problem, it is possible to maximize one’s functional capabilities through pain control and aggressive rehabilitation. It is a well-documented fact that extended time lost from work decreases the likelihood of a successful return to the workplace.Types of Injuries and TreatmentThe overwhelming majority of injuries in the work place involve simple strains and strain type syndromes. These represent simple soft tissue related injuries that are time limited in scope and do not represent long term injuries. They are easily and effectively treated with proper early intervention. This includes interruption of the pain cycle while encouraging progressive activity levels to effectively and quickly return patients to the work place. This approach typically involves the prudent use of anti-inflammatory medication in conjunction with aggressive back reconditioning, streaming function, and strengthening.All too frequently, patients are placed on extended courses of passive modalities, which leads to extended time lost from work with further rehabilitation of the patient. Some patients develop disc related injuries, most typically a herniated disc. Most disc herniations can be treated nonoperatively and frequently improve in a period of 46 weeks. Treatment modalities again include the prudent use of medication, effective rehabilitation, and injection therapy for the control of pain. The only indication for emergent surgery involves progressive neurologic deficits.  In a select group of patients, comprehensive nonoperative treatment fails requiring surgical intervention.The advent of microsurgical procedures of the spine represents a major advance for the treatment of herniated discs. This is typically undertaken as an outpatient procedure with early mobilization of the patient, facilitating early active rehabilitation. Patients typically are successfully returned to work in a limited capacity soon after surgery with improved long term results. The combination of outpatient surgery coupled with early aggressive rehabilitation results in significant cost savings to the carrier.Failed Back SurgerySurgery should only be undertaken when there is effective correlation between a patient’s complaints, physical examination, and imaging studies. The absence of complete correlation of all factors significantly decreases the likelihood of a successful surgical outcome. Failed back surgery represents a major proportion of expense in the treatment of work related injuries.  The greatest likelihood of success is with the initial procedure. Revision spine surgery holds a more guarded prognosis and should only be undertaken by those who are highly trained in this more demanding procedure.RehabilitationEarly mobilization of the patient in conjunction with control of pain represents the cornerstone of treatment. The initial step is to obtain a pain free range of motion followed by back strengthening and reconditioning. The goal is to ultimately return the patient to prior functional levels and minimize the likelihood of recurrent injuries.ConclusionThe effective treatment of back related injuries involves the coordination of care by a spinal specialist trained in the effective diagnosis and treatment of spine related injuries. Early intervention resulting in an accurate working diagnosis, coupled with well-trained academic decision making, is the most effective way to return patients to their pre-injury level of function.Coordination of care with the case manager, clinical specialist, and employer is mandatory for a successful outcome. If things are not working within the timeframe originally projected, or there are other unresolved issues pushing end of healing out further than expected, an IME may be indicated. For more information please visit www.MedicalSystemsUSA.com

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