The balance of providing quality care

By Dr. Stephen Woods, BWC Chief Medical Officer

Many of our medical initiatives at BWC focus on musculoskeletal care. Opioid analgesics tend to be a significant part of musculoskeletal care. In addition to my administrative role as BWC’s CMO, I also practice in a musculoskeletal clinic and see a variety of patients with joint and back conditions.

Opioids are now considered to be more aggressive than conservative care. My approach is to begin with conservative treatment. The key is to balance the risk/benefit ratio for each patient individually. The vast majority of sprains and strains can be managed without opioids. However, customized care is important – if a patient is writhing in pain with a major fracture or spinal disc herniation or other major trauma, most would tend to treat those conditions acutely with opioids, and appropriately so. Later in care, when the patient’s symptoms are better controlled, the risk of opioids goes up as far as duration of prescribing and dosing. Longer duration and higher doses tend to be riskier. Again, the risk/benefit analysis is important to strike the right balance.

I know firsthand how tough that balancing act is with addressing short term pain management and the longer term risk of addiction. That risk is very real. Ohio has been active in establishing guidelines to help providers with their awareness of the latest tools in balancing the risk. This all started in 2011 with Governor Kasich’s Cabinet Opiate Action Team (GCOAT), where John Hanna, BWC’s pharmacy director, and I have held seats over the years. GCOAT first focused on emergency room guidelines, and then released guidelines that addressed chronic pain management and most recently released guidelines for acute prescribing.

I encourage my colleagues to review these guidelines as they work through the challenging balancing act of providing the right care at the right time for the right reason.

I also encourage you to learn more about pain management by attending BWC’s Medical & Health Symposium in March, which will cover clinical care, regulatory issues and ethics, among other areas. The symposium offers free educational opportunities for physicians, nurses and chiropractors, and will feature several leading national and state experts in the area of pain management. Bonnie K. Burman, Director of the Ohio Department of Aging and a leader of the GCOAT, will also speak. After hearing the speakers, we expect providers will find that compliance is easier than they think and that there are many tools that make the balancing act much less difficult.

I encourage my colleagues to join BWC in our pursuit of providing world class care to Ohio’s injured workers.