Continuing Coverage: Doctors Discuss the Role They Play in Pain Treatment for Injured Workers

In Continuing coverage: KX News has been reporting on the number of opioids prescribed to injured workers for months. 

The narcotics given to these injured workers are funded by North Dakota Workforce Safety and Insurance. 

This is not just a state problem, but a prescriber problem as well.

In the past few months, we’ve sat down with WSI. We’ve heard from lawmakers and lobbyists about failed legislation that they hoped would lessen the number of opioids prescribed. And, of course, we’ve heard from several workers who feel they have no other options for pain management after years of doctors visits and multiple injuries.

Today, we hear from doctors on their responsibility to patients, and what kind of alternatives are truly being offered.

Sanford Pain Management Physician Laura Matzke says, “It doesn’t matter whether they are workers’ compensation, a Blue Cross patient, a Medicaid patient…”

Dr. Matzke says it’s a doctor’s responsibility to discuss alternative treatment methods with every patient,
as well as any risks associated, especially with narcotics.

She adds, “There always has to be a discussion that these medications can be very sedating, they can also alter mental judgment to the point where you may not be able to go back to work.”

Dr. Matzke has worked with many WSI clients after a work-related injury.

She says WSI is open to alternative treatment, including acupuncture and psychotherapy.

She explains, “When you light up the pain processing center of the brain, the emotional processing center lights up just as hard, if not harder.”

Like Dr. Matzke, CHI Family Physician Laura Archuleta believes opioids have their place, but she says she rarely prescribes them for chronic pain. This includes her patients, covered under North Dakota Workforce Safety and Insurance.

Dr. Archuleta explains, “With chronic pain, there’s a disconnect in the brain. So the body has the sensation of pain, but there isn’t the underlying injury. At least not to the degree that the brain is telling you that. So that’s where we get into trouble with opioids for chronic pain because we’re protecting something that is actually a short-circuit kind of thing in the brain.”

Dr. Matzke adds, “There’s a ceiling with these drugs, and if you’re starting them on someone who’s 26, there’s a long time for that person to get addicted to that medication.”

Dr. Matzke says it’s also a cultural issue. Between prescribers, influencing drug companies and patients, she says there is a societal belief that, ‘If I’m in pain, someone needs to fix it.’

She explains, “There aren’t many other industrialized countries in the world that have that same mindset. So as a result of that, we’ve gotten to the point where we’re over-treating pain. And as a consequence of that, we’ve come into this opioid epidemic.”

Dr. Archuleta shares, “There’s become an expectation that we as physicians have a responsibility to treat our patients and to some degree, to keep them happy. So I think it’s kind of a change in thinking that needs to happen on both sides.”

Dr. Matzke says the solution to this crisis will come from educating prescribers about the risks of opioids and of alternatives, as well as honestly managing patients’ expectations when it comes to their level of pain.

Dr. Archuleta says doctors need to start thinking outside the box, and always look for alternatives for chronic pain. 

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