When you become injured on the job in Ohio, you expect to be able to receive any type of treatment you need. Say you were working on a construction site and hurt your back after a bad fall. You’re in excruciating pain and unable to work. Your doctor may say you need painkillers, or perhaps a life-altering back surgery.
Unfortunately, new workers’ care guidelines in Ohio are now saying an injured worker cannot receive some treatments like painkillers or spinal fusion surgery before trying other methods first.
These guidelines are meant to attack the problem of opioids in Ohio, but may create a few of their own problems along the way. Let’s take a look.
Ohio Back Surgery & Opioid Guidelines Explained
The new policy from the Ohio Bureau of Workers’ Compensation (BWC) went into effect Jan. 1, 2018. It requires an injured worker to complete 60 days of alternative treatment before opting for spinal fusion surgery. There are a few exceptions to this rule, like the most severe cases, but opioid use will be frowned upon during the alternative treatment period, as well.
Types of alternative treatment include:
- Physical therapy;
- Chiropractic care;
- Anti-inflammatories;
- Ice;
- Rest; and
- Other non-surgical methods, such as spinal manipulation therapy, acupuncture, and cognitive behavior theory.
Those exempt from the new rule include people facing serious injury, such as:
- Spinal fractures;
- Tumors;
- Infections; and
- Functional neurological deficits.
The Associated Press notes that this is a more aggressive approach than other states are taking due to the opioid clause. One spinal surgeon, however, said the new Ohio rule is too broad and will result in more hurdles than necessary to treat back injuries. For one, more time will be spent with workers taking two months to explore other treatment options rather than getting pain relief right away with a lumbar fusion. In addition, workers will spend more money on the required alternative treatments before they even get to the operating table.
Delaying treatment, of course, could also make an injury worse and lead to potential legal claims.
However, the BWC has been vocal in wanting to spend less on opioid treatment. Some spinal fusion surgeries are ineffective and the worker becomes more dependent on painkillers after surgery than before. Many people also never return to work.
Terrence Welsh, BWC chief medical officer, told the AP:
“We now have better knowledge of who responds better to surgery, and we also know that some patients actually require more opioid medication after surgery than they did before surgery.”
See also: Ohio Construction Workers and Opioid Death Rates
How effective are spinal fusion surgeries?
By now, you may be wondering what exactly goes into a spinal fusion surgery and why they are such a big deal in workers’ compensation claims. In a spinal fusion, two or more vertebrae are joined together to stop slipping of affected vertebrae, usually due to herniated discs, spinal stenosis, scoliosis, or spondylolisthesis. This is accomplished using a bone graft, screws, plates, cages, or rods, making the vertebrae stable but immobile.
When undergoing a bone graft, the patient will need two surgeries: one at the site of where the bone is being grafted, such as from the hip or pelvis, and the other at the site of the affected vertebrae. Risks in a spinal surgery include infection, damage to the spinal nerve, or wearing away later of the surrounding vertebrae, which may result in more problems.
People with chronic back pain before surgery are likely to still have some after a spinal fusion. It’s also difficult for a surgeon to predict before surgery how much a patient will improve, so you’re rolling the dice when you decide to go under. One of the biggest issues, however, may be the stress put on the spinal column above and below the fusion.
The outcomes of spinal surgeries are not often comprehensively reported outside of clinical trials. Of those outcomes, the benefits of surgery are small — not all patients benefit, so they must be carefully selected. In one study, fusion was found to be no more effective than cognitive therapy and exercises, but other studies found spinal fusion did make a difference. Yet even in one of those pro-lumbar studies, only 29% of patients found themselves to feel “much better” after surgery and no patient was reported to be free of pain completely.
Alternatives to Pre- and Post-Operative Pain
Researchers in Ohio are working on alternatives to opioids after surgery, which could fix some of the issues seen with lumbar fusions. Additionally, Medicaid is opening up coverage in several states for alternative treatments for pain, including acupuncture, massage, and yoga.
Non-Opioid Polymer Mesh
In late 2017, the University of Akron shared in $10 million in grant money to explore new methods of pain relief. One polymer scientist at the university is testing dissolvable polymers containing non-opioid drugs that would be inserted after a surgical procedure. The mesh is considered targeted pain relief and creators hope it’ll be on the market in a year or so.
Of course, part of the grant money came from pharmaceutical giant Merck, whose own products have been under fire in recent years with lawsuits against its defective products, including the Zostavax vaccine, the Fosamax osteoporosis drug, and the Nuvaring contraceptive. The University of Akron and Merck are working together on experimenting with seven non-opioid drugs for the polymer mesh.
Medicaid Coverage for Acupuncture
Low-income patients on Medicaid may be able to get a little help in Ohio with alternative pain management. In 2017, coverage was extended for acupuncture done by non-medical providers to relieve lower back pain and migraines. Previously, acupuncture had only been covered by Medicaid when delivered by a physician and deemed medically necessary. Eleven other states also are expanding Medicaid coverage for alternative pain relief in an effort to combat the opioid crisis.
While proponents say this may decrease reliance on opioid painkillers over time, others say it may make these alternative therapies more expensive in the long run if the medical benefits don’t pan out. Acupuncture may offer only small, short-term benefits for those suffering from chronic back pain.
An acupuncturist who led a Medicaid study on alternative pain treatments and their results in Vermont notes:
“Acupuncture is not going to solve the opioid crisis. But acupuncture is one tool that helps patients. It helps them get their feet back under them.”
Getting Help When Injured on the Job in Ohio
At Plevin & Gallucci, we applaud any efforts to reduce the amount of people who are addicted to painkillers in the Buckeye State. We’ve worked to serve as local counsel on behalf of local governments that have been stretched thin in dealing with the opioid crisis and watched their residents needlessly suffer at the hands of a culture of addiction, overprescribing of medication, and deceptive marketing of these drugs by manufacturers.
However, we believe Ohio workers should receive prompt but proper treatment for their injuries. If a spinal fusion surgery is likely to be their best option to relieve pain, they should be able to pursue it without facing unnecessary hurdles.
If you’ve been injured on the job in Ohio, the experienced workers’ compensation attorneys of Plevin & Gallucci have nearly 50 years of experience fighting for your rights. Don’t be fooled — the Ohio BWC does not exist to serve workers, but to serve the insurance industry and its bottom line of keeping costs down. Contact us today for a free consultation to ensure you are getting the compensation you deserve.
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