Mark's Musings - July 30

Below is an aggregation of the stories I posted on LinkedIn since my last edition. I curate them through the prism of an "intersection of chronic pain and appropriate treatment" and so they come attached with my opinion.

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You Don't Have to Hire the Psychologist, But You Must Understand the Psychology (926 views)

Ignoring the whole person often leads to sub-optimal outcomes (clinical & financial). Which means, ironically, that we end up paying for "psych." While the #BioPsychoSocialSpiritual treatment model can uncover and help address psychosocial co-morbidities, if done properly in the Work Comp context it's more about changing behavior than diagnosing "crazy." We are making progress, but not as much as needed. For example, I have been talking about the need for CBT (as part of the tapering process and at first red flags) since 2012. Within the past year I've mentioned it to an audience of approximately 300 people in CA, GA and NY. Half of the audience in CA said they paid for it. 5-10 people in GA and NY did. So the more we talk about it, and focus on the better clinical & financial outcomes that come from a whole person approach while comparing it to the negative impacts of over-prescribing Rx painkillers, more payers will jump on the bandwagon. Work Comp has for too long ignored the "whole person" for fear of what will then be included within the scope of the claim. At this point we know what happens when you do not address the "whole person" - nobody wins.

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Stuck in an opioid crisis, officials turn to acupuncture (363 views)

When in Columbus OH a couple of weeks ago I heard that #acupuncture is increasingly being used, or at least considered, in Ohio to help deal with the #opioid epidemic, especially for those going thru the weaning/detox process. From what I understand some of that is because of the local presence of the American Institute of Alternative Medicine and some of it is related to the city’s highly diverse population. That approach has been corroborated by New York's movement towards allowing acupuncture for injured workers (SB 6666 unanimously approved by both houses, ready for Governor signature). Also, just this week, by a reaffirmation from the California DWC that acupuncture was defined in 2007 and should still be evaluated as "medical treatment". Does including "acupuncture" and "workers' compensation" in the same sentence still sound weird to you? It shouldn't. This is part of the momentum towards non-opioid treatments for pain. Does acupuncture work for everyone? No. But neither does any other particular treatment. By considering acupuncture we are adding a potential tool to the physician's toolbox and a potential option to the patient.

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Neuroplasticity: Are You Making A Masterpiece or Mess of Your Brain? (377 views)

According to medicine.net, #neuroplasticity is "the brain's ability to reorganize itself by forming new neural connections throughout life." That means who you are now isn't who you will always be. And change happens, whether you're strategic about it or not. This article explains how there can be hope for those that need help: "Neuroplasticity works under the same conditions as physical exercise does for the body. A single Zumba class or one run is not going to make much difference. However, the same practices done with consistency, over time, will gradually have noticeable, lasting effects on your body. The same is true for the practices which shape your brain." So how are you re-training your brain? #Resilience #CleanUpTheMess Training your brain is just as important, and should be as much of a habit, as training your body. If anyone has ever driven a manual transmission car on the hills of downtown San Francisco, you know that you're always going either forward or backward. Your brain is the same - it's constantly changing. If you consciously manage that process by looking for positive inputs and dismissing negative inputs, you can make a significant difference.

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Purdue Pharma (2,527 views)

An interesting full-page ad in the Wall Street Journal on July 23. I don't disagree with anything they say. It would have been nice for them to have said this 20 years ago ... There were some comments that wondered whether this ad was related to the lawsuits that have been logged against Purdue Pharma. The cynical among us could certainly infer this is part of the settlement, or in preparation for negotiations. It's impossible to fully understand the motivation behind the ad. However, I found this Wall Street Journal article from January 23, 2003 entitled "FDA Orders Purdue Pharma To Pull Its OxyContin Ads" as a nice book-end to their "epiphany." I found another interesting article about a strategy by fellow opioid manufactures Endo Pharmaceuticals and Mallinckrodt LLC to "shift blame" in Kingsport TN by initiating lawsuits against illegal drug dealers. Needless to say, the activity around the opioid epidemic is nowhere near complete.

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National Safety Council's Prescription Drug Employer Kit (232 views)

I have posted this in the past but with new connections / followers thought now would be a good time to re-post. The National Safety Council has an excellent web portal for EMPLOYERS (yes, all caps, so you'd notice) about identifying, managing and mitigating prescription drug use/overuse/abuse in the workplace. They include help on drafting drug policies as well as educational resources for employers and employees. Given my focus on the #BioPsychoSocialSpiritual treatment model, I'm especially gratified they have unique brochures for the self management of pain, acupuncture and "alternatives" like CBT and exercise. It's almost like they've heard one of my presentations! Bottom line: If you're an EMPLOYER, use this resource.

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ACOEM: Defining Worker Well-Being – Experts Propose New Framework (260 views)

"Worker well-being" and "Total Worker Health" - what a novel concept! "The goal of helping workers to flourish is an occupational safety and health and population health endeavor worth pursuing" - You got that right! #CleanUpTheMess #BioPsychoSocialSpiritual The framework consists of:

• Workplace physical environment and safety climate — including physical and safety features of the work environment.
• Workplace policies and culture — organizational policies, programs, and practices with potential to influence worker well-being.
• Health status — factors related to individuals’ physical and mental health and welfare.
• Work evaluation and experience — perceived factors related to quality of work life.
• Home, community, and society — external factors affecting worker well-being.

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Why Attitude Is More Important Than IQ (360 views)

Why Attitude Is More Important Than IQ ... "People with a growth mindset believe that they can improve with effort. They outperform those with a fixed mindset, even when they have a lower IQ, because they embrace challenges, treating them as opportunities to learn something new." Do you have a "fixed" or "growth" mindset? High IQ + growth mindset = unstoppable. But, in reality, any brainwaves + growth mindset = unstoppable. That's because your mindset / attitude has a disproportionate impact on your +/- outcomes. Especially when it comes to managing chronic pain.

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Compassion Fatigue: The high toll of caring (1,142 views)

Whether you're a clinician or a caregiver, "compassion fatigue" (secondary traumatic stress) can be real. And negatively impact not just your ability to help but your ability to cope. The first step is awareness and recognition. Not only is this article helpful with an introduction of the concept and a Do and Don't list, but it also includes other helpful resources. Invest 17 minutes and please watch the TED talk about becoming self-compassionate caregivers ("on the road to healing" at 11:47). If you recognize warning signs in yourself or others, don't wait or hesitate - seek help. It's very difficult to help someone from a position of weakness.

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2018 CCWC Panel Discussion: Exploring the Impact of SB 1160 (178 views)

Excellent recap from Doug Benner and EK Health in regards to his panel at CCWC with Alex Swedlow, Roman Kownacki, M.D., M.P.H. and Rajiv Das. I was in attendance. Their collective experience in dealing with the CA drug formulary thus far in 2018 has matched the feedback I've heard as well as my own observations. While there are some positive trends after seven months of the drug formulary, it's waaaaaay too early to declare victory. Especially for those "legacy" claims that have been problems for payers and patients for months / years / decades.

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In addition, I published one blogpost:

• "Mark's Musings - July 23" on July 24

And a YouTube video of me was published by the Tennessee Department of Labor & Workforce Development, recorded just prior to speaking at their statewide conference on June 6:

• "Tennessee Workforce Weekly" on July 23

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"It's Never the Wrong Time to do the Right Thing" - Martin Luther King, Jr.

#CleanUpTheMess