Workers’ Compensation Pain Medication Guidelines Attorneys Buffalo, NY

A workplace injury can lead to many new and unexpected expenses. One of the most prevalent financial burdens an injured work must endure is the cost of medication, which is needed to help recover from an on-the-job injury as well as manage the pain that the injury is causing.

New York State’s workers’ compensation benefits include coverage of medication expenses. While medication costs may be covered by workers’ compensation benefits, claimants are subject to insurance carriers specifying the pharmacies that can be used and well as New York State enforcing specific guidelines on medication treatment.

The information on this page provides details on New York State Workers’ Compensation Board’s medication treatment guidelines, which address medication for acute pain caused specifically by neck injuries, back injuries, shoulder injuries, or knee injuries. In addition, there is information regarding chronic pain guidelines, which include rules on treating non-acute pain with opioids.

Lipsitz Green Scime Cambria has a department dedicated to fighting denied medication coverage for workers’ compensation clients.  If you have been denied coverage for medication or have any questions, contact Lipsitz Green Scime Cambria today.

Medical Treatment Guidelines

Neck Injuries

Acetaminophen: Acetaminophen is often recommended for treatment of neck pain, particularly for those with contraindications for NSAIDs. The optimum duration for pain management with acetaminophen is seven to ten days. Chronic use may be appropriate in certain cases.

Narcotics: These medications should be reserved for the treatment of severe neck pain. If the pain is mild to moderate, narcotics should be used on a case-by-case basis. The Workers’ Compensation Board recommends that they be prescribed with strict time, quantity, and duration guidelines. The optimum duration for taking narcotics is 3 to 7 days with a maximum duration of 2 weeks, except in appropriate cases. Any use beyond this maximum duration should be documented and justified, as narcotics have physically addictive properties and can cause withdrawal symptoms if abruptly discontinued.

NSAIDs: NSAIDs are recommended as first-line medications in the treatment of neck pain. Chronic use of NSAIDs is not recommended, but it may be viable in certain cases.

Muscle relaxants: Muscle relaxants are recommended as a second-line treatment for select cases of moderate to severe acute neck pain. The Workers’ Compensation Board recommends that these medications be taken in small doses. The optimum duration for taking muscle relaxants is one week with a maximum duration of two weeks, except in appropriate cases.

Steroids: Glucorticosteroids are recommended for treatment of acute severe radicular pain. One course of five to 14 days of oral treatment is recommended. If additional treatment is needed, the Workers’ Compensation Board recommends epidural injections. Intravenous steroids are not recommended except in an acute pain emergency.

Topical treatments: Capsaicin and topical NSAIDs are considered to be safe alternatives to systemic NSAIDs when treating neck pain. The optimal duration of capsaicin treatment is one to two weeks to determine its effectiveness. A four week trial period of topical lidocaine may also be considered if there is a diagnosis of neuropathic pain. Topical salicylates or nonsalicylates can also be used for a short-term course.

Tramadol: Tramadol has been shown to provide neck pain relief similar to the relief provided by NSAIDs. The maximum duration for tramadol treatment is two weeks, although use beyond two weeks is acceptable in appropriate cases. It is not recommended for those with prior opioid addiction, as it has physically addictive properties. Withdrawal symptoms may accompany abruptly ending treatment with tramadol.

Back Injuries

Acetaminophen: Acetaminophen is effective and recommended for treatment of back pain both with and without radicular symptoms, particularly if there are contraindications for NSAIDs. The optimum duration of treatment with acetaminophen is 7 to 10 days with a maximum duration determined on a case-by-case basis.

NSAIDs: NSAIDs are recommended as first-line medications for back pain. Chronic use is not recommended, but may be appropriate in certain cases.

Opioids: Opioids should be reserved for the treatment of severe back pain except in certain cases. The optimum duration of treatment is 3 to 7 days with a maximum duration of two weeks. These guidelines should be followed strictly, except in certain cases, due to the addictive nature of the medication.

Muscle Relaxants: Muscle relaxants are recommended as a second- or third-line treatment for some back pain. The optimum duration of treatment is one week with a maximum duration of two weeks.

Steroids: Glucorticosteroids are recommended in certain cases of acute severe back pain for short-term relief. One course of 5 to 14 days of oral medication is recommended. If additional treatment is needed, injections may be a viable option. Intravenous steroids should only be used in case of an emergency and their use should be confined to a hospital setting.

Topical treatments: In certain cases, topical pain management is a viable option for treating back pain. Capsaicin can be used as an alternative to NSAIDs and should be used for one to two weeks to determine effectiveness. Topical use of NSAIDs can also be considered if oral treatment is contraindicated. Topical salicylates or nonsalicylates may be used for a short term course.

Tramadol: When treating back pain, tramadol can be used in place of NSAIDs. The maximum recommended duration of treatment is two weeks, although this can be extended in certain cases.

Shoulder Injuries

Acetaminophen: Acetaminophen is accepted as an alternative to NSAIDs for shoulder pain. The optimum duration of treatment is 7 to 10 days and the maximum duration is determined on an individual basis.

Hypnotics: Hypnotics may be given to those with shoulder injuries if they complain of an inability to sleep. The optimum duration of this treatment is one week with a maximum duration of two to three weeks. These medications have addictive properties so their use should be monitored carefully.

Narcotics: Narcotics should be reserved for severe shoulder pain and prescribed with strict time, quantity, and duration guidelines due to the medication’s physically addictive properties. The optimum duration of treatment with narcotics is 3 to 7 days with a maximum duration of two weeks unless otherwise determined.

NSAIDs: NSAIDs can be useful for combatting shoulder pain and inflammation. They are recommended as a first-line treatment. Chronic use is not generally recommended but may be employed in select cases.

Topical treatments: In select patients, topical treatments for shoulder pain can be beneficial. Capsaicin can be used in place of systemic NSAIDs for one to two weeks, but long-term use is not recommended. Topical NSAIDs may also be used when systemic administration is not an option. Topical salicylates and nonsalicylates can be used for a short-term course, as well.

Tramadol: Tramadol can provide pain relief similar to that provided by NSAIDs. The maximum duration of tramadol treatment is recommended to be two weeks, although that may be extended in certain cases.

Knee Injuries

Acetaminophen: Acetaminophen is effective for relieving knee pain, although research shows it is not as effective as NSAIDs. The optimum duration of treatment with acetaminophen is 7 to 10 days and chronic use should be determined on a case-by-case basis.

Narcotics: Narcotic use should be reserved for severe knee pain. The optimum duration of pain management with narcotics is 3 to 7 days with a maximum duration of two weeks. Narcotic use should be monitored closely as these medications have addictive properties.

NSAIDs: NSAIDs are considered to be a first-line treatment for knee pain. Chronic use is generally not recommended but may be appropriate in certain cases.

Topical treatments: Topical pain relief can be an appropriate knee pain treatment option for certain patients. The use of capsaicin for one to two weeks can be a safe and effective alternative to systemic NSAIDs. Topical NSAIDs have also proven to be effective, as have topical salicylates and nonsalicylates, although the latter two options should be used for a short-term course.

Tramadol: Tramadol may be used to relieve knee pain. The maximum recommended duration for tramadol treatment is two weeks. Tramadol usage should be monitored, as the medication has physically addictive properties.

Chronic Pain Guidelines

The Non-Acute Pain Guidelines are effective for dates of treatment on or after December 14, 2014. These guidelines detail several things, including methods of pain management, patient evaluation, and general guideline principles and recommendations for those suffering from a workplace injury or illness. Below is a brief summary of some of these guidelines. For the full Non-Acute Pain Medical Treatment Guidelines, please visit the Workers’ Compensation Board Website.

Opioid Treatment

In order to begin treating non-acute pain with opioids, the Workers’ Compensation Board recommends a trial period in order to see if increased function and decreased pain occur with the usage of opiates. When considering treating pain with long-term opioid use and before beginning this trial period, physicians should ensure that other pain management regimes have failed. A successful trial is one that has lasted for 30 to 60 days and has resulted in:

• Improved function, either by the patient’s ability to return to work or an increase in their daily living activities,
• At least a 30% reduction in pain,
• No significant adverse side effects, and
• No aberrant drug-related behaviors.

If these goals are not met, the trial should be discontinued and alternative pain management measures should be explored.

For patients who have already been prescribed opioids for long-term pain management, a reassessment of the treatment is recommended in order to transition to the new guidelines. The goal of this reassessment is not to discontinue the treatment; if you are denied your opioid prescription, be sure to contact an attorney who will be able to obtain the medication you need. Your physician is responsible for monitoring the safety and effectiveness of your opioid treatment. It is recommended that you be prescribed the lowest possible effective dose and that you are limited to being prescribed a maximum of two opioids at a time.

When optimizing opioid treatment for long-term pain management, a physician should take a number of factors into account. These factors include:

• The patient’s function and pain status,
• Possible adverse effects of the medications,
• The age of the patient,
• Any possible psychiatric disorders that may affect treatment,
• Conditions such as COPD or sleep apnea, which may lead to adverse effects when combined with opioids, and
• Drug combinations that may lead to adverse effects, such as the interaction between opioids and sedative-hypnotics, benzodiazepines, or barbiturates.

If there is any evidence of adverse effects, you may need to taper or discontinue your usage of opiates. Inpatient treatment for addiction or drug tapering may also be required.

Non-Opioid Treatment

In the event that opioid treatment is not recommended for treating your long-term pain, there are non-opiate medications that may be appropriate for pain management. Some of those medications are listed below.

Acetaminophen: Acetaminophen is generally regarded as effective and well-tolerated for long-term pain management. It is, however, associated with liver toxicity if the recommended daily dose is exceeded. Except if otherwise indicated, the Workers’ Compensation Board recommends that the daily dose not exceed 3 grams every 24 hours.

NSAIDs: Although NSAIDs are generally not recommended for chronic use, they are useful and may be the only drug required for pain management in certain cases.

Skeletal muscle relaxants: Skeletal muscle relaxants are useful for managing pain due to acute musculoskeletal injury or the exacerbation of such an injury. However, due to the habit-forming nature of these medications, they are generally not recommended for chronic use.

Topical drugs: Some topical treatments may be acceptable for certain patients, but the Workers’ Compensation Board recommends that these treatments be used episodically as the long-term effects are currently unknown. Capsaicin is considered a safe and effective alternative to systemic NSAIDs, but long-term use is not recommended. Lidocaine is recommended only if there is a diagnosis of neuropathic pain. A trial period of at most 4 weeks with documentation of functional gains is required as a criterion for additional lidocaine use. Topical NSAIDs are a viable option and may achieve therapeutic levels of pain management. Topical salicylates and nonsalicylates have been proven to be about as effective as topical NSAIDs and are useful in the short-term for patients who have contraindications with systemic medication.