The SIAA conference took place this past weekend in Washington, D.C. and there were a lot of interesting discussions and panels if you were lucky enough to catch them. While reading the post-conference news one panel that talked about over-diagnosis and chronic pain caught my eye. Chronic pain or back injuries can be lengthy and costly types of workers’ comp claims, but if they are over-diagnosed then physicians might not be getting to the root of the problem and that might not always result in a good outcome, or even the correct treatment for a patient.

A panel consisting of Dr. David Ross of NeuroPas Global LLC, Keith Rosenbloom of Lockton Companies LLC and Dr. Jennifer Christian of the Webility Corporation discussed the topic in their session “How Medical Red Herrings and Over-Diagnosis Drive Poor Outcomes and Big Losses”.

They noted that over the past two decades treatments for back pain have skyrocketed- with back surgeries increasing by 300 percent, spinal injections increasing 400 percent and opioid prescriptions increasing by 500 percent. They also noted that although we are a country which spends the most per person on healthcare yet we rank 37^th in the world for quality of care.

So what’s going wrong? Why aren’t patients getting better and why do these numbers continue to increase dramatically?

The panelists pointed to one common issue in which a patient is diagnosed with something that is not the root of the problem but presents similar symptoms. A patient may feel back pain but they can be misdiagnosed and given a treatment for a subsidiary condition that is not the true cause of their chronic pain. MRI readings can be misread due to factors from aging or other degenerative conditions and doctors rely on pain cues from the patient to diagnose. The speakers said the problem with relying on MRI tests to diagnose often leads to over-diagnosis and might not be the best thing for the injured worker. Back surgery may not be the silver bullet to fix back pain if doctors have not identified the real cause of pain.

In their report they cited a statistic from the American College of Occupational and Environmental Medicine (ACOEM) that states that only five percent of workers create 80 percent of the cost and lost time in workers’ compensation claims.

The panelists looked to the use of evidence-based medicine so that physicians can better understand what has worked in the past and pinpoint the real source of the pain or the problem rather than go on what can be misleading tests or what the patient tells them subjectively. They suggested that adjusters and other claims professionals look at all of their options and get a couple of evaluations before they approve a major surgery or other aggressive treatment.

They encouraged physicians to treat the cause of the pain rather than simply the symptoms, or risk a minor injury ballooning into a major claim when the patient is not correctly diagnosed or treated and their recovery is affected. They suggested that employers and physicians identify Bio Psycho Social Economic (BPSE) factors that could contribute to a claim’s success or downfall, and then put a plan in place to address those factors before the patient starts the healing process. Working with a patient on BPSE factors could help them to cope better and understand what’s going on with their injury and healing process.