1. Bruno Kovacic RN CECD CET
MANAGING CHRONIC PAIN IN THE WORKPLACE THE TALE OF 1,000 CHRONIC PAIN PATIENTS
Presented By:
Bruno Kovacic RN CECD CET
Sr. Work Restoration Analyst
BioFunction® LLC

2. OUR EXPERIENCE
BioFunction® – Chronic Pain Restoration Company Founded in 1998
We are a Peer-Reviewed, Published, Researcher in Chronic Pain Work Restoration (IARP; The Rehabilitation Professional; January 2008)
Our Outcome Studies Now Exceed 1,000 Restoration Patients – A Major Research Benchmark & Industry First!

3. OUR SERVICES Muscle Strengthening Program (Acute Pain)
45 Min Sessions / 2X Per Week 3 Weeks Duration
Work Capacity Evaluations (Baseline Testing)
5-6 Hr Objective Physical Performance Testing
Chronic Pain Work Restoration Program (Chronic Pain)
4-Hr Sessions / 2X Per Week Weeks Duration

4. Highest, published, verifiable positive outcomes for:
OUR OUTCOMES
Highest, published, verifiable positive outcomes for:
Return-To-Work,
Full Duty, &
Chronic Pain Work Restoration (Chronic Pain Restoration; 2015 Outcome Study)

5. Chronic Pain Treatment Guidelines
WHAT IS CHRONIC PAIN
“ANY PAIN
that persists BEYOND
the time of anticipated HEALING”
California Medical Treatment Utilization Schedule
Chronic Pain Treatment Guidelines
Effective July 18, 2009

6. CHRONIC PAIN
Leading cause of disability in US (The American Academy of Pain Medicine)
Affects over 100 million adults (Institute of Medicine; 2011)
Cost $635+ billion annually (American Pain Society Study; 2012)

7. THE WORKPLACE IMPACT
$61.2 billion was due to lost work productivity (American Academy of Pain Medicine; 2003)
76.6% of this was due to reduced work performance, not absence from work
Does not include pain-induced disability with continuous absences of one week or more
83.4% of California’s federal SSDI recipients are “disabled workers”

8. THE SOCIETAL IMPACT
14 million new SSDI enrollees in last 8 yrs (Social Security Administration)
SSDI Fund will be insolvent by end of 2016
40% estimated to be “fraudulent”
(Government Accounting Office)

9. THE ROAD AHEAD (Poll; ABC News - USA Today - Stanford Medical Center; 2005)
More than 50% of Americans live with chronic recurrent pain
40% of Americans report REGULAR pain that interferes with their:
Mood,
Activities,
Sleep,
Relationships,
Ability to work, &
Enjoyment of Life
67% of the population already report interference in one of these areas

10. THE BOTTOMLINE “CHRONIC PAIN” We need to get serious about addressing
It is devastating the economic fabric of our society!

11. CHRONIC PAIN IS DIFFERENT THAN ACUTE PAIN
Acute pain is a crisis of the body (tissue related)
Chronic pain is a crisis of the “self” (body, mind & spirit relationships)

12. ACUTE VS CHRONIC PAIN CHRONIC PAIN ACUTE PAIN
Primary reason a patient goes to a doctor
Triggers treatment-seeking behaviors
The goal is to have pain go away
Patients seek a return to their normal lives (primary gain)
CHRONIC PAIN
Distortion of “self” because pain FAILED to go away
Poorly understood & many misconceptions exist
Triggers delayed recovery
“Disabled” rather “Injured”
Secondary gain motives emerge (both conscious & unconscious)

13. UNRELENTING PAIN Causes patients to lose hope & self-control
It triggers “suffering” reactions that amplifies pain intensity (psychosocial overlays)
Suffering reactions are not psychiatric conditions… They are simply poor pain coping abilities

14. THE LOSS OF SELF-IMAGE Our Self Image Before We Get Hurt The MMI
Image Gap
Our Self Image After
We Get Hurt
Our Job Image Is Here

15. The Patient’s Reactions The Clinical Presentation
PSYCHOSOCIAL CASCADE
The Patient’s Reactions
The Clinical Presentation
I’m Afraid
I Don’t Think I Can
It’s Too Hard To Do
I Can’t Do It
There’s No Help
Hope Is Lost
I’m Done
Nothing Works
Physio-Behavioral Pain Responses
Harm Avoidance Behaviors
Activity Avoidance Behaviors
Catastrophizing & Somatization
Disability Mindedness
Functional Disability Mindset
Secondary Gain Motives Dominate
Uncooperative Malingering Behaviors

16. CROSSING THE THRESHOLD
Acceptance is the primary barrier to recovery
Chronic pain necessitates major life adjustments
Patients who deny chronic pain accelerate treatment-seeking behaviors even though these same treatments failed in the past

17. NEUROSCIENCE & PAIN
Pain does not influence our ability (strength) to work
Pain does influence our motivation (desire) to work
Pain is interpreted by the brain but is felt in the body
Pain is a “result” (not the “cause”) of an injury

18. PAIN & THE BRAIN Motion Sensation Memory Thoughts, Beliefs & Emotions
Our Ability To Move Even With Pain
(The More We Move The Better We Feel)
Sensation
The “Ouch” Part
(Pain Intensity)
Thoughts, Beliefs
& Emotions
Determines The Meaning Of Pain & Our “Worry” Factor
(Our Ability To Cope)
Memory
Uses Our Past Pain Experiences To Guide Our Present Behavior (Pain Vigilance)

19. Which Person Has A Level “8” Pain?
POP QUIZ!
Which Person Has A Level “8” Pain? A B C

20. RESTORATION METHOD Enabling Disability (I Can’t) Is Not Compassion…
Empowering Capability (I Can) Is!
Turn The “I Can’t” Belief Back Into An “I Can” Mentality
Restore Lost Strength & Endurance
Reduce & Eliminate Psychosocial Suffering Barriers

21. STEP 1: GET A “WORK” CAPACITY EVALUATION
I knew it. It’s only 17 inches…
I told you I couldn’t lift 20 pounds!
Objectively Measure Existing Strength & Endurance
Compare It To The Physical Demands Of Their Job
Identify Work Deficiencies & Recovery Barriers, If Any!
And Range of Motion Has Very Little To Do With Strength Capability!

22. EVIDENCE-BASED WORK SIMULATION
The OBJECTIVE separation of:
Muscle strength & endurance,
Pain reactions,
Psychosocial overlays, &
Motivation
Based on physics, not guesstimates, of work capability!

23. BIOFUNCTION®’S WORK CAPACITY EVALUATION OUTCOMES
Demonstrate:
67.1% of cases were eligible for immediate case closure
Full Duty
MMI
Motivation Barriers
32.2% needed a short, but intensive, chronic pain work restoration program

24. STEP 2: RESTORE WORK FUNCTIONS
Fix “True” Deficient Work Motions
Improve Pain & Motion Integration
Improve Behavioral Reactions To Work

25. CHRONIC PAIN REHAB COMPONENTS
Aggressive Work
Simulator Exercises
To change tissue structure, &
To collateralize lost work function +
Pain Coping Skills
Training
To Improve exercise tolerance,
To rebuild mental resilience
To reduce suffering reactions, &
To repair self-image

26. WHY USE AGGRESSIVE MOBILIZATION?
Simply, because it works!
100% improve to a more functional level,
73.5% restore back to full duty, and
The age of the case doesn’t matter!

27. WHICH BUILDS STRENGTH & ENDURANCE BETTER?VS
COMPUTER-PACED
AGGRESSIVE MOBILIZATION
MANUAL PHYSICAL
THERAPY GYM CONDITIONING

28. IF WE FAIL… OR TREATMENT IS DENIED!
The consequences can be harsh:
Loss of income / employment
Broken family relationships
Wealth, savings & retirements are depleted,
Employers lose productivity & knowledge base
Some patients face dire personal peril (suicide)
State & federal disability rolls escalate

29. WILL THIS BE OUR “OPIATE” ALTERNATIVE?

30. Prevention Is The Best Medicine
HOW EMPLOYERS CAN HELP
Prevention Is The Best Medicine
Discuss safety concerns & the physical demands of work
Maintain the injured worker’s social work connection while recovering
Discuss with the employee & their claims adjuster how their progress toward full duty is going
Reinforce the expectation that you want them back as soon as possible
Offer & encourage “wellness” programs (self-empowerment) to all employees

31. HELPING THE MEDICAL PROVIDERS
Ask your medical providers to address “chronic pain” issues early
Support the medical providers requests for proper testing & work restoration
Let the claims adjuster know you desire expedited patient recovery
When recovery goes off track because the employee is not actively participating in their care inform them that not getting well could mean losing their job

32. HELPING REHAB PROVIDERS
If PT is not effective after visits - ask for muscle strengthening
PT is for range of motion & flexibility only
If employees do not show for their treatment ask the claims adjuster to stop their TTD
Patients cannot get well if they do not go to treatment & it increases the providers cost of doing business
The Rapid, Yet Safe,
Restoration Of Function

33. HELPING CLAIMS ADJUSTERS
Discuss with the claims adjuster that the most important outcomes to you are:
Return to work,
Return to full duty, &
Positive sustainable restoration (“stay-at-work”)
If UR denies restoration – speak to a claims manager – tell them you want your employee restored as quickly as possible
PTPs have no control over treatment approvals - employees can’t get well without treatment - and you can’t just “grin & bear” chronic pain

34. HELPING NURSE CASE MANAGERS
60% of chronic pain restoration programs are denied by UR – get the Nurse Case Manager involved
Delaying & denying care simply does not work!
When cases stall ask the Nurse Case Manager to have the PTP get objective physical performance testing
Hold regular “chart reviews” with the Nurse Case Manager & Claims Adjusters – question any lack of progress

35. THANK YOU FOR ATTENDING!
Got Questions?
Contact Info:
Bruno Kovacic RN CECD CET
(408)
(408) fax