3 minute read
Which Came First: The Accident or Injury?
from wph
Ankur Patel, D.O., RPH
Many things in the field of medicine are absolute. Black and white. Positive or negative. Hot or cold. However, when considering a workers’ compensation case, circumstances and the actual course of injury may not always be imminently clear.
When there is an accident or event that causes direct injury, questions can be answered in a straightforward manner. When the injured worker has a preexisting condition, the narrative and subsequent treatment require a degree of historical perspective.
In the state of Georgia, preexisting conditions are defined as “a medical problem that existed prior to the workrelated injury that is the reason for filing a claim.” Further, Georgia workers’ compensation laws allow aggravation of preexisting conditions due to work-related injuries to be covered by the workers’ compensation program.
From a pain management view, a preexisting condition often makes a workers’ compensation claim complex. Questions may arise such as:
• Is the injury truly preexisting? • Is it an aggravation? • Is it a side effect of treatment from other colleagues on the workers’ compensation medical team?
Claimants can have previous large joint (shoulder, knee, hip) injuries, degenerative disc disease, and systemic diseases, such as arthritis. The goal of the workers’ compensation treatment team is to return the injured worker to his/her pre-injury condition (baseline), not necessarily render the patient pain free. Many times, companies have completed pre-employment questionnaires, tests, and functional physical exams. It is helpful to have this information when patients are seen in the office as it can help determine the direction of care.
Patients sent to a pain management and spine physician who are being treated at a pain clinic prior to their work injury can be particularly problematic to treat. The physician must carefully evaluate their level of pain related to injury versus their baseline pain. Additionally, any interventional procedures performed must be evaluated carefully to account for a minimum level of pain the claimant is accustomed to without the current injury.
Pain management physicians must rely on prior medical data, detailed and extensive physical exam skills, and outside information such as surveillance, etc. Further, physicians must evaluate imaging such as MRIs and CT scans using “context clues.” For example, degenerative disc disease, lumbar facet arthropathy, and mild bulging discs are common findings on imaging. However, these findings usually are not related to an acute event/injury. Most likely, if there is pain associated with this particular region of the body, it is an aggravation of this pathology. If patients continue to have pain even after there has been treatment of the aggravation, a functional capacity evaluation may be warranted.
Deciphering preexisting versus current injury versus aggravation can definitely be confusing and a grey zone in many situations. Clinical judgment and objective data must be equally weighed.
Ankur Patel, D.O., RPH, is the founding/managing partner of Southern Pain and Spine Associates, LLC. He is a board-certified anesthesiologist, pharmacist, and fellowship trained interventional pain management physician. Dr. Patel is dedicated to advancing patient care to the highest levels via a conservative approach with medications while using his interventional pain management training. He is a graduate of the prestigious pain fellowship program at Texas Tech University Health Sciences Center in Lubbock, Texas. Southern Pain and Spine has locations in Athens, Gainesville, Jasper, Newnan, and Fayetteville.
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