6th Annual EOOC/NSS Workers' Comp Seminar 2/26/2015 1 The Role of Adjuvant Medications in the Treatment of the Injured Worker Benjamin G Benner, MD, FACS

6th Annual EOOC/NSS Workers' Comp Seminar 2/26/2015

1

The Role of Adjuvant Medications in the Treatment of the Injured Worker

Benjamin G Benner, MD, FACS

Neurosurgery Specialists, Tulsa


2

Introduction Today we want to review the role

of traditional and non-traditional medications in the initial and subsequent treatment period.

Explore proposed mechanism of actions, effectiveness, complications, and costs

Place emphasis on the antineuritics class


3

General Treatment Options Accupunture Chiropractic Injections Medications Physical Therapy Surgery


4

Medication Classes

Anti-inflammatory Pain Relievers Muscle relaxants Tranquilizers Antidepressants Antineuritics Stimulants


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Anti Inflammatory

Work on a number of enzyme paths to reduce swelling and irritation.

Main side effects are GI irritation, fluid retention, and bleeding

Include steroidal (use only for short periods) and non-steroidal class.

Effectiveness varies and cost related more to newness


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Pain Relievers

Best in short term format. Problems with habituation and dependence. Work generally at the brain level to block pain

perception. Narcotic and non-narcotic classes Side effects may include impaired judgment,

increase risk of injury, reduced motivation. Costs are mainly related to the patent status

and newness or complexity of the drug


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Muscle Relaxants

Reduce muscle and ligament pain Reduce “tension” Variable costs Use with caution in the elderly Confusion Dizzyness Dryness and constipation


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Accupunture

Several review articles indicate a limited benefit for accupunture or accupressure.

Difficult to establish credentials or locate well trained practioners

Essentially no significant side effects


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Tranquilizers Represents multiple families of

medicines which all aim to reduce anxiety and agitation thus improving the effectiveness of other class medicines and healing.

Minor: anxiolytic Major: antipsychotic Variable cost Dependence and withdrawal

issues


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Anti Depressants

Since most injuries result in some element of diminished worth and future, depression is common.

A more positive outlook results in more patient engagement in care.

Some antidepressants actually have a specific pain relieving effect

such as Cymbalta.


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Anti Neuritics

Collection of anticonvulsants, analgesics, and vitamins which help neuropathic pain.

Most helpful in nerve injury, diabetic neuropathy, and radicular pain.

Common side effects include fatigue, weight gain, swelling.


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Stimulants

Have been shown to improve the effectiveness of pain meds when given together.

More common use is to combat the sedative side effects of other prescribed medication.

Has high abuse and diversion potential.


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Neurontin, (gabapentin)

90 % off label use Diabetic neuropathy Post-herpetic npathy Relatively cheap Rare dependence Slow habituation

Dizziness Fatigue Weight gain Peripheral edema Sexual dysfunction Watch with renal

impairment. $$ $250/mo


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Lyrica (pregabalin)

2nd Gen Neurontin Diabetic, post-herp Epilepsy Fibromyalgia Ca channel stabliz Small abuse

potential.

Dizziness Drowsiness Withdrawal symptoms Depression $$$ $230/mo Generic in 2018


15

Tegretol (carbamazepine)

Anticonvulsant Mood stabilizer Epilepsy partial Bipolar disorder Neuropathic pain Trigeminal neuralgia Stabilizes Ca channel $$ $100

Teratogenic Drowsiness Headache GI effects Blood dyscrasias ^ Hypothyroidism Requires lab tests ^ Myoclonis Stevens-Johnson


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CYMBALTA (duloxetine)

Major depression Generalized

anxiety disorder Neuropathy Fibromyalgia Stress

Incontinence SNRI action

Nausea Insomnia Withdrawal ^ Suicide < 25 yo $$$ $250/mo


17

Thank You For Your

Attention !

Questions ?

Samples ??

Documents

6th Annual EOOC/NSS Workers' Comp Seminar 2/26/2015 1 The Role of Adjuvant Medications in the Treatment of the Injured Worker Benjamin G Benner, MD, FACS