Today’s post comes from guest author Kristina Brown Thompson, from The Jernigan Law Firm.
The North Carolina Industrial Commission recently joined many other states (i.e. Massachusetts) in tackling the issue of opioids in the workers’ compensation cases by creating a Workers’ Compensation Opioid Task Force. The goal of the task force is to “study and recommend solutions for the problems arising from the intersection of the opioid epidemic and related issues in workers’ compensation claims.” According to the Chair, “[o]pioid misuse and addiction are a major public health crisis in this state.”
As of last June, a study by the Workers’ Compensation Research Institute (WCRI) noted “noticeable decreases in the amount of opioids prescribed per workers’ compensation claim.” From 2012 – 2014, “the amount of opioids received by injured workers decreased.” In particular, there were “significant reductions in the range of 20 to 31 percent” in Maryland, Massachusetts, Michigan, Oklahoma, North Carolina, and Texas.
Additionally last March, the Centers for Disease Control and Prevention (CDC) issued new recommendations for prescribing opioid medications for chronic pain “in response to an epidemic of prescription opioid overdose, which CDC says has been fueled by a quadrupling of sales of opioids since 1999.”
Currently, the CDC’s recommendations for prescribing opioids for chronic pain outside of active cancer, palliative, and end-of-life care will likely follow these steps:
1. Non-medication therapy / non-opioid will be preferred for chronic pain.
2. Before starting opioid therapy for chronic pain, clinicians should establish treatment goals and consider how therapy will be discontinued if benefits do not outweigh risks.
3. Before starting and periodically during opioid therapy, clinicians should discuss with patients known risks and realistic benefits of opioid therapy.
Here’s another “helpful hint” about your own health, for attorneys and clients who may be tuning in to our blog. Nothing here directly related to workers’ compensation, except to the extent that overall good health can ward off injury and illness.
A Kansas State University study in 2013 concluded the people who sit for four hours or more each day are at a substantially greater risk for developing cancer, diabetes and heart disease. And the risk for degenerative disease continues to increase at a consistent rate for six hours, eight hours, and more, of daily sitting.
The further finding of the study was that the increased risk of disease was not correlated with high or low body mass index, meaning that outside factors, such as poor eating and other negative lifestyle habits are not nearly as significant as the risk factor of just sitting.
A report from Northwestern University earlier this year found that, over age 60, every additional hour spent sitting doubles the risk of becoming disabled. And, somewhat disappointingly, additional exercise has no impact on the disability risk. Australian researchers recently found that people whose job or other circumstances require prolonged sitting, but who just regularly stood up and moved around frequently, were better off than sitters who did 30 minutes of exercise each day.
None of the foregoing is intended to diminish the importance of regular exercise in our daily lives, but the lesson is: don’t stay chained to your desk and computer. Stand up and walk around when you’re on the phone, do laps around the office, walk to a coworker’s office instead of emailing – – do whatever it takes to get out of the sitting position as often as possible.
Your author manages his law firm mostly on his feet. After reading about the issue with sitting, he stood and walked, without sitting, for four hours at a firm event last week. (He’s now training himself to stand — and rock back and forth on his feet– for long periods when watching TV at home. Houseguests will be fully advised.)
Today’s post comes from guest author Rod Rehm, from Rehm, Bennett & Moore.
The issue raised by Mr. Rehm was investigated thoroughly in a book given to us by a client, an injured nurse who contributed her story to the effort under a pseudonym: Back Injury Among Healthcare Workers, published by Lewis Publishers. It is a great resource, providing case-studies, statistics and suggestions for improvements for workers in the healthcare field.
The article that today’s blog post is based upon is an in-depth look at how one state’s OSHA office interacts with a sector of the healthcare community: hospitals. Like Iowa, but unlike Nebraska, Oregon is one of 27 states or U.S. territories that has an OSHA office at the state level.
The “Lund Report: Unlocking Oregon’s Healthcare System” article talks extensively about nuances within ways that OSHA offices, whether state or federal, can measure the safety of healthcare providers like hospitals and nursing homes.
As evidenced in previous blog posts about senior-care workers and lifting injuries, I have continuing concerns for the safety of healthcare workers.
According to the in-depth article, “A Lund Report review suggests that in Oregon, regulators are de-emphasizing attention to hospital employee safety, despite national data showing that healthcare workers are injured in the U.S. each year at rates similar to farmers and hunters. Most Oregon hospitals have not been inspected by the state Occupational Safety and Health Division in years. And when on-the-job hazards are detected, Oregon’s OSHA office levies the lowest average penalties in the country.”
Should workers get lost as the patients are the focus of these healthcare institutions? Should regulation and inspections or fines by such groups as OSHA be the driving force toward workplace safety for healthcare employees?
It seems to me that healthcare administrators’ emphasis on profit is more important than proper concern for their employees – the nation’s caregivers. And if you or your family member is the healthcare worker who gets hurt on the job, this lack of focus on the worker is more than just a philosophical argument.
Thomas Holmes and Richard Rahe in 1967, examined the medical records of over 5,000 medical patients as a way to determine whether stressful events might cause illnesses. Patients were asked to tally a list of 43 life events based on a relative score. A positive correlation was found between their life events and their illnesses.
Their results were published as the Social Readjustment Rating Scale (SRRS), known more commonly as the Holmes and Rahe Stress Scale.
To measure stress according to the Holmes and Rahe Stress Scale, the number of “Life Change Units” that apply to events in the past year of an individual’s life are added and the final score will give a rough estimate of how stress affects health.
Note: the table, below, is from the Wikipedia page on this subject. For a fee of $5.00, you can go directly to Dr. Rahe’s website and obtain the full test materials as well as background information and details of this and other products and services available.
To measure stress according to the Holmes and Rahe Stress Scale, the number of “Life Change Units” that apply to events in the past year of an individual’s life are added and the final score will give a rough estimate of how stress affects health.
Life event
Life change units
Death of a spouse
100
Divorce
73
Marital separation
65
Imprisonment
63
Death of a close family member
63
Personal injury or illness
53
Marriage
50
Dismissal from work
47
Marital reconciliation
45
Retirement
45
Change in health of family member
44
Pregnancy
40
Sexual difficulties
39
Gain a new family member
39
Business readjustment
39
Change in financial state
38
Death of a close friend
37
Change to different line of work
36
Change in frequency of arguments
35
Major mortgage
32
Foreclosure of mortgage or loan
30
Change in responsibilities at work
29
Child leaving home
29
Trouble with in-laws
29
Outstanding personal achievement
28
Spouse starts or stops work
26
Begin or end school
26
Change in living conditions
25
Revision of personal habits
24
Trouble with boss
23
Change in working hours or conditions
20
Change in residence
20
Change in schools
20
Change in recreation
19
Change in church activities
19
Change in social activities
18
Minor mortgage or loan
17
Change in sleeping habits
16
Change in number of family reunions
15
Change in eating habits
15
Vacation
13
Christmas
12
Minor violation of law
11
Score of 300+: At risk of illness.
Score of 150-299+: Risk of illness is moderate (reduced by 30% from the above risk).
Score 150-: Only have a slight risk of illness.
Recommended methods for relieving chronic stress include exercise (which can be modified to accommodate physical restrictions after an injury), meditation, music therapy, breathing techniques, and such simple things as companionship – from a pet, friend or family member.
Stress is how the body reacts to a real or imagined stressor — a stimulus that causes stress. Acute stressors affect a bodily organ in the short term; chronic stressors over the longer term. Chronic stress is the state of prolonged tension from internal or external stressors which may cause various physical manifestations such as asthma, back pain, arrhythmias, fatigue, headaches, irritable bowel syndrome, ulcers, and suppression of the immune system. Chronic stress takes a more significant toll on the body than acute stress. It can raise blood pressure, increase the risk of heart attack and stroke, and induce symptoms of anxiety and depression.
The Three Stages of Stress – From Acute to Chronic
Alarm: In this first stage, when the threat or stressor is first identified or realized, the body’s stress response is in a state of alarm. During this stage, adrenaline is produced in order to bring about the flight-or-fight response, causing sweating, raised heart rate, etc. The body’s resistance to the stressor drops temporarily below the normal range and some level of shock may be experienced. There is also some activation of the HPA Axis, producing cortisol, as discussed in our last post.
Resistance: If the stressor persists, the body must find some means of coping with the stress. Although it begins to try to adapt to the strains or demands of the environment, the body cannot keep this up indefinitely, so its resources are gradually depleted. As it attempts to cope with the condition that is causing the stress, the mind may try to focus on the problem, which can actually exaggerate the awareness of the problem and make it seem difficult to overcome.
Exhaustion: third stage. At this point, all of the body’s resources are eventually depleted and the body is unable to maintain normal function. The initial symptoms may reappear (sweating, raised heart rate, etc.). Long-term damage may result, as the body’s immune system becomes exhausted, and bodily functions become impaired. The result can manifest itself in obvious illnesses such as ulcers, depression, diabetes, digestive system problems or cardiovascular problems. It can also manifest as a chronic pain syndrome, guarding/avoidance behavior, and/or sleep disturbance. Hopelessness can set in.
Chronic Stress and Cortisol
When the body’s HPA-axis cannot overcome a challenge and/or is chronically exposed to a threat, this system becomes overtaxed and can be harmful to the body and brain. An increased level of cortisol is one of the most dangerous outcomes of chronic stress.
Cortisol is an important hormone in the body, secreted by the adrenal glands and involved in some of the following functions: proper glucose metabolism, regulation of blood pressure, insulin release for blood sugar maintenance, immune function and inflammatory response. Normally, cortisol is present in the body at higher levels in the morning and is at its lowest level at night. Although stress is not the only reason that cortisol is secreted into the bloodstream, it has been termed “the stress hormone” because it’s also secreted in higher levels during the body’s ‘fight or flight’ response to stress, and is responsible for several stress-related changes in the body. Small increases of cortisol have some positive effects: a quick burst of energy for survival reasons, heightened memory functions, a burst of increased immunity, lower sensitivity to pain, and helping to maintain homeostasis in the body.
People are biologically ‘wired’ to react differently to stress.
While cortisol is an important part of the body’s response to stress, it is important that the body’s relaxation response be activated so the body’s functions can return to normal following a stressful event. Unfortunately, in our current high-stress culture, the body’s stress response is activated so often that the body doesn’t always have a chance to return to normal, resulting in a state of chronic stress, thus producing high chronic cortisol levels.
Higher and more prolonged levels of cortisol in the bloodstream like those in chronic stress have been shown to have negative effects, such as:
Impaired cognitive performance (loss or poor concentration, inability to complete tasks or heightened confusion in mildly stressful situations
Suppressed thyroid function
Blood sugar imbalancessuch as hyperglycemia
Decreased bone density
Decrease in muscle tissue
Higher blood pressure
Lowered immunity and inflammatory responses in the body, slowed wound healing, and other health consequences
Increased abdominal fat, which is associated with a greater amount of health problems than fat deposited in other areas of the body.
When people feel stressed, stress hormones can be over-secreted, dramatically affecting the brain. Cortisol also plays a large part in post-traumatic stress disorder (PTSD) and memory. In a 2002 article in Biological Psychiatry regarding cortisol, PTSD and memory1, cortisol was noted to work with epinephrine (adrenaline) to create memories of short-term emotional events. This effect may serve as a means to help a person remember what situations to avoid in the future. However, long-term exposure to cortisol damages cells in the hippocampus and can create impaired learning ability. It has been shown that cortisol inhibits memory retrieval of already stored information.
Cortisol secretion varies among individuals. People are biologically ‘wired’ to react differently to stress. One person may secrete higher levels of cortisol than another in the same situation. Studies have shown that people who secrete higher levels of cortisol in response to stress also tend to eat more food, and food that is higher in carbohydrates, than people who secrete less cortisol.
1“Depression. What happens in the brain?” Biological Psychiatry, 2002
