Ask The Pharmacist: Six Ways to Shape Safer, More Effective Pain Care in Workers’ Compensation
Jonathan Rowell, Pharm. D.
Pharmacist, Clinical Operations
What emerging trends are influencing pain management approaches in workers’ compensation?
Pain management in workers’ compensation is continuing to shift as opioid prescribing declines and non-opioid alternatives gain traction. These changes reflect a growing emphasis on safety, function and evidence-based care, along with increased scrutiny of medication risk and cost. For adjusters, understanding these trends helps support safer recovery while managing claim complexity.
Require guideline-based care plans with measurable functional and return-to-work goals
Workers’ compensation pharmacy data show a clear drop in opioid prescribing. Even with this decline, opioids remain one of the most commonly prescribed drug classes, highlighting the complexity of pain management and the need for safer alternatives.
Reducing reliance on opioids lowers the risk of misuse, opioid use disorder, sedation and functional impairment, which helps injured employees return to work sooner. Require care plans that align with clinical guidelines and include measurable functional and return-to-work goals and monitor progress to ensure treatment supports recovery without added harm.
Prioritize non-opioid and multimodal approaches for chronic and complex pain
Other drug classes are gaining traction. One notable shift is increased use of topical analgesics. These agents, including creams and gels containing lidocaine, diclofenac or methyl salicylate, provide localized pain relief with fewer systemic effects and reduced addiction risk.
Industry reporting also points to growth in migraine medications, reflecting clinicians’ efforts to offer pain relief while avoiding the risks associated with systemic opioids.
Trade-offs remain. Topicals may not provide the same potency as systemic agents for certain types of pain, and per-claim spend on topical drugs has risen in some markets. Align medication selection with injury type, functional goals and expected duration of use.
Flag high-risk combinations, such as gabapentinoids with other sedating drugs
No drug class is risk free. Use of gabapentinoids, such as gabapentin and pregabalin, has increased despite concerns about sedative effects and potential interactions when combined with other central nervous system depressants.
These concerns have prompted regulatory scrutiny and audits in some states to confirm that formulary recommendations and prescribing practices align with safety standards, reinforcing the importance of identifying high-risk combinations and escalating them for clinical review when appropriate.
Watch for high-cost agents, including certain topicals and specialty migraine drugs
Spending on opioid alternatives, especially specialty drugs and topicals, has grown with overall per claim spending on topical medications having increased significantly, and some specialty migraine therapies carry high prices.
To control spend, focus on treatments that demonstrate clear clinical benefit for their cost. Pair pharmacy oversight with functional goals so dollars support therapies that help injured employees progress.
Encourage early use of physical therapy, behavioral health and functional restoration when appropriate
Clinical guidelines increasingly emphasize multimodal and non-pharmacologic strategies to improve function and reduce long-tern medication reliance. For example, California’s Medical Treatment Utilization Schedule (MTUS) prioritizes evidence-based, non-opioid care for chronic and complex pain.
Recommended approaches include physical therapy, cognitive behavioral therapy, functional restoration programs and targeted use of medications such as topical NSAIDs, anticonvulsants and antidepressants for neuropathic pain. Early use of these strategies can support recovery and reduce prolonged medication reliance.
Use utilization review and pharmacy benefit tools to support safe prescribing
Utilization review, formulary management and pharmacy benefit tools play a critical role in supporting guideline-based prescribing. Use these tools to identify outliers, address safety concerns and reinforce care plans that align with functional recovery and return-to-work goals.
Keep the focus on function and safe return to work. Monitor prescribing patterns, review outcomes and align care with current guidance so injured employees get relief without added harm.
This information is meant to serve as a general overview, and any specific questions should be fully reviewed with a health care professional such as the prescribing doctor or dispensing pharmacist.
Do you have a workers’ compensation or auto-related pharmacy question? Send us an email at AskThePharmacist@enlyte.com.
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