Five Pain Management Trends Workers’ Compensation Leaders Should Watch

Pain management remains one of the most complex and costly components for workers’ compensation claims. Non-opioid therapies are gaining traction and new options are entering the market, but unexpected cost drivers are also emerging. Understanding these trends is essential for improving outcomes and controlling costs.

Here are five trends shaping pain management that your pharmacy program should be paying close attention to.

1. Opioid Management Continues to Adapt

Despite ongoing decreases, opioids remain the most commonly-prescribed medication for pain management in workers’ compensation. Increased awareness of opioid misuse, addiction, and overdose have driven significant changes, and pharmacy programs are seeing measurable progress with reductions in utilization and dosing levels.

Clinical guidance increasingly emphasizes judicious prescribing and shorter treatment durations, and there is a broader shift underway toward safer, evidence-based alternatives.

2. A Pivot Toward Non-Opioid Treatments

Current clinical guidelines consistently recommend non-opioid therapies as the first-line approach for many pain conditions. Evidence increasingly shows that these therapies can provide comparable and even superior pain relief to opioids for many conditions while avoiding the risks associated with long-term opioid therapy.

Equally important is the growing recognition that medication alone is rarely sufficient to manage complex pain. Multidisciplinary approaches that combine pharmacologic treatment with physical therapy, behavioral interventions, and rehabilitation services are increasingly considered best practices.

3. Expanding Treatment Options Can Come at a Cost

In 2025, the Food and Drug Administration (FDA) approved the first new class of oral non-opioid analgesic (Journavx) in more than two decades for the treatment of acute pain. While promising, this medication comes with a high price point ($600 average cost per prescription) and limited long-term data.

Other emerging trends include targeted therapies for specific conditions such as migraines. Newer migraine medications have demonstrated strong clinical effectiveness but carry significant costs, often exceeding $1,000 per prescription. This migraine class overall has experienced a double digit rise in utilization (up 15.2%) since 2023.

These innovations can provide valuable treatment options but require thoughtful clinical oversight to ensure appropriate use to manage costs.

4. Certain Medications are Driving up Costs

Topical medications have emerged as one of the largest cost drivers in workers’ comp, accounting for over 23% of total pharmacy costs despite representing a smaller share of prescriptions. In 2024, the number of injured employees using topicals rose 6.4% to 19.9%. When paired with overall growth in topical prescription volume and spending, this data highlights a sustained upward trend that has continued for the past six years.

Similarly, specialty drugs have seen significant growth in utilization and their cost per claim has increased 9.0%. These medications can be highly effective for certain patients but highlight the need for careful monitoring to identify emerging cost pressures.

5. Watch out for Opportunistically Priced Pain Products

The industry is seeing a rising trend in the development and prescribing of pharmaceutical products that significantly increase costs while providing little-to-no added clinical value. These drugs include private-label topical analgesics, combo packs or convenience kits, and designer dosage versions of existing drugs. While overall volume is low (3.9%), they represent 20.5% of workers’ comp spend.

These products often contain ingredients available in lower-cost alternatives but are marketed at substantially higher prices. Consider recently approved 300mg ibuprofen.  While readily available in 200, 400, 600, and 800mg doses at comparable unit prices around $0.65, this new 300mg version averages $15.83 per tablet with no demonstrated clinical advantage over existing strengths.

In many cases, these products are dispensed through out-of-network channels where traditional point-of-sale pharmacy controls may not apply.

Strategies for Optimizing Your Pharmacy Program

As pain management evolves, workers’ compensation stakeholders have an opportunity to strengthen pharmacy program oversight and improve outcomes.

Key strategies you can implement:

• Formulary optimization to ensure medications align with evidence-based treatment guidelines
• Prior authorization protocols to add clinical review for high-cost or non-preferred medications
• Dispensing channel oversight to monitor out-of-network and physician-dispensed prescriptions
• Advanced analytics to identify emerging utilization and cost trends
• Clinical collaboration that engages pharmacists and physicians to support appropriate therapy decisions

Looking Ahead

Pain management will remain a central challenge in workers’ compensation, but the tools available to address it are expanding. Ultimately, effective pain management requires balancing clinical outcomes and patient safety with cost containment. Programs like Enlyte Pharmacy Solutions combine strong clinical oversight with multidisciplinary care approaches to manage the evolving dynamics of pain treatment.

To take a deeper dive into the complexities of pain management, watch our on-demand webinar Pharmaceuticals, Pricing & Protocols: What's new in pain management for workers' comp claims where Nikki Wilson, Pharm.D./MBA, Senior Director, Clinical Pharmacy Services shares more insights into current and emerging options for pain management in workers' compensation.