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Chronic Pain 101 Evidence Based Medicine – Dr. William Nemeth


Chronic Pain 101 Evidence Based Medicine

Chronic Pain 101  was the next topic at the conference.

Dr. Nemeth  ([email protected]) with RestoreFx was the prior Medical Director for the TDI – State of Texas.  He is from Austin, TX.   He is going to talk about medication misuse.

Picture Of Man With Chronic Pain 101 Black And White Picture
Wikimedia – Simon James


  • Abuse – Addiction is a brain disease with loss of control, compulsive use, craving, and consequences.
  • Tolerance – the state of physical adaption in which exposure to a drug induces changes that result in decreases of drug effect over time
  • Hyperalgesia-  a state of hypersensitivity following the withdrawal or of opioids or in chronic addiction
  • Pseudoaddiction – drug seeking due to the undertreatment of chronic pain


  • Acute
  • Chronic
  • Nocieceptive
  • Neuropathic
Chronic Pain Syndrome
  • Up to 56% of Pain Clinic patients
  • Alcohol/Drug/Use
  • Family History of Addiction
  • Behavioral indicators
  • Urine Drug Screening
  • Smoking
  • Medical Indicators


Dr. Suzanne Novak – Board Certified Anesthesiologist, PhD Outcomes research and pharmacoeconomics, Professor in pharmacotherapy, at University of Texas, lead author ODG Treatment Guidelines
She is the wife of the prior speaker – Dr. Nemeth
Medicines Chronic Pain 101 Vector Graphic
Wikimedia – Pöllö

ODG- National Guidelines- prescribing guidelines that are now accepted in the 13 states.

Evidence Based Medicine (EBM) is here to stay
There are obviously limitations to the use of EBM
Handling a Complex Case Main Focus
  • Evidence based
  • Effective
  • Safe
  • Cost-effective in most cases
Paying for something that is not work-related
  • Diabetes
  • Hepatitis
  • Autoimmune disease
  • Numerous other conditions
Part of the problem missed
  • Injections
  • Other care – e.g. urine drug screens
  • Compounded drugs
  • Causality
  • Underlying comorbidity
Why to do the review and uses of info
  • Treatment plan issues
  • Settlement//MSA
  • Have a plan
  • Get a team
  • Who will first contact provider?
  • Type of info
  • Options to offer
State of Washington – Labor and Industry has a daily morphine equivalency calculator – used to see the amount of morphine can be equated to a daily amount of narcotics.   There is also a  Benzodiazepine equivalency calculator.


  • Interventional techniques  increased by 228% – 2000 to 2011
  • Medicare expenditures increased by 240% – 2000 to 2008
  • Office of Inspector General (DHHS) significant proportion of facet joint and ESI’s were not medically necessary.
  • A single facet joint injection is recommended
  • If 50% or more pain relief for 6 weeks from the single facet injection,  proceed to other blocks
  • Series of three injections is antiquated
Urine Drug Testing 
  • A Point of Care screen is recommended before initiating chronic opioid therapy
  • Risk assessment should be made on a schedule determined by patient abuse risk factor
  • Random collection is encouraged
  • Quantitative testing is not recommended
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James J Moore - Workers Comp Expert

Raleigh, NC, United States

About The Author...

James founded a Workers’ Compensation consulting firm, J&L Risk Management Consultants, Inc. in 1996. J&L’s mission is to reduce our clients’ Workers Compensation premiums by using time-tested techniques. J&L’s claims, premium, reserve and Experience Mod reviews have saved employers over $9.8 million in earned premiums over the last three years. J&L has saved numerous companies from bankruptcy proceedings as a result of insurance overpayments.

James has over 27 years of experience in insurance claims, audit, and underwriting, specializing in Workers’ Compensation. He has supervised, and managed the administration of Workers’ Compensation claims, and underwriting in over 45 states. His professional experience includes being the Director of Risk Management for the North Carolina School Boards Association. He created a very successful Workers’ Compensation Injury Rehabilitation Unit for school personnel.

James’s educational background, which centered on computer technology, culminated in earning a Masters of Business Administration (MBA); an Associate in Claims designation (AIC); and an Associate in Risk Management designation (ARM). He is a Chartered Financial Consultant (ChFC) and a licensed financial advisor. The NC Department of Insurance has certified him as an insurance instructor. He also possesses a Bachelors’ Degree in Actuarial Science.

LexisNexis has twice recognized his blog as one of the Top 25 Blogs on Workers’ Compensation. J&L has been listed in AM Best’s Preferred Providers Directory for Insurance Experts – Workers Compensation for over eight years. He recently won the prestigious Baucom Shine Lifetime Achievement Award for his volunteer contributions to the area of risk management and safety. James was recently named as an instructor for the prestigious Insurance Academy.

James is on the Board of Directors and Treasurer of the North Carolina Mid-State Safety Council. He has published two manuals on Workers’ Compensation and three different claims processing manuals. He has also written and has been quoted in numerous articles on reducing Workers’ Compensation costs for public and private employers. James publishes a weekly newsletter with 7,000 readers.

He currently possess press credentials and am invited to various national Workers Compensation conferences as a reporter.

James’s articles or interviews on Workers’ Compensation have appeared in the following publications or websites:

  • Risk and Insurance Management Society (RIMS)
  • Entrepreneur Magazine
  • Bloomberg Business News
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  • Claims Magazine
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  • Insurance Journal
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