Musculoskeletal (MSK) conditions have been steadily increasing over the last few decades. With this increase, they have become the leading contributor to disability worldwide and a major driver of health care costs, absenteeism, and lost productivity. Nearly 1 in 4 people currently need MSK rehabilitation, and the disability and chronic pain that results from MSK conditions have been linked to poor mental health outcomes and substance use disorders, including opioid use disorder.

For employers, being able to proactively identify MSK issues can help mitigate costly impacts to worker productivity, as well as burnout and turnover. The first step is offering comprehensive, holistic care options that provide measurable impact and value, no matter how invisible health issues may be. Combining this with benefits that use real-time, integrated data to predict MSK conditions can help improve health outcomes and reduce costs for businesses in any industry.

The complex connections between physical pain, mental health, and substance use

The relationship between MSK conditions, mental illnesses such as depression and anxiety, and substance use is so intricate that they shouldn't be thought of separately. Almost half of patients with substance use disorder also experience chronic pain, and research has identified chronic pain and substance use as developmentally similar and mutually reinforcing. A recent JAMA study also revealed comorbid physical and mental health impairment from conditions such as musculoskeletal disorders, anxiety, and depression, with poor mental health status worsening both physical limitations and pain interference (the impacts of pain on a person's quality of life).

"We see a significant comorbidity with mental health and substance use in MSK and chronic pain conditions," says Dr. Douglas Nemecek, chief medical officer of Behavioral Health at Evernorth, the health services division of The Cigna Group. "And it's understandable: If I have chronic pain and I can't function as well physically, that's going to impact my resilience. It's going to impact my ability to feel productive."

While the connections between physical pain, mental health, and substance use are not fully understood, there are a few possible root causes of the complexity:

• Stigma and lack of access are prompting self-medication: People experiencing chronic pain are more likely to engage in substance use (e.g., excessive drinking) to relieve their pain and associated symptoms (e.g., difficulty sleeping).
• Quality of life is decreasing in undetected ways: Even people who don't experience chronic or excessive pain – or diagnosed depression or anxiety – may turn to substance use to relieve mental distress associated with disability (e.g., loss of mobility) or social isolation (inability to work or socialize).
• Prior exposure is driving patient decision-making: Following injuries or surgery, a small but significant minority of people will continue long-term opioid use and, in some cases, go on to develop opioid use disorder. A study of construction workers who had experienced MSK pain found that it was strongly associated with long-term opioid use and that chronic pain from physically demanding work is a likely driver of the opioid epidemic in heavy industries.

A preventive, holistic approach to MSK treatment

When solving for MSK conditions and their impact on business health, an integrated, holistic approach is needed – one that spans coverage offerings for physical well-being, behavioral health, and substance use treatment. In all areas, Dr. Nemecek said, early identification and prevention should be a primary focus.

"One of the key issues is, how do we make it simple for individuals to access support? How do we help them know where to go?” he said. “That gets to the point of navigation. Finding people sooner and making it easy for them to raise their hand, or identifying them so we can treat them early, before problems get severe and become a crisis. When each person gets connected to the right resources as early as possible, so they can stay engaged in the right care – that's how we optimize health outcomes."

Promoting physical well-being through proactive benefits

When employers proactively identify MSK issues, there is a reduced risk of them becoming chronic and turning into substances use to cope with the pain. Solutions that improve the physical health of your workers while also providing them with recovery options in case of an injury or worsening condition are key.

Cigna Pathwell Bone & Joint is shaping a new standard of MSK care starting with addressing spine, hip, knee, and shoulder pain. The program uses state-of-the-art predictive models – which can predict the need for intervention up to a year in advance – combined with personalized guidance, expansive networks, and digital navigation tools to empower customers to take charge of their health. And when surgery is the optimal path, navigation assistance guides members to a list of designated providers who meet quality and cost criteria and offer a zero- or low-cost surgery benefit for covered procedures.

Our integrated medical, behavioral, and pharmacy benefits also work together to enhance care for patients who are fighting chronic pain and substance use disorder.

Cigna Healthcare research shows that MSK patients with triple-integrated benefits experience:

• 133% lower rate of surgeries in an inpatient setting.
• 26% lower rate of opioid overdoses.
• 16% fewer interventional procedures, such as injections and biopsies.

Supporting lasting mental wellness

Given the comorbidity of physical and mental illness, proactive and long-term behavioral health services are necessary to improve the complete well-being of your employees dealing with MSK issues. Employees should have access to comprehensive, convenient, and confidential resources that connect them with the help they need – sometimes before they even realize they need it.

Cigna Total Behavioral Health is our integrated solution that considers holistic health with the goal of lasting behavioral change and increased employee vitality. It combines inpatient and outpatient case management and a full suite of specialty coaching and support programs to provide personalized support. And with Cigna Healthcare’s Confide Behavioral Health Navigator, we've created a powerful, 24/7/365 virtual front door that can identify customers with depression and anxiety not receiving outpatient care and help them navigate to affordable and convenient digital coaching and virtual care options.

Addressing substance use and addiction

Finally, for employees who develop substance use disorder related to an MSK condition, a combination of behavioral health counseling, coaching, and treatment is necessary to improve short- and long-term outcomes.

Cigna Healthcare offers medication-assisted treatment (MAT) and several other Cigna Pharmacy utilization management programs that are laser-focused on preventing opioid overdoses. And when a member engages in MAT, substance use coaches provide compassionate, one-on-one support, evidence-based education, and resources that empower the patient to fully engage in their treatment plan and leverage support within the recovery community to sustain it.

Don't let chronic pain impact the health of your business

With a challenge as complex as addressing the perfect storm of MSK conditions, mental health issues, and substance use disorders, you need a growth partner to translate your business's needs into positive outcomes and maximized investment in the health of your employees. To learn how you can increase productivity and lower costs through health coverage backed by Cigna Healthcare's suite of preventive, holistic solutions, contact your representative or broker today.

*2019, B2B International

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