There are four major areas of concern when medicating an injured worker:
1. Is the patient inadequately medicated and, therefore, is in such pain that all attempts to chart a path for a future becomes blocked by the discomfort that he/she is unable to tolerate?
2. Is the patient overly-medicated so that there days are filled with adverse side effects including somnolence, nausea, dizziness and/or disorientation?
3. Is the patient appropriately medicated for the true problem or are they medicated for sleep when the problem is depression or medicated for pain when the problem is anxiety.
4. Is the medication itself giving rise to psychological complaints such as agitation, irritability, restlessness, alterations of mood, apprehension and even mild hallucinations?
Quite often we have very inadequate histories on these patients. We do know whether they are capable of, or willing to, take their medication as prescribed. We do not know if they are reliant upon other family members to titrate their medication.
Not infrequently, lack of timely approval for medication results in either delayed initiation of a needed medication or delay in timely refill of approved medication.
I believe one of the greatest concerns is the we medicate these patients with mood and cognition altering drugs and then fail to measure the changes that occur. Months later someone says they are depressed or agitated, but there has been no psychological assessment as to whether these symptoms are the direct result of the medication regimen and/or the patient_s compliance with that regimen.