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State pain management costs vary as opioids fall, topicals rise: NCCI - Business Insurance Skip to content Register for free Search Search Log In Risk Management Cyber Risks Pricing Trends Mergers & Acquisitions Technology Sponsored Content WSIA RISKWORLD Workers Comp & Safety Workers Comp Cost Control Pain Management Workplace Safety International EMEA Asia-Pacific Latin America People Events BI Intelligence Top 100 Agents & Brokers Best Places to Work 2025 Lists Directories Insurance Pricing BI Stock Index Magazine Current Issue Past Issues Subscribe Women to Watch ALL INsurance Resources Risk Perspectives Sponsored Content Webinars White Papers Risk Management Cyber Risks Pricing Trends Mergers & Acquisitions Technology Sponsored Content WSIA RISKWORLD Workers Comp & Safety Workers Comp Cost Control Pain Management Workplace Safety International EMEA Asia-Pacific Latin America People Events BI Intelligence Top 100 Agents & Brokers Best Places to Work 2025 Lists Directories Insurance Pricing BI Stock Index Magazine Current Issue Past Issues Subscribe Women to Watch ALL INsurance Resources Risk Perspectives Sponsored Content Webinars White Papers Risk Management Cyber Risks Pricing Trends Mergers & Acquisitions Technology Sponsored Content WSIA RISKWORLD Workers Comp & Safety Workers Comp Cost Control Pain Management Workplace Safety International EMEA Asia-Pacific Latin America People Events BI Intelligence Top 100 Agents & Brokers Best Places to Work 2025 Lists Directories Insurance Pricing BI Stock Index Magazine Current Issue Past Issues Subscribe Women to Watch ALL INsurance Resources Risk Perspectives Sponsored Content Webinars White Papers Risk Management Cyber Risks Pricing Trends Mergers & Acquisitions Technology Sponsored Content WSIA RISKWORLD Workers Comp & Safety Workers Comp Cost Control Pain Management Workplace Safety International EMEA Asia-Pacific Latin America People Events BI Intelligence Top 100 Agents & Brokers Best Places to Work 2025 Lists Directories Insurance Pricing BI Stock Index Magazine Current Issue Past Issues Subscribe Women to Watch ALL INsurance Resources Risk Perspectives Sponsored Content Webinars White Papers State pain management costs vary as opioids fall, topicals rise: NCCI by Louise Esola Workers Comp Coverage , Workplace Safety Feb 25, 2026 Pain management accounted for 30% of workers compensation medical costs in 2023, according to a new research brief released Wednesday by the National Council on Compensation Insurance that revealed a “wide” variation in pain management costs across states. The report found that pain management paid-per-claim increased an average of 1% annually from 2012 to 2023 across 36 study states. Louisiana recorded the largest increase over that period, while Alaska saw the largest decline. Even after adjusting for differences in diagnosis mix, substantial cost variation remained, according to the report. Major surgery, drugs and physical medicine were the largest components of pain management spending in 2023, accounting for 34%, 14% and 14% of total costs, respectively. Physical medicine costs rose an average 2.3% per year since 2012, driven primarily by increased utilization. Major surgery costs increased 1.9% annually, largely because of rising prices rather than higher use. Drug costs, by contrast, declined 2.8% per year on average, reflecting a sharp reduction in opioid use. Opioid costs paid per claim fell dramatically over the past decade, in line with other industry analyses. However, the drop in opioid spending has been partially offset by rising costs for topical medications. In 2023, topical paid per claim ranged from $10 to $630 across states, and in some jurisdictions exceeded opioid spending. High-priced topicals, particularly those dispensed by physicians, have emerged as a key driver of interstate variation. States with stricter physician dispensing limits and broader pharmaceutical regulations generally reported lower topical costs, suggesting policy plays a significant role in managing pain-related drug spending, the report said. 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