Chronic Pain Disorder Medical Treatment Guideline
RULE 17, EXHIBIT 9
Chronic Pain Disorder
Medical Treatment Guideline
Revised: 10/6/2017 Effective: 11/30/2017
Adopted: January 8, 1998 Revised: May 27, 2003 Revised: September 29, 2005 Revised: April 26, 2007 Revised: December 27, 2011
Effective: March 15, 1998 Effective: July 30, 2003 Effective: January 1, 2006 Effective: July 1, 2007 Effective: February 14, 2012
Presented by:
DIVISION OF WORKERS' COMPENSATION
TABLE OF CONTENTS
SECTION
DESCRIPTION
PAGE
A.
INTRODUCTION.............................................................................................................................. 1
B.
GENERAL GUIDELINE PRINCIPLES ............................................................................................ 2
1.
APPLICATION OF THE GUIDELINES ............................................................................... 2
2.
EDUCATION ....................................................................................................................... 2
3.
INFORMED DECISION MAKING ....................................................................................... 2
4.
TREATMENT PARAMETER DURATION........................................................................... 2
5.
ACTIVE INTERVENTIONS ................................................................................................. 2
6.
ACTIVE THERAPEUTIC EXERCISE PROGRAM.............................................................. 2
7.
POSITIVE PATIENT RESPONSE ...................................................................................... 3
8.
RE-EVALUATION OF TREATMENT NO LESS THAN EVERY 3 TO 4 WEEKS ............... 3
9.
SURGICAL INTERVENTIONS ........................................................................................... 3
10. SIX-MONTH TIME FRAME................................................................................................. 3
11. RETURN-TO-WORK........................................................................................................... 3
12. DELAYED RECOVERY ...................................................................................................... 3
13. GUIDELINE RECOMMENDATIONS AND INCLUSION OF MEDICAL EVIDENCE .......... 4
14. TREATMENT OF PRE-EXISTING CONDITIONS .............................................................. 4
C.
OVERVIEW OF CHRONIC PAIN MANAGEMENT ......................................................................... 5
D.
INTRODUCTION TO CHRONIC PAIN ............................................................................................ 8
E.
DEFINITIONS ................................................................................................................................ 11
1.
AFTER SENSATION......................................................................................................... 11
2.
ALLODYNIA ...................................................................................................................... 11
3.
ANALGESIA ...................................................................................................................... 11
4.
BIOPSYCHOSOCIAL........................................................................................................ 11
5.
CENTRAL PAIN ................................................................................................................ 11
6.
CENTRAL SENSITIZATION ............................................................................................. 11
7.
DYSESTHESIA ................................................................................................................. 11
8.
HYPERALGESIA .............................................................................................................. 11
9.
HYPERESTHESIA (POSITIVE SENSORY PHENOMENA)............................................. 11
10. HYPERPATHIA................................................................................................................. 11
11. HYPOALGESIA................................................................................................................. 11
12. HYPOESTHESIA/HYPESTHESIA (NEGATIVE SENSORY PHENOMENA) ................... 12
13. MALINGERING ................................................................................................................. 12
14. MYOFASCIAL PAIN.......................................................................................................... 12
15. MYOFASCIAL TRIGGER POINT ..................................................................................... 12
16. NEURALGIA ..................................................................................................................... 12
17. NEURITIS ......................................................................................................................... 12
18. NEUROGENIC PAIN ........................................................................................................ 12
19. NEUROPATHIC PAIN....................................................................................................... 12
20. NEUROPATHY ................................................................................................................. 12
21. NOCICEPTOR .................................................................................................................. 12
22. PAIN BEHAVIOR .............................................................................................................. 12
23. PAIN THRESHOLD........................................................................................................... 12
24. PARESTHESIA ................................................................................................................. 12
25. PERIPHERAL NEUROPATHIC PAIN............................................................................... 12
26. SOMATIC DYSFUNCTION............................................................................................... 13
27. SUMMATION .................................................................................................................... 13
28. SYMPATHETICALLY MAINTAINED PAIN (SMP)............................................................ 13
Chronic Pain Disorder
29. TENDER POINTS ............................................................................................................. 13
F.
INITIAL EVALUATION & DIAGNOSTIC PROCEDURES ............................................................ 14
1.
HISTORY TAKING AND PHYSICAL EXAMINATION (HX & PE) .................................... 14
a.
Medical History..................................................................................................... 14
b.
Pain History.......................................................................................................... 15
c.
Medical Management History: ............................................................................. 16
d.
Substance Use/Abuse: ........................................................................................ 17
e.
Other Factors Affecting Treatment Outcome:...................................................... 17
f.
Physical Examination: .......................................................................................... 17
2.
PERSONALITY/ PSYCHOLOGICAL/PSYCHOSOCIAL EVALUATIONS FOR PAIN
MANAGEMENT ................................................................................................................ 18
a.
Qualifications........................................................................................................ 19
b.
Clinical Evaluation................................................................................................ 20
c.
Tests of Psychological Functioning...................................................................... 22
3.
DIAGNOSTIC STUDIES ................................................................................................... 24
4.
LABORATORY TESTING ................................................................................................. 25
5.
INJECTIONS?DIAGNOSTIC ............................................................................................ 26
a.
Spinal Diagnostic Injections ................................................................................. 26
6.
SPECIAL TESTS .............................................................................................................. 29
a.
Computer-Enhanced Evaluations ........................................................................ 29
b.
Functional Capacity Evaluation (FCE) ................................................................. 30
c.
Jobsite Evaluation and Alterations ....................................................................... 31
d.
Vocational Assessment........................................................................................ 32
e.
Work Tolerance Screening (Fitness for Duty)...................................................... 32
G. THERAPEUTIC PROCEDURES ? NON-OPERATIVE................................................................. 34
1.
ACUPUNCTURE............................................................................................................... 34
a.
Overview .............................................................................................................. 34
b.
Acupuncture ......................................................................................................... 36
c.
Acupuncture with Electrical Stimulation ............................................................... 37
d.
Other Acupuncture Modalities.............................................................................. 37
e.
Total Time Frames for Acupuncture and Acupuncture with Electrical Stimulation
............................................................................................................................. 38
2.
BIOFEEDBACK................................................................................................................. 39
a.
Overview .............................................................................................................. 39
b.
EMG/Electromyogram (EMG) .............................................................................. 39
c.
Skin Temperature................................................................................................. 39
d.
Respiration Feedback (RFB) ............................................................................... 39
e.
Respiratory Sinus Arrhythmia (RSA) ................................................................... 39
f.
Heart Rate Variability (HRV) ................................................................................ 39
g.
Electrodermal Response (EDR)........................................................................... 39
h.
Electroencephalograph (EEG, QEEG) ................................................................ 39
3.
COMPLEMENTARY MEDICINE....................................................................................... 41
a.
Overview .............................................................................................................. 41
b.
Alternative Medical Systems ................................................................................ 41
c.
Mind-body Interventions....................................................................................... 41
d.
Biological-based Practices ................................................................................... 41
e.
Body-based Therapy............................................................................................ 41
f.
Energy-based Practices ....................................................................................... 41
4.
DIRECT CORTICAL STIMULATION ................................................................................ 42
5.
DISTURBANCES OF SLEEP ........................................................................................... 42
a.
Overview .............................................................................................................. 42
6.
EDUCATION/INFORMED/SHARED DECISION MAKING............................................... 45
7.
INJECTIONS?SPINAL THERAPEUTIC ........................................................................... 46
a.
Steroid Associated Issues.................................................................................... 46
Chronic Pain Disorder
b.
Epidural Steroid Injection (ESI) ............................................................................ 47
c.
Intradiscal Steroid Injections ................................................................................ 48
d.
Sacroiliac Joint Injection ...................................................................................... 48
e.
Transforaminal Injection with Etanercept............................................................. 48
f.
Zygapophyseal (Facet) Injection .......................................................................... 48
8.
INJECTIONS ? OTHER (INCLUDING RADIO FREQUENCY)......................................... 50
a.
Botulinum Toxin Injections ................................................................................... 50
b.
Epiduroscopy and Epidural Lysis of Adhesions ................................................... 52
c.
Prolotherapy......................................................................................................... 53
d.
Radio Frequency Ablation ? Dorsal Nerve Root Ganglion .................................. 54
e.
Radio Frequency Ablation ? Genicular Nerves.................................................... 54
f.
Radio Frequency (RF) Denervation - Medial Branch Neurotomy/Facet Rhizotomy
............................................................................................................................. 55
g.
Radio Frequency Denervation - Sacro-iliac (SI) Joint Cooled ............................. 57
h.
Transdiscal Biacuplasty ....................................................................................... 60
i.
Trigger Point Injections ........................................................................................ 60
9.
INTERDISCIPLINARY REHABILITATION PROGRAMS ................................................. 61
a.
Overview .............................................................................................................. 61
b.
Formal Interdisciplinary Rehabilitation Programs ................................................ 64
c.
Informal Interdisciplinary Rehabilitation Program ................................................ 67
10. MEDICATIONS AND MEDICAL MANAGEMENT ............................................................ 69
a.
Alpha-Acting Agents ............................................................................................ 71
b.
Anticonvulsants .................................................................................................... 72
c.
Antidepressants ................................................................................................... 79
d.
Cannabinoid Products.......................................................................................... 83
e.
Hypnotics and Sedatives ..................................................................................... 86
f.
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)................................................. 87
g.
Opioids ................................................................................................................. 89
h.
Post-Operative Pain Management..................................................................... 111
i.
Skeletal Muscle Relaxants ................................................................................. 111
j.
Smoking Cessation Medications and Treatment ............................................... 114
k.
Topical Drug Delivery......................................................................................... 115
l.
Other Agents ...................................................................................................... 120
11. NON-INVASIVE BRAIN STIMULATION ......................................................................... 121
12. OPIOID ADDICTION TREATMENT................................................................................ 121
13. OPIOID/CHEMICAL TREATMENT PROGRAM REQUIREMENTS ............................... 125
14. ORTHOTICS/PROSTHETICS/EQUIPMENT.................................................................. 127
15. PERSONALITY/PSYCHOLOGICAL/PSYCHOSOCIAL INTERVENTION ..................... 128
a.
Introduction ........................................................................................................ 128
b.
Hypnosis ............................................................................................................ 130
16. RESTRICTION OF ACTIVITIES ..................................................................................... 133
17. RETURN-TO-WORK....................................................................................................... 134
a.
Job History Interview.......................................................................................... 134
b.
Coordination of Care .......................................................................................... 134
c.
Communication .................................................................................................. 134
d.
Establishment of Return-To-Work Status .......................................................... 134
e.
Establishment of Activity Level Restrictions ...................................................... 135
f.
Rehabilitation and Return-To-Work ................................................................... 135
g.
Vocational Assistance ........................................................................................ 135
18. THERAPY--ACTIVE....................................................................................................... 136
a.
Activities of Daily Living (ADL) ........................................................................... 137
b.
Aquatic Therapy ................................................................................................. 137
c.
Functional Activities ........................................................................................... 139
d.
Functional Electrical Stimulation ........................................................................ 139
e.
Neuromuscular Re-education ............................................................................ 139
f.
Spinal Stabilization............................................................................................. 140
Chronic Pain Disorder
g.
Therapeutic Exercise ......................................................................................... 140
h.
Work Conditioning.............................................................................................. 145
i.
Work Simulation ................................................................................................. 145
19. THERAPY--PASSIVE .................................................................................................... 146
a.
Electrical Stimulation (Unattended).................................................................... 146
b.
Iontophoresis...................................................................................................... 147
c.
Low Level Laser ................................................................................................. 147
d.
Manual Treatment including Manipulation ......................................................... 147
e.
Manipulation Under General Anesthesia (MUA)................................................ 150
f.
Manipulation Under Joint Anesthesia (MUJA) ................................................... 151
g.
Massage--Manual or Mechanical...................................................................... 151
h.
Mobilization (Soft Tissue)................................................................................... 152
i.
Percutaneous Electrical Nerve Stimulation (PENS) .......................................... 152
j.
Superficial Heat and Cold Therapy (Including Infrared Therapy) ...................... 153
k.
Traction--Manual............................................................................................... 153
l.
Traction--Mechanical ........................................................................................ 153
m. Transcutaneous Electrical Nerve Stimulation (TENS) ....................................... 154
n.
Trigger Point Dry Needling (TDN)...................................................................... 154
o.
Ultrasound (Including Phonophoresis)............................................................... 155
p.
Vertebral Axial Decompression (VAX-D)/DRX, 9000 ........................................ 156
H.
THERAPEUTIC PROCEDURES ? OPERATIVE ........................................................................ 157
1.
NEUROSTIMULATION ................................................................................................... 157
2.
DORSAL ROOT GANGLION STIMULATOR ................................................................. 163
3.
PERIPHERAL NERVE STIMULATION........................................................................... 163
4.
INTRATHECAL DRUG DELIVERY................................................................................. 163
5.
NEUROABLATION WITH RHIZOTOMY AS THE EXCEPTION .................................... 165
6.
DORSAL NERVE ROOT RESECTION .......................................................................... 166
I.
MAINTENANCE MANAGEMENT ............................................................................................... 167
1.
HOME EXERCISE PROGRAMS AND EXERCISE EQUIPMENT ................................. 167
2.
EXERCISE PROGRAMS REQUIRING SPECIAL FACILITIES...................................... 168
3.
PATIENT EDUCATION MANAGEMENT........................................................................ 168
4.
PSYCHOLOGICAL MANAGEMENT .............................................................................. 168
5.
NON OPIOID MEDICATION MANAGEMENT ................................................................ 169
6.
OPIOID MEDICATION MANAGEMENT ......................................................................... 169
7.
THERAPY MANAGEMENT ............................................................................................ 170
8.
INJECTION THERAPY ................................................................................................... 170
9.
PURCHASE OR RENTAL OF DURABLE MEDICAL EQUIPMENT (DME) ................... 172
APPENDIX: DESCRIPTION OF TESTS OF PSYCHOLOGICAL FUNCTIONING ..................... 173
Chronic Pain Disorder
................
................
In order to avoid copyright disputes, this page is only a partial summary.
To fulfill the demand for quickly locating and searching documents.
It is intelligent file search solution for home and business.
Related download
- chronic pain disorder medical treatment guideline
- new york knee injury medical treatment guidelines
- medical treatment form missouri labor
- louisiana workforce commission office of workers
- commonwealth of massachusetts
- odg twc pain
- low back pain medical treatment guidelines
- new york mid and low back injury medical treatment
- contents background new effective
- chapter 21 pain medical treatment guidelines subchapter a
Related searches
- treatment of chronic pain syndrome
- stemi treatment guideline 2019
- chronic pain disorder va disability
- chronic pain disorder icd 10
- 9422 pain disorder va disability
- expert medical treatment for chronic fatigue viruses
- complex regional pain disorder treatment
- chronic adjustment disorder va rating
- chronic adjustment disorder va disability
- chronic adjustment disorder military
- chronic adjustment disorder icd 10
- chronic adjustment disorder dsm 5