The Board has announced the adoption of the Non-Acute Pain Medical Treatment Guidelines (“NAP MTG”). As with the other MTGs for the neck, back, knee, shoulder and carpal tunnel syndrome, there are 22 guiding principles which provide a general framework for all the MTGs. The emphasis is on FUNCTIONAL ABILITIES, OBJECTIVE EVIDENCE of the treatment’s efficacy and ACTIVE INTERVENTIONS. These guiding principles also apply to the NAP MTGs. Two surgical procedures which are directed at NAP are on the list of procedures which require prior authorization: implantation of a spinal cord stimulator and a pain pump.
The NAP MTGs employ a Biopsychosocial, not a Biomedical approach to addressing Non-Acute Pain. Thus there is extensive discussion in the NAP MTGs about evaluating and treating the many disciplines which may contribute to the employee’s Non-Acute Pain.
The NAP MTGs also discuss specific pharmacological treatments. For example, many employers and carriers will be thrilled to learn that compound creams are not recommended for the treatment of Non-Acute Pain. Additionally, buccally (via the lining of the mouth) delivered fentanyl products, like Actiq ® and Subsys ® are not recommended.
Opioids are only continued after a successful trial and require demonstration of objective positive patient response and functional improvement. Urine drug testing based on the employee’s risk for potential abuse is evaluated is recommended, although the results are confidential and not to be shared with the employer, carrier or the Board. Weaning for a variety of clinical indications, i.e., evidence of abuse, lack of efficacy, hyperalagesia, side effects, etc., is discussed.
The bottom line is that treatment of chronic pain must now demonstrate objective results, both in pain reduction and improvement in function, not simply subjective reports of improvement in pain, to be implemented and continued. This appears to be very positive development to me.
For additional information, please feel free to contact us for an in-house or online presentation about the new on-Acute Pain Medical Treatment Guidelines.