Transcript
The Colorado Chronic Pain Disorder Medical Treatment
Guideline
How does it affect patients, employers, and insurers?
Is the “Treatment Guideline” really just a “Guideline”?
““Although the primary purpose of this document is advisory and educational, these guidelines are enforceable under the Workers’ Compensation Rules of Procedure, 7CCR 1101-3.”
The Guidelines have, in essence, the power of regulation or law, and doctors are
essentially obligated to follow them when treating injured workers.
What is meant by “Chronic Pain”?
“Chronic pain is defined as “Pain that persists for at least 30 days beyond the usual course of an acute disease or a reasonable time for an injury to heal or that is associated with a chronic pathological process that causes continuous pain.”
Why does pain become “chronic”?
--Perhaps the diagnosis is incorrect--Perhaps the treatment is incorrect--Perhaps we’re not all “wired” the same (pain threshold, pain tolerance)--Perhaps there are non-physical issues (more on this from Dr. Bruns)--Perhaps the nervous system becomes rewired from pain (neural remodeling)
Neural RemodelingThe nervous system, if exposed to an abnormal state long enough, develops new and long-lasting pain pathways that can be hard to overcome.
The Traditional Medical Approach
--Take a medical history--Perform a physical examination--Order appropriate tests--Establish a diagnosis--Recommend treatment (medications, PT, temporary work restrictions, injections if
needed, surgery if needed)--MOST PEOPLE GET BETTER!!!
People in chronic pain need a different approach
--A psychological evaluation (also called a “psychosocial evaluation” or a “behavioral pain management evaluation”). ---More on this from Dr. Bruns.--Sometimes a different approach to medication
or exercise or rehabilitation--Sometimes a work modification (change jobs,
permanent work restrictions)
Yes, People Do Reach “MMI”
MMI—Colorado legal definition
“’Maximum medical improvement’ means a point in time when a physical or mental injury has become stable and when no further treatment is reasonably expected to improve the condition.”
“Maintenance” Treatment
“When the patient has reached MMI, a physician must describe in detail the maintenance treatment….Maintenance care will be based on principles of patient self-management.”
Patients can and should be taught how to manage their symptoms and function.
Maintenance Treatment may include…
--Long-term medication and medical monitoring--Continued therapy, psychological care, or other interventions (chiropractic, acupuncture), within limits--Management of flare-ups
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