Chronic pain guideline v.2

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.

113 pages

113+ pages!

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)

What is “neural remodeling”?

“You do that too long, you’ll stick that way!!!” --(everyone’s mom)

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.

Pain Threshold Some of us just feel pain more than others. Rocky Balboa The Princess & the Pea

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!!!

“But, Doctor, I’m still in pain.”

Pain has many dimensions:

Physical–

Psychological—

Cultural—

Chronic Pain is more than just Pain.

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)

Is treatment ever “done”?

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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