We have seen a drastic increase in denials of prescription medicine.

These Chronic Pain Medical Treatment Guidelines apply when the patient has chronic pain as determined by following the clinical topics section of the Medical Treatment Utilization Schedule (MTUS). In following the clinical topics section, the physician begins by assessing the presenting complaint and determining whether there is a “red flag for a potentially serious condition” that would trigger an immediate intervention. Upon ruling out a potentially serious condition, the physician should provide conservative management. If the complaint persists, the physician needs to reconsider the diagnosis and decide whether a specialist evaluation is necessary.

If the patient continues to have pain that persists beyond the anticipated time of healing without plans for curative treatment that meet MTUS Guidelines, such as surgical options, the chronic pain medical treatment guidelines apply. They provide a framework to manage all chronic pain conditions, even when the injury is not addressed in the clinical topics section of the MTUS.

The chronic pain medical treatment guidelines consist of an introduction (Part 1) and specific information on interventions and treatments for chronic pain (Part 2), an edited version of evidence-based treatment guidelines from the April 10, 2014, version of the Work Loss Data Institute’s Official Disability Guidelines (ODG) Treatment in Workers’ Compensation – Chapter on Pain (Chronic), adapted with permission from the publisher. For specific guidance on opioid use, refer to the Division of Workers’ Compensation (DWC) “Guideline for the Use of Opioids to Treat Work-Related Injuries.”