Chronic Pain Treatment Guidelines Take Effect

Date: June 26, 2009, Volume: 09-5, Number: 02

On July 18, 2009, the new Chronic Pain Treatment Guidelines will take effect as part of the Medical Treatment Utilization Schedule (“MTUS”) under Labor Code 5307.27. The regulations governing these new treatment guidelines are 34 pages long. However, the actual guidelines span some 127 pages with an “A to Z” alphabet soup approach. In other words, the type of treatment for chronic pain is stated and then determined whether recommended or not.


Under these rules, chronic pain is defined as “any pain that persists beyond the anticipated time of healing.”

Types of Pain: Pain mechanisms can be broadly categorized as nociceptive or neuropathic.


Yoga –only for selected, highly motivated patients

Work conditioning and hardening: (welcome back rehab?)


Behavioral intervention

Aquatic therapy – as an optional form of exercise

Chronic pain management programs

Education (ongoing education for the patient and the family)

Functional restoration programs

Massage therapy (limited to 4-6 visits in “most cases” so what does this mean?)


Psychological evaluations (not because of a psyche injury but as part of the pain treatment)

Psychological treatment

Return to Work (what does this mean in this new treatment context?)

Topical analgesics (limited to some extent, but these are the notorious “compounds” being dispensed out of treating physician offices and they are truly expensive since it is hard to tell what is in them )


The new chronic pain guidelines are not just a recipe for expanded medical treatment; they are a whole veritable cookbook of treatment options, which carry very serious implications well beyond anything in ACOEM.

Chronic pain is indeed a serious and difficult condition to treat, however these new guidelines, which span over 100 pages, are a potential roadmap for some physicians to dramatically increase the extent, scope and nature of current ACOEM based treatment considerations. Also, I am somewhat concerned about the “return to work” aspect as being part of the actual regimen of treatment. It seems that rehabilitation keeps creeping back into the system in one form or another. Although it is too early to know, under these new guidelines, a part of the repealed rehabilitation program may be wending its way back in the side door, morphed into the form of a treatment plan for chronic pain.

Needless to say, everyone needs to be aware of these new guidelines. I strongly suggest that you ensure that your Utilization Review process is tooled and calibrated to the new chronic pain guidelines; that the UR physicians become very familiar with these new aspects, so they can respond correctly and properly to what will certainly be a host of new and expansive requests for authorization for the treatment for chronic pain.

I also expect more primary treating physicians to determine the existence of chronic pain and the intended referral to pain specialists, including outpatient pain management treatment facilities.

Stay aware.


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