Pain -Evaluation & Management

Published by: Apollo Managed Care Consultants

Published: Jan. 1, 2009 - 254 Pages

Table of Contents

Part I

Pain Evaluation and Management

Pain management introduction

Pain as a 5th vital sign (New 11-06)

Scope of Pain Management

Pain Management Guidelines (New 11-05, update 8-06)

Classification of Pain (update 4-08)

Pain measurement/scoring/scales (updated 8-04, update 6-06, 10-07, 5-08)

Barriers to adequate pain control (added 08-02, update 11-05)

Behavioral Therapy: Adjunctive Pain Management

Palliative and ‘End-of-life’ care pain management (update 2-06, 12/06, 2-07, 9-08)

Cancer pain management

Drugs for pain that are often used inappropriately/abused - guidelines (New 2-09)

Opioid or pain treatment contracts (New 4-06, update 3-07)

Joint Commission standards

Documentation system for pain assessment at each visit (New 6-07)

Patient satisfaction

Pain Management Payment Issues (added 11-01, updated 1-07)

Pain rehabilitation programs (update 5-08)

Inpatient Pain Rehabilitation (update 8-04, 12-04, revised 5-07)

Drug dependence issues (update 12-08)

Outpatient pain management programs (update 5-07)

Outpatient Hospital-based Pain Rehabilitation (new 05-04, 5-07)

Pain Clinics or Centers, comprehensive (update 3-05, 10-06)

Chronic/Persistent Pain Programs - coverage (updated 09-01, 4-09)

Collaborative care model (New 4-09)

Chronic/Persistent Pain Programs - Inpatient (updated 07-03, 1-05)

Denial of coverage for pain management

Exit Criteria from chronic pain programs

Clinical pain management issues - refer to Chronic Pain reference list/links

Breakthrough pain (New 9-08)

Chronic pancreatitis - pain management (New 6-08)

Diabetic peripheral neuropathy (also refer to the following Pharmacologic Management section (New 6-06, update 1-07)

Surgical pain management -

Fentanyl patches (update 3-08)

Conscious sedation P & P (added 08-02, update 2-05, 12-06)

Post-operative wound irrigation with local anesthetics for pain management (New 12-06)

Opioid-related adverse events in surgical patients: increased LOS (New 4-07)

Dental pain management - after hours care (New 11-04)

Headaches (New 12-04, update 6-05, 7-07)

Opioid treatment for chronic back pain (New 1-07)

Pain Management - Evaluation and Treatment Issues

Chronic Abdominal Pain (New 3-05)

Preemptive Analgesia Pain Management (update 3-05)

Case Management (New 4-07)

Pain Management Notes (New 11-04, update 10-05)

Pharmacologic Management of Pain

Introduction (update 2-05)

Initial oral mild to moderate pain management (update 3-05, 2-07)

Prescribing Guidelines for controlled substances - California model (New 10-03, update 2-07)

Medical Marijuana (New 3-07)

Adjuvant non-narcotic pain medications

Opioid therapy (update 2-06, 12-06, 2-07, 3-09) Refer to preceding related opioids therapy topics

Methadone (New 2-05, update 4-05, 3-07, 3-09)

Radiopharmaceuticals for metastatic bone pain (New 7-06)

NSAIDs

NSAIDs as preferred pain management for ureteral/renal colic (New 3-05)

Topical NSAIDs for chronic musculoskeletal pain, arthritis (update 2-05, 1-07)

Neuralgic/Neuropathic Pain (added 08-02, update 1-04, 12-04, 2-05, 6-05, 3-06, 4-07) Also refer to diabetic neuropathy in a preceding section.

Complex regional pain syndrome management (New 7-05, update 2-07)

Coanalgesic drug therapy to manage specific pain syndromes (Table) (New 3-07)

Osteoarthritis Pain Management (New 1-07)

Reflex sympathetic dystrophy (RSD); Pharmacologic challenges for sympathetically maintained pain - (new 3-01, update 6-07)

Trigger Point Injections (new 11-01, update 2-06, 1-07, 5-09)

Induced Lesions of Nerve Tracts (New 04-04)

Patient Controlled Anesthesia (PCA) by proxy (New 12-04, update 8-06, 3-08)

Ziconotide Intrathecal Infusion (Prialt®) for Severe Chronic Pain (New 10-05)

Addiction as a consequence of chronic opioid therapy for pain

Diversion

Pain Management in Long Term Care/SNFs - Plan of care (New 4-05, update 4-06, 6-07)

Pain Management in the Emergency Department - links (update 7-05, 7-06, 10-06)

Pain Management Rehabilitation Matrix - Musculoskeletal Pain (New 10-06)

Pain evaluation and monitoring tools (New 10-06)

Daily pain diary - example

WHO pain ladder; Pain related to ESRD - application of WHO ladder (New 11-06)

Drug therapy and equivalency conversion tables (New 9-06)

Pain Resources/Notes

Anesthesia - Review Criteria and Payment Guidelines [refer to back guidelines in the following Skeletal-muscular chapter for additional pain management guidelines]

Anesthesia Services- General/Regional/Procedural Sedation[refer to back guidelines in Skeletal-muscular chapter for additional pain management guidelines] (New 3-05, update 6-05, 9-05, 7-07)

Anesthesia, office-based (New 6-05, update 9-05, 11-05, 7-07)

Bispectral Index Monitor (New 10-05)

Dental/Oral anesthesia (New 5-05. update 9-05, 7-07)

Sedation of children/Procedural Sedation and Analgesia (PSA) (New 5-05, update 7-05, 7-07)

Pain Management (New 6-05, update 3-06, 7-07)

Cold Laser (low-energy or low-level) Therapy (new 2-01, update 5-05, 10-05, 8-06)

Cryoanalgesia (new 2-01, update 5-05)

Nerve blocks

Nerve blocks (New 6-05, 4-06)

Intrathecal/subarachnoid injections (New 6-05, update 10-05)

Intrathecal fentanyl for chronic nonmalignant pain (New 2-07)

Epidural injections - Diagnostic and/or therapeutic; steroids (rev 4-00, update 5-05, 6-05, 4-06)

Obstetrical pain management - resources (New 4-07)

Continuous epidural anesthesia for ‘Complex Regional Pain Syndrome/Reflex Sympathetic Dystrophy’ (New 1-01, update 5-05, 12-05, 9-06, 3-07)

Celiac plexus nerve blocks (New 11-06)

Facet joint injections/median branch nerve blocks (update 6-02, update 3-05, 6-05)

Intercostal nerve blocks (New 7-07)

Paravertebral nerve blocks (New 6-05)

Percutaneous alcohol injections for ablation of pain (New 3-07)

Transforaminal epidural injections - refer to the preceding epidural injections

Intraoperative awareness - monitoring (New 12-05)

Anesthesia-assisted opioid detoxification (New 2-07)

Electrical Stimulators - Refer to the DME, Skeletal-Muscular, Neurology/Neurosurgery, Pulmonary and Urology chapters for additional electrical stimulation guidelines in Apollo’s Medical Review Criteria Guidelines manual.

Introduction/Limitations (New 6-01, update 9-05, 4-07)

Dorsal Column Stimulators/Spinal Cord Stimulators: Chronic pain, Angina pectoris (New 11-00, update 06-01, 5-05, 10-05, 10-08)

Neuromuscular electrical stimulation (NMES) (update 04-03, 4-05, 5-05, 6-06, revised 5-07)

Electrical Stimulators for Levator Syndrome (New 06-01, update 5-05, 7-07)

Transcutaneous electrical nerve stimulation (TENS) including TENS Supplies - Form-fitting Conductive Garment for TENS or NMES (updated 06-01, 11-04, 4-05, 9-05, 5-06, 4-07)

ReliefBand (New 06-01, update 11-04, 7-07)

Interferential/Inferential current stimulation/therapy/‘Sympathetic Therapy’ (updated 06-01, update 12-04, 7-05, 5-06, revised 7-07)

Percutaneous electrical nerve stimulation (PENS)/Peripheral Neuromodulation (update 04-04, 9-05, 7-07)

Peripheral Electrical Nerve Stimulation, Implanted (New 3-01, update 12-04, 5-05, 9-05)

Pulsed electrical stimulation/Signal Therapy (New 11-04, update 9-05, 7-06, 2-07)

H-wave stimulation for the treatment of diabetic neuropathy (update 11-04, 9-05, 7-07)

Anesthesiology Notes

Complementary and Alternative Medicine; Approaches to pain management

Alternative medicine guidelines - Introduction (update 7-06, 2-07)

Acupuncture/acupressure/dry needling (update 4-04, 1-05, 4-05, 7-05, 10-05, 5-06, 2-07)

Applied Kinesiology (New 3-05, update 10-05)

Aromatherapy (New 3-05, update 10-05)

Ayurvedic medicine (update 12-04, update 10-05)

Biofeedback (update 10-03, 3-05, 10-05, 3-06, 2-07, 7-07)

Biofeedback for urinary or fecal incontinence; training (update 10-03, 4-05, 10-05, 2-07)

Magnetic and Bioelectromagnetic Therapy (update 5-02, 4-05)

Diet and Nutrition (update 4-05)

Guided Imagery (update 4-05)

Homeopathy (update 03-03)

Hypnosis/Hypnotherapy (added 03-03, update 3-05, 7-07)

Manual and Massage therapies - including Reflexology (update 9-04, 2-05, 6-06)

Meditation/Mindulness, Transcendental Meditation (update 4-05, revised 3-07)

Naturopathy (update 4-05)

Relaxation therapy (update 4-05)

Yoga (New 6-06)

CAM resources, references, suggested reading (update 10-04, 4-05, 4-06, 2-07)

Legal issues related to pain management (update 3-07)

Elder abuse d/t inadequate pain management

Notes

References/suggested reading by topic related to Pain Management (update 12-08)

References/suggested reading by topic related to CAM

Web resources/links

CAM

Pain Management (update 6-07)

Palliative/End-of-Life Care

Consent and Agreement Forms for long-term controlled substance/opioid therapy (New 2-05)

Informed Consent for Long-term Narcotic Use - example

Opioid Contract - UC Davis form (New 2-05) - also refer to links in the reference list

Additional Resources - Pain Management

Pain Publications/Web site links for Patients and Their Families (update 9-06)

Palliative Care Leadership Centers

Model Policy for the Use of Controlled Substances for the Treatment of Pain. Federation of State Medical Boardsof the United States, Inc.

California Codes Health And Safety Code Section 124960-124961 (New 2-06)

Pain Management Provider Credentialing

Pain Management Resources/Notes (update 9-06)

Speak Up: What You Should Know About Pain Management - patient brochure from the Joint Commission (New 11-08)

Part II

Skeletal Muscular Somatic Pain - Guidelines related to pain management (complete Skeletal-muscular guidelines are in Apollo’s Medical Review Criteria for Managing Care)

Autologous blood injections for tendinitis (New 1-09, update 6-09))

Knee - refer to the radiology chapter of Medical Review Criteria for Managing Care

Knee resources, referrals (update 8-07, 2-09, 4-09)

Arthroscopy, knee (updated 07-04, 1-05, update 8-07, 10-08)

Electrothermal joint repar

Arthroscopic lavage and/or debridement, knee (new 06-04, update 08-04, 1-05, 4-07, 9-07, 1-08, 2-09)

Total Knee Replacement/Arthroplasty (new 10-00, update 04-04, 7-05, 10-05, revised 8-07, update 7-08)

Chondrocyte implantation, autologous cultured & Meniscal transplantation - Knee (update 11-01, 1-04, 1-05, 4-05, 6-05, 10-05, 3-06, revised 4-07)

Viscosupplementation therapy

Glucosamine and Chondroitin sulfate - (New 2-07, 2-09)

Hyaluronidase or steroid intra-articular injections for osteoarthritis, knee (updated 1-04, 5-05, 8-07, 2-09)

‘Healing Response Surgery’ for ACL Repair (New 5-05)

Meniscectomy (rev 4-00, update 6-05, 2-07)

Unicondylar Interpositional Spacer (New 10-05, 8-07)

Knee, general references (update 3-05, 8-07, 11-08, 2-09)

Back and Neck Disorders - Evaluation and Procedures; Refer to the preceding Anesthesiology chapter as well as Neurology/Neurosurgery, Radiology and DME chapters for additional guidelines in Apollo’s Medical Review Criteria for Managing Care

Low back pain - evaluation and management introduction (‘acute’, ‘slow to recover’) (updates 10-03, 2-05, 2-06, 2-07, 12-07, 2-09, 5-09)

Algorithm for ‘slow to Recover’ back pain evaluation

Anterior spinal surgery, Endoscopic/Minimally invasive/Discectomy (cervical or lumbar)/laser lumbar discectomy (rev 4-00, 6-05, 3-07, 5-09)

Artificial/Prosthetic Intervertebral Discs/Disc replacement /LADR (New 1-05, update 4-05, 11-05, 5-06, 2-07, 8-07)

Cervical Spine - refer to related guidelines in this chapter and the Neurology/Neurosurgery chapter

Referral guideline links (New 8-07)

Cervical pain, acute, without preceding trauma - guideline (updated 6-05, 1-07)

Cervical nerve root entrapment - surgical indications (New 3-07)

Cervical Laminoplasty (New 6-05, update 3-07)

Spinal Instability, cervical - lateral screw fixation (New 12-05)

Chymopapain Chemonucleolysis (rev 4-00, update 4-05, 1-07)

Discectomy - refer to the preceding Anterior spinal surgery and related guidelines

Endoscopic/Minimally Invasive Anterior Spinal Surgery- refer to Anterior Spinal Surgery

Epidural injections - steroids, nerve blocks - refer to spinal stenosis and the Anesthesiology chapter: Nerve blocks

Epidural adhesions - neurolysis (New 10-05, 7-07)

Facet Denervation: Neurotomy, Rhizotomy, or Articular Rhizolysis (update 6-02, 1-05, 3-07) Refer to facet joint injections in the Anesthesiology chapter.

Facet Denervation: Percutaneous Radiofrequency (New 10-05, update 4-08)

Implantable Infusion Pumps for Chronic Severe Back Pain (rev 4-00, update 3-05, 6-05, 1-07)

Intervertebral Discs/Disc replacement - refer to ‘Artifical/prosthetic intervertebral discs’

Intradiscal Electrothermal Therapy (IDET)/Thermal Intradiscal Procedures (TIPs) (added 04-01, update 1-04, 12-04, 10-05, 1-07, 7-08, 1-09)

Skeletal-muscular (continued)

Laminectomy (rev 4-00, review 6-05, update 3-07, 12-07)

Laser assisted spinal endoscopy (New 5-05,update 1-07)

Lumbar fusion - refer to Spinal Fusion that follows in this section

Machines to treat low back pain (review 6-05)

Magnets for the treatment of chronic low back pain (new 7-00, update 1-05)

Metastatic spinal cord compression - clinical guideline (New 11-08)

Microdiscectomy, Percutaneous Lumbar Discectomy, automated (rev 11-00, update 1-05, 11-05, 5-06, 6-07)

Neuroreflexotherapy (NRT) (New 1-05)

NucleoplastyTM (added 09-03, update 1-05, 6-05, 10-05, 8-07)

Percutaneous vertebroplasty/kyphoplasty (update 04-03, 9-04, 11-04, 11-05, 4-06, 2-07, 7-07)

Postural Reconstruction Physiotherapy (New 2-07)

Prolotherapy (New 12-04, update 10-05, 2-07)

Sacro-iliac joint arthrography, injections (New 4-07, update 8-07)

Scoliosis - Therapies (New 6-05, 10-07)

Spinal fusion/arthrodesis (New 4-04, revised 3-07, update 8-07, 12-07)

Spinal Instability, lumbo-sacral - Pedicle screw fixation (update 4-04, 7-06)

Spinal stenosis (update 6-07, 12-07, 3-08)

Interspinous distraction or dynamic stabilization for spinal stenosis (X-stop or Dynesys) (New 3-06, update 7-06, 3-07, 5-08)

Surface electrical muscle stimulation for juvenile scoliosis- refer to guideline in DME chapter

Trigger Point Injections (Revised and update 11-01, 4-04, 6-05)

Vertebroplasty, kyphoplasty - refer to the preceding ‘percutaneous’ guideline

Chiropractic medicine/Chiropractor services

General coverage (updated 02-03, 11-04, 6-05, 7-05, 11-05, 6-06)

Craniosacral therapy (New 7-05, update 2-07)

Cranial laser release therapy (CLRT) (New 1-08)

Myofascial release (New 5-05, revised 8-07)

Spinal manipulation under anesthesia (added 11-00, update 6-05, 2-07)

Vertebral decompression/Vertebral axial decompression (VAX-D) - Refer to the DME chapter

Spine Notes

H-wave therapy for diabetic neuropathy

Skeletal-muscular (continued)

Shoulder

Osteoarthritis, shoulder (New 10-08)

Shoulder Arthrography (New 1-05)

Arthroscopy, shoulder (New 1-05, update 8-08)

Electrothermal capsular shrinkage (update 8-07)

Electrothermal arthroscopic repair for shoulder instability (New 10-05)

Extracorporeal Shock Wave Therapy (ESWT) for Calcific Tendinitis, Shoulder (New 6-05, update 2-07)

Impingement Syndromes, Shoulder Bursitis, Rotator Cuff Tendinitis & Tears (New 1-05)

Ultrasound therapy for calcific tendonitis of the shoulder (new 7-00, update 1-05)

Leg

Distraction osteosynthesis, Ilizarov method/Intramedulary distraction for lower limb lengthening (rev 4-00, update 12-06)

Extracorporeal Shock Wave Therapy (ESWT) for musculo-skeletal conditions, tendinitis

(New 1-04, update 7-04, 2-05, 6-05, 11-05, 1-06, 5-07)

Gait or motion analysis, electrodynogram (Added 4-00, updates 1-04, 11-04, 4-05, 10-05, 8-07)

Hydrotherapy - Hubbard tank, whirlpool (also refer to whirlpool in the DME chapter) (New 2-07)

Injection/Aspiration/Ganglion Cysts

Ganglion Cysts (New 6-05, 8-07)

Aspiration/Injection Therapy: Tendon Sheath, Ligament, Trigger Points or Ganglion Cysts (added 12-00, update 6-05, 2-06, 8-07)

Olecranon bursa aspiration (update 6-05, 2-06)

Aspiration/Injection Therapy: Arthrocentesis - Joints (update 11-01, update 6-05, 8-07)

Osteoarthritis management (New 7-05)

Osteogenic Protein-1 for the Treatment of Nonunion Fractures (New 12-04)

Osteoid osteoma - thermal coagulation (New 10-06)

Prosthetic implants (New 11-08)

Titanium rib implants (New 4-05)

Rheumatology Referral Guideline - links (New 3-05)

Sacro-iliac fusion (New 1-07)

Sprains and strains (New 12-06)

Stimulators, bone growth: electrical stimulation, low-intensity ultrasound therapies - refer to the DME chapter in Medical Review Criteria for Managing Care for comprehensive guideline resources

Hip

Hip resurfacing (New 10-05, update 3-07)

Open femoro-acetabular surgery for hip impingement syndrome (New 1-07, update 9-07)

Steroid Injections for Osteoarthritis of the Hip (New 9-07)

Total Hip Replacement (hip arthroplasty) (update 9-04, 6-05, 10-05, 1-06, 2-07, 4-08, 7-08)

Hip notes

Wrist, Hand, Fingers

Carpal tunnel syndrome and Carpal Tunnel Release - refer to the Neurology/Neurosurgery chapter in Apollo’s Medical Review Criteria for Managing Care

Finger/Hand/Wrist joint implants/arthroplasty (New 10-05, update 10-06)

Trigger finger (New 1-06)

Skeletal-muscular notes

Post-work Injury Evaluation and Work Hardening

‘Prehab’

Web Links - Skeletal-Muscular System-related (update 6-09)

Part III

Apollo’s publication list and order form

Abstract

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