La. Admin. Code tit. 40 § I-2133

Current through Register Vol. 50, No. 9, September 20, 2024

Section I-2133 - Therapeutic Procedures-Operative

A. When considering operative intervention in chronic pain management, the treating physician must carefully consider the inherent risk and benefit of the procedure. All operative intervention should be based on a positive correlation with clinical findings, the clinical course, and diagnostic tests. A comprehensive assessment of these factors should have led to a specific diagnosis with positive identification of the pathologic conditions(s).

B. Surgical procedures are seldom meant to be curative and would be employed in conjunction with other treatment modalities for maximum functional benefit. Functional benefit should be objectively measured and includes the following:

1. Return to work or maintaining work status.

2. Fewer restrictions at work or performing activities of daily living (ADL).

3. Decrease in usage of medications.

4. Measurable functional gains, such as increased range of motion or documented increase in strength.

C. Education of the patient should include the proposed goals of the surgery, expected gains, risks or complications, and alternative treatment.

1. Intrathecal drug delivery. This mode of therapy delivers small doses of medications directly into the cerebrospinal fluid. Refer to the Chronic Pain Medical Treatment Guideline's for detailed information and recommendations for its use in CRPS patients with chronic pain.

2. Neurostimulation is the delivery of low-voltage electrical stimulation to the spinal cord or peripheral nerves to inhibit or block the sensation of pain. Refer to the Chronic Pain Medical Treatment Guideline's for detailed information and recommendations for its use in CRPS patients with chronic pain.

3. Sympathectomy

a. Description. Destruction of part of the sympathetic nervous system, which is not generally accepted or widely used. Long-term success with this pain relief treatment is poor. This procedure requires prior authorization.

b. Indications. Single extremity CRPS-I or SMP; distal pain only (should not be done if the proximal extremity is involved). Local anesthetic Stellate Ganglion Block, Kuntz Fiber Block or Lumbar Sympathetic Block consistently gives 90 to 100 percent relief each time a technically good block is performed (with measured rise in temperature). The procedure may be considered for individuals who have limited duration of relief from blocks. Permanent neurological complications are common.

La. Admin. Code tit. 40, § I-2133

Promulgated by the Louisiana Workforce Commission, Office of Workers Compensation Administration, LR 37:1733 (June 2011), Amended LR 46267 (2/1/2020).

AUTHORITY NOTE: Promulgated in accordance with R.S. 23:1203.1.