Friday, April 13, 2012

Massachusetts: New Chronic Pain Guidelines

The new Massachusetts guidelines have been out for a while, but I finally had a chance to sit down (on an airplane, of course) and read through them in detail. A few quick comments:

Generally, I'm not a fan of state-specific sets of guidelines. While I've been accused in the past of acting as an agent of certain other sets of guidelines (no, I don't work for WLDI), I like the idea of evidence-based guidelines over consensus-based guidelines. Massachusetts chose to take Washington, Colorado, mix in a little ACOEM, and voila - new guidelines. I can understand the rationale (consensus does have a certain amount of value, albeit political value and not clinical value), but it calls into question the credibility of the guidelines from the outset. Who was on the committee? Who had influence? Who had the most lobbyists? In this case, the process appears to have been fairly inclusive, transparent, and thorough... it just creates another niche set of guidelines for all of us in work comp to have to get to know.

The section on medications in deceivingly simple. While it's roughly only a single printed page, it does contain the straightforward theme of valuing documented functional improvement above all else and does emphasize the need to incorporate the psycho-social component of care. The guidelines discuss the need to consult the Massachusetts Prescription Monitoring Program database, the need for a patient-physician agreement, and the need for ongoing drug screening. Perhaps most importantly, the guidelines strongly suggest that providers seek additional specialist-based consultation for any narcotic regimen exceeding 120 mg MED per day.

Alas, however, the guidelines in Massachusetts are only advisory in nature. They are to be considered by treating physicians, work comp judges, and utilization review agents, but none of these parties is bound by the guidelines.

A potential bright spot: Deborah Kohl, a member of the Massachusetts Academy of Trial Lawyers, commented on the new guidelines in a workcompcentral article, "On face value, I find them disturbing."

When the plaintiffs' attorneys find something disturbing, that's typically a good sign.

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1 comment:

  1. 1. The Guideline was the product of a Guideline subcommittee and then approved by the entire Health Care Services Board. (A list of this Board is available on the Department of Industrial Accident web site.
    It is true that the Colorado State material was utilized as well as many other sources but the goal (which I believe we met) was to have much less "detailed" report as the Colorado Guideline thus being "user friendly".
    While your point that it is not a "binding" set of "rules" it allows for 10% of cases being "outliers" and for these a RATIONALE for using that 10% rule is necessary.