Treatment Guidelines for Continuing Medical Maintenance 1 2

							     Physician Advisory Committee                                    For Consideration at Public Hearing
     DRAFT Treatment Guidelines for Continuing Medical Maintenance           To be Held on April 9, 2010




 1              Treatment Guidelines for Continuing Medical Maintenance
 2
 3   Preamble
 4
 5   (1) Chronic pain management can only be provided by practitioners with
 6   the necessary skill to manage difficult clinical situations with accompanying
 7   co-morbid conditions.
 8
 9
10   Mechanism of the CMM Program
11
12   (1) Mechanism for entry into CMM
13
14   (1a) Every claimant requesting CMM must be evaluated by either a
15   specialist in CPM (chronic pain management) or someone from the CMM-
16   IME List of approved treating doctors to approve entry into the CMM
17   program.
18
19   The following must be considered in this determination:
20
21   (1a.i ) Did the claimant's treating physician recommend CMM.
22
23   (1a.ii) Did the claimant require more than a nominal amount of pain
24   medication during the final months of treatment.
25
26   (1a.iii) Does the claimant have a bona-fide medical condition with objective
27   medical evidence of an injury.
28
29   (1a.iv) Does the claimant have more than pain alone
30
31   (1a.v) Does the claimant have a condition that normally warrants CMM.
32
33
34   (2) Criteria for Providing CMM
35
36   (2a) Most doctors (without special training) are not equipped to provide
37   chronic pain management.


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     Physician Advisory Committee                                    For Consideration at Public Hearing
     DRAFT Treatment Guidelines for Continuing Medical Maintenance           To be Held on April 9, 2010




38   (2b) CMM can only be provided by physicians selected from the CMM-
39   IME list as maintained by the WCC under the direction and control of the
40   judges.
41
42
43   (3) Criteria for Providing CMM
44
45   (3b) Criteria for Selection (Must have at least one of the following). It is
46   anticipated that most doctors on this list will qualify by board-certification.
47
48   (3b.i) Education. Board-certified in Pain Management.
49
50   (3b.ii) CME. Must have as least 10 hours of CME in Pain management
51   within the preceding two years.
52
53   (3b.iii) Experience. Must have a substantial amount of documented
54   experience treating claimants with chronic pain.
55
56   (3c) Urine Drug Screens must be done per PAC guidelines with a chain of
57   custody.
58
59   (3d) Must utilize the Oklahoma Prescription Monitoring Program (PMP)
60   Drug website as maintained by the Oklahoma Bureau of Narcotics and
61   Dangerous Drugs (OBNDD).
62
63
64   (4) Treatment Protocols
65
66   (4a) The claimant and CMM-physician must sign the Opioid Treatment
67   Agreement and the Informed Consent document.
68
69   (4b) The CMM-physician must exactly follow the Chronic Pain Disorder
70   and Narcotic Treatment Guidelines and the Guidelines for Prescription of
71   Opiod Medications for Acute and Chronic Pain as developed by the PAC.
72
73
74   (5) Exit Criteria


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     Physician Advisory Committee                                    For Consideration at Public Hearing
     DRAFT Treatment Guidelines for Continuing Medical Maintenance           To be Held on April 9, 2010




75   (5a) There is zero-tolerance for violation of the Opioid Treatment
76   Agreement. If the claimant violates the Opioid Treatment Agreement,
77   CMM immediately stops. There is no second chance and no referral to a
78   Form-A physician.
79
80   (5b) There is a Mandatory review of CMM by the Court after 6-months of
81   CMM with accompanying recommendations from the CMM-physician.
82
83   (5c) If the claimant cannot demonstrate an improvement in function at the
84   6-month period, CMM stops automatically.
85
86   (5d) If the claimant can return to work prior to the 6-month time period,
87   CMM can continue.
88
89
90   (6) Automatic Court Review of CMM
91
92   (6a) There is an automatic CMM-review at the 12-month mark of CMM and
93   at 12-month intervals thereafter, unless modified by the Court.
94
95   (6b) CMM can be reviewed at any time upon application of either party.
96
97   (6c) CMM can stop at any time as determined by the CMM-physician or by
98   Order of the Court.




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