Louisiana Administrative Code › Title 40 - LABOR AND EMPLOYMENT › Part I - Workers' Compensation Administration › Subpart 2 - Medical Guidelines › Chapter 23 - Upper and Lower Extremities Medical Treatment Guidelines › Subchapter A - Lower Extremities › Section I-2311 - Therapeutic Procedures- Non-Operative

Current through Register Vol. 50, No. 6, June 20, 2024
A. Treating providers, as well as employers
					 and insurers are highly encouraged to reference the General Guidelines
					 Principles (Section B) prior to initiation of any therapeutic procedure. Before
					 initiation of any therapeutic procedure, the authorized treating provider,
					 employer and insurer must consider these important issues in the care of the
					 injured worker.
B. First, patients
					 undergoing therapeutic procedure(s) should be released or returned to modified,
					 restricted duty during their rehabilitation at the earliest appropriate time.
					 Refer to Return-to-Work in this section for detailed information.
C. Second, cessation and/or review of
					 treatment modalities should be undertaken when no further significant
					 subjective or objective improvement in the patient's condition is noted. If
					 patients are not responding within the recommended duration periods,
					 alternative treatment interventions, further diagnostic studies or
					 consultations should be pursued.
D.
					 Third, providers should provide and document education to the patient. No
					 treatment plan is complete without addressing issues of individual and/or group
					 patient education as a means of facilitating self-management of
					 symptoms.
E. Lastly, formal
					 psychological or psychosocial evaluation should be performed on patients not
					 making expected progress within 6 to 12 weeks following injury and whose
					 subjective symptoms do not correlate with objective signs and tests.
F. In cases where a patient is unable to
					 attend an outpatient center, home therapy may be necessary. Home therapy may
					 include active and passive therapeutic procedures as well as other modalities
					 to assist in alleviating pain, swelling, and abnormal muscle tone. Home therapy
					 is usually of short duration and continues until the patient is able to
					 tolerate coming to an outpatient center.
G. The following procedures are listed in
					 alphabetical order.
1. Acupuncture is an
					 accepted and widely used procedure for the relief of pain and inflammation in
					 the lower extremity. There is some scientific evidence to support its use for
					 hip and knee osteoarthritis. The exact mode of action is only partially
					 understood. Western medicine studies suggest that acupuncture stimulates the
					 nervous system at the level of the brain, promotes deep relaxation, and affects
					 the release of neurotransmitters. Acupuncture is commonly used as an
					 alternative or in addition to traditional Western pharmaceuticals. While it is
					 commonly used when pain medication is reduced or not tolerated, it may be used
					 as an adjunct to physical rehabilitation and/or surgical intervention to hasten
					 the return of functional activity. Acupuncture should be performed by licensed
					 practitioners.
a. Acupuncture is the
					 insertion and removal of filiform needles to stimulate acupoints (acupuncture
					 points). Needles may be inserted, manipulated and retained for a period of
					 time. Acupuncture can be used to reduce pain, reduce inflammation, increase
					 blood flow, increase range-of-motion, decrease the side effect of
					 medication-induced nausea, promote relaxation in an anxious patient, and reduce
					 muscle spasm.
i. Indications include joint
					 pain, joint stiffness, soft tissue pain and inflammation, paresthesia,
					 post-surgical pain relief, muscle spasm, and scar tissue pain.