West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-20 - Medical Management Of Claims, Guidelines For Impairment Evaluations, Evidence, And Ratings, And Ranges Of Permanent Partial Disability Awards › Section 85-20-50 - Treatment Guidelines: Interventional Management of Chronic Pain

Current through Register Vol. XLI, No. 28, July 12, 2024
Definitions:
As used in this exempt legislative rule, the following terms
				  have the stated meanings unless the context of a specific use clearly indicates
				  another meaning is intended.
50.1.
				"Acute pain" means pain experienced as the result of injury, disease, or
				operative procedure. Treatment usually consists of medications, surgical
				repair, and/or physical medicine therapies. Care may be provided in the office,
				clinic, or hospital setting.
50.2.
				"Bier block" means the instillation of medication into the venous system of a
				limb for anesthetic or therapeutic purposes; venous circulation is occluded
				with a tourniquet to retain medication in the veins of the limb.
50.3. "Chronic pain" means pain lasting more
				than three months. The cause of the pain is often unknown and may not be linked
				to an actual physiological event. Chronic pain complaints are usually
				accompanied by other psychophysiological disorders such as depression, weight
				gain or loss, sleep disorder and digestive disorder. A nurse case manager must
				coordinate care for claimants experiencing chronic pain, including intervention
				by a pain management specialist early in the treatment process and involvement
				of other treatment modalities and consultative specialists as needed.
50.4. "Interdisciplinary" means including
				representation from two or more health care fields.
50.5. "Medical Services Unit" or "Office of
				Medical Services" means a group of Commission, Insurance Commissioner, private
				carrier or self-insured employer, whichever is applicable, personnel designated
				to deal with health care issues; such personnel may be supplemented with health
				care personnel providing services on a contract or other basis.
50.6. "Nerve block" means injection of a
				local anesthetic medication in proximity to a nerve or nerve plexus to block
				nerve transmission.
50.7. "Nurse
				Case Manager" means a duly licensed registered professional nurse authorized by
				the Commission, Insurance Commissioner, private carrier or self-insured
				employer, whichever is applicable, to coordinate health care and rehabilitative
				services for injured workers.
50.8.
				"Pain" refers to a complex unpleasant sensory and emotional experience
				associated with actual or potential tissue damage or which may just be a
				subjective experience described in terms of such damage.
50.9. "Pain management specialist" means a
				licensed physician with specialized training and experience in the diagnosis
				and/or treatment of chronic pain.
50.10. "Steady dose" refers to the amount and
				frequency of pain relief medication that is required to maintain optimum pain
				relief, once the dosage of such medication has become fixed or nearly fixed in
				amount and frequency.
50.11.
				"Trigger point injection" means placement of a needle into a myofascial space
				with or without injection of medication.
General:
50.12. All practitioners who treat chronic
				pain need to address goals in three major life areas: physical; social; and
				psychological.
a. Physical goals include:
				analgesia, early mobility, functional restoration and increased exercise
				tolerance, strength and range of motion.
b. Social goals include: a positive
				expectation for recovery from family and support systems; avoiding
				identification with disabled family prototypes; resistance to the negative
				reinforcement from interested other parties; and recognition of the deleterious
				effects of the disability lifestyle.
c. Psychological goals include: dealing with
				grief and loss over altered function and coping with chronic distress and a
				changed lifestyle; maintaining a positive attitude toward recovery; focusing
				motivation; appreciating primary, secondary and tertiary gains; and obtaining
				diagnosis and treatment for any psychiatric diagnosis.