Doctors who specialize in treating head pain, such as chronic migraines, are the latest to list the procedures and treatments they think have risks or costs that may outweigh the benefits to patients. To come up with the recommendations, Loder and her coauthors asked physician members of the American Headache Society (AHS) to identify tests and treatments they view as being used incorrectly or too often, and which methods of care had benefits too small to outweigh the risks.
According to the report in Reuters Health, the researchers evaluated more than 100 items suggested by AHS members, distilling the list down to five items based on current evidence.
The guidelines advise against imaging the brains of patients who get headaches that have not changed over time.
They also discourage the long-term use of over-the-counter pain pills to treat headaches, and recommend that physicians avoid using certain pain medications – opioids like oxycodone and drugs containing butalbital like Fioricet – for patients who get headaches often.
Finally, physicians should not perform computed tomography, or CT, on a patient with a headache when magnetic resonance imaging, or MRI, is available, except if it’s an emergency, the recommendations state.
The recommendations, Loder said, “are a nice distillation for patients when thinking about their care.” Patients and their families can use the guidelines to start a conversation with their doctor about the pros and cons of a given test or procedure.
“In addition to thinking about the good things that may come about from interventions, it’s also important to think about situations in which caution can be used,” Loder told Reuters Health.
Labor Code section 4600 provides that medical care provided in workers’ compensation cases conform to standards of evidence based medicine that is peer reviewed. While the DWC published Medical Treatment Utilization Schedule (MTUS) is presumed to be correct, it can be overcome by higher quality medical evidence. Thus, utilization review vendors may rely on better guidelines as they review requests for authorization for medical care.