The Division of Workers’ Compensation (DWC) has posted a first 15-day notice of modification to the proposed Chronic Pain Medical Treatment Guidelines and the Opioids Treatment Guidelines of the Medical Treatment Utilization Schedule (MTUS) regulations to the DWC website. Members of the public are invited to present written comments regarding the proposed modifications to dwcrules@dir.ca.gov until 5 p.m. on December 19. The proposed modifications include:
1) Clarification of the definition for Chronic Pain as pain “lasting three or more months from the initial onset of pain” to use the same definition set forth in section 9792.20 and to remove inconsistencies in the proposed Chronic Pain Medical Treatment Guidelines, the Opioids Treatment Guidelines and section 9792.23(b)(1).
2) Replacement of the words “must” and “required” with “should” and “recommend” where appropriate in the proposed Opioids Treatment Guidelines to clarify that guidelines set forth in the MTUS are designed to assist providers by offering an analytical framework for the evaluation and treatment of injured workers and is not intended to mandate specific clinical practices.
3) Removal of the phrase “alternative therapies do not provide adequate pain relief and” from section 9792.24(b) to prevent misinterpretation that opioids cannot be prescribed until a clinical history established inadequacies of all alternative therapies listed in the proposed Opioids Medical Treatment Guidelines.
4) Addition of pregnancy as a condition for consideration when tapering opioids with reference to the Medical Board of California’s guidelines for further guidance.
5) Removal of the statement that naloxone is “not recommended for patients on chronic opioid treatment” to reflect evolving scientific knowledge on the benefits and risks of this medication to treat opioid overdose.
6) Deletion of the words “Soft-Tissue” from a section heading in the proposed Opioids Treatment Guidelines to clarify that the recommendations for “Moderate to Severe Injuries” are not limited to soft-tissue injuries.
7) Formatting changes, corrections to typographical errors, and language clarifications.
Text of the regulations can be found on the proposed regulations page.