The document discusses Colorado's Chronic Pain Disorder Medical Treatment Guideline and how it affects patients, employers, and insurers. It defines chronic pain as pain lasting over 30 days from an injury or illness. The guideline has the power of law for doctors treating injured workers. Chronic pain can become long-lasting due to incorrect diagnosis, treatment, neural remodeling of the nervous system from prolonged pain exposure, or psychological/cultural factors. Maximum medical improvement is reached when further treatment is not expected to improve the condition, and maintenance treatment focuses on self-management.

1. The Colorado Chronic Pain
Disorder Medical Treatment
Guideline
How does it affect patients,
employers, and insurers?

2. The Messenger
Requests
That He Please
Not Be Shot

3. Is the “Treatment Guideline” really
just a “Guideline”?
““Although the primary purpose of this document is
advisory and education, these guidelines are
enforceable under the Workers’ Compensation
Rules of Procedure, 7CCR 1101-3.”
The Guidelines have, in essence, the power of
regulation or law, and doctors are essentially
obligated to follow them when treating injured
workers.

4. 113 pages

5. What is meant by “Chronic Pain”?
“Chronic pain is defined as
“Pain that persists for at
least 30 days beyond the
usual course of an acute
disease or a reasonable
time for an injury to heal
or that is associated with a
chronic pathological
process that causes
continuous pain.”

6. Why does pain become “chronic”?
--Perhaps the diagnosis is incorrect
--Perhaps the treatment is incorrect
--Perhaps we’re not all “wired” the same
(pain threshold, pain tolerance)
--Perhaps there are non-physical issues
(more on this from Dr. Bruns)
--Perhaps the nervous system becomes
rewired from pain (neural remodeling)

7. What is “neural
remodeling”?

8. “You do that too long, you’ll stick that
way!!!” --(everyone’s mom)

9. Neural Remodeling
The nervous system, if exposed
to an abnormal state long
enough, develops new and long-
lasting pain pathways that can
be hard to overcome.

10. Pain Threshold
Some of us just feel pain more than others.
Rocky Balboa The Princess & the Pea

11. The Traditional Medical Approach
--Take a medical history
--Perform a physical examination
--Order appropriate tests
--Establish a diagnosis
--Recommend treatment (medications, PT,
temporary work restrictions, injections if
needed, surgery if needed)
--MOST PEOPLE GET BETTER!!!

12. “But, Doctor, I’m still in pain.”

13. Pain has many dimensions:
Physical–
Psychological—
Cultural—

14. Chronic Pain is more than just Pain.

15. People in chronic pain need a different
approach
--A psychological evaluation (also called a
“psychosocial evaluation” or a “behavioral pain
management evaluation”. (More on this from
Dr. Bruns.)
--Sometimes a different approach to medication
or exercise or rehabilitation
--Sometimes a work modification (change jobs,
permanent work restrictions)

16. Is treatment ever “done”?

17. Yes, People Do Reach “MMI”
MMI—Colorado legal definition
“’Maximum medical improvement’ means a
point in time when a physical or mental injury
has become stable and when no further
treatment is reasonably expected to improve
the condition.”

18. “Maintenance” Treatment
“When the patient has reached MMI, a
physician must describe in detail the
maintenance treatment….
Maintenance care will be based on principles of
patient self-management.”
Patients can and should be taught how to
manage their symptoms and function.

19. Maintenance Treatment may include…
--Long-term medication and medical monitoring
--Continued therapy, psychological care, or other
interventions (chiropractic, acupuncture),
within limits
--Management of flare-ups