Some of you may be aware of a possible trend occurring with a state agency’s policies affecting the treatment of chronic pain. In December of 2014, the Division of Workers’ Compensation proposed new guidelines that would affect injured workers’ access to implantable drug delivery (IDD) and spinal cord stimulation (SCS) for the treatment of chronic pain. It is my understanding that other states are considering or have implemented such policies.
The proposed California guidelines stated: “There is insufficient evidence to recommend the use of implantable / intrathecal drug-delivery systems (IDDS) for the treatment of chronic pain.” This was quite alarming. One of my primary personal reasons for entering the field of treatment of chronic pain was the plight of wounded workers and the system’s failure to appropriately treat injured industrial workers with non-interventional pain management methods. I have cared for many injured workers and witnessed the lack of adequate pain relief with traditional systemic medications.
Over the past 10 months, a few committed clinicians began voicing their concerns with the Division of Workers’ Compensation. Two in particular were Dr. Francis Riegler and Dr. Joshua Prager, both of whom were very vocal as they actively combatted these proposed new guidelines. Dr. Prager spent numerous hours of his time developing and obtaining evidence contrary to the Division’s current rationale. He traveled to Sacramento and presented voluminous information to counter the proposed guidelines. It is my understanding that Dr. Prager’s efforts were successful and the committee is not moving forward.
I wish to caution that the jury is still out in California, but we are monitoring this situation. This movement may appear in other states. I strongly encourage all interventional pain clinicians to reach out to Dr. Prager and Dr. Riegler and thank them for their efforts.
The bottom line is that everyone must stay informed on government’s actions as they relate to health care. Take action when necessary!