1. 2004;7;229-238California Workers? Compensation System: Are Occupational Medicine Practice Guidelines Sufficient for the Treatment of Chronic Spinal Pain or Do They Require Supplementation by Guidelines for Interventional Techniques?
   A Focused Review
   Standiford Helm II, MD.

Background: The California Workers’ Compensation system mandates the use of occupational medicine practice guidelines developed by the American College of Occupational and Environmental Medicine (ACOEM). These Guidelines cover the treatment of acute (less than three months’ duration) injuries. The presence in the ACOEM Guidelines of references to procedures which may be of use after the three-month acute period creates ambiguity as to whether the ACOEM Guidelines are applicable after three months.

ASIPP’s “Evidence-Based Practice Guidelines for Interventional Techniques in the Management of Chronic Spinal Pain” are comprehensive, focusing on management of chronic spinal pain.

ACOEM guidelines, mandated by the legislature, do not deal explicitly with chronic pain. Their application in managing chronic pain may result in denial of access to appropriate treatment. Thus, ASIPP guidelines may be supplemental to the ACOEM Guidelines. Evaluation of the two Guidelines may clarify which should be followed in the event of ambiguity or conflict.

Methods: The ACOEM and ASIPP Guidelines were evaluated to determine which more closely conformed with accepted standards for guideline creations; which was listed in the Agency for Health Care Research and Quality’s (AHRQ) National Guideline Clearinghouse; and what the common references were, how these references were evaluated, how they supported the treatment guidelines offered, and how the ACOEM and ASIPP guidelines differed.

Results: The ASIPP Guidelines complied with 23 out of 25 elements of guideline creation, whereas ACOEM complied with only 12 out of 25. Only ASIPP is listed in the National Guideline Clearinghouse. ACOEM lists 154 references; ASIPP, 1175; only 20 appear in common. ASIPP’s evaluation methodology more closely adhered to the AHRQ methodology. ASIPP’s Guidelines are based upon a more robust, detailed analysis.

Conclusion: The ASIPP Guidelines may be considered the applicable Guidelines for the treatment of work-related low back activity limitations persisting beyond three months.

Keywords: Practice guidelines, acute pain, chronic pain, low back pain, activity limitation, work related injuries