ASIPP Practice Guidelines - Pain Physician

Manchikanti et al • ASIPP Practice Guidelines
70
six times for local anesthetic and steroid blocks
for a period of one year.
• Under unusual circumstances with a recurrent
injury or cervicogenic headache blocks may be
repeated at intervals of six weeks after stabilization
in the treatment phase.
Medial Branch Neurolysis:
• The frequency should be three months or longer
between each neurolytic procedure provided that
at least > 50% relief is obtained for 10 weeks.
However, if the neural blockade is applied for
different regions, they can be performed at intervals
of no sooner than one week and preferably
two weeks for most type of blocks. The therapeutic
frequency for neurolytic blocks must remain
at three months for each region.
• Neurolytic procedures should be repeated only
as necessary judging by the medical necessity criteria
and these should be limited to a maximum
of four times for a period of one year.
Epidural Injections:
• In the diagnostic or stabilization phase, a patient
may receive injections at intervals of no sooner
than one week and preferably two weeks except
for blockade in cancer pain or when a continuous
administration of local anesthetic is employed for
RSD.
• In the treatment or therapeutic phase (after the
stabilization is completed), the frequency of interventional
techniques should be two months or
longer between each injection provided that at
least >50% relief is obtained for six weeks. However,
if the neural blockade is applied for different
regions, they can be performed at intervals of
no sooner than one week and preferably two
weeks for most type of blocks. The therapeutic
frequency must remain two months for each region.
• In the diagnostic or stabilization phase, the number
of injections should be limited to no more
than four times except for RSD, in which case six
times should be reasonable.
• In the treatment or therapeutic phase, the interventional
procedures should be repeated only as
necessary judging by the medical necessity criteria
and these should be limited to a maximum of
six times.
• Under unusual circumstances with a recurrent injury,
carcinoma, or reflex sympathetic dystrophy,
blocks may be repeated at intervals of 6 weeks
after stabilization in the treatment phase.
Percutaneous Lysis of Adhesions:
• For percutaneous non-endoscopic adhesiolysis
with a 3-day protocol, 2 to 3 interventions per
year are recommended; with a 1-day protocol, a
maximum of four times per year is recommended.
• For endoscopic adhesiolysis, it is recommended
that there be no more than two interventional procedures
per year.
Sympathetic Blocks:
• In the diagnostic or stabilization phase, a patient
may receive injections at intervals of no sooner
than one week and preferably two weeks except
in cancer pain or when a continuous administration
of local anesthetic for sympathetic block is
employed. However, the total number of injections
in the stabilization phase should be limited
to 4 to 6.
• In the treatment or therapeutic phase, that is after
the stabilization phase, the frequency of sympathetic
blocks should be limited to two months or
longer between each injection provided that at
least greater than 50% relief is obtained for six
weeks.
Sacroiliac Joint Injections:
• In the diagnostic or stabilization phase, a patient
may receive injections at intervals of no sooner
than one week and preferably two weeks.
• In the treatment or therapeutic phase (after the
stabilization is completed), the frequency should
be two months or longer between each injection
provided that at least > 50% relief is obtained for
six weeks. However, if the neural blockade is
applied for different regions, they can be performed
at intervals of no sooner than one week
and preferably two weeks for most type of blocks.
The therapeutic frequency must remain at two
months for each region.
• In the diagnostic or stabilization phase, the number
of injections should be limited to no more
than four times.
• In the treatment or therapeutic phase, sacroiliac
Pain Physician Vol. 4, No. 1, 2001