Code of Colorado Regulations
1100 - Department of Labor and Employment
1101 - Division of Workers' Compensation
7 CCR 1101-3 R17 Ex 01 - Rule 17, Exhibit 1 - LOW BACK PAIN MEDICAL TREATMENT GUIDELINES
Section 7 CCR 1101-3-17-01-1 - Guidelines Introduction
Current through Register Vol. 47, No. 17, September 10, 2024
Section 1.a. Context and Use
This document has been prepared by the Colorado Department of Labor and Employment, Division of Workers' Compensation (Division) and should be interpreted within the context of guidelines for physicians/providers treating individuals who qualify as injured workers with low back pain under the Colorado Workers' Compensation Act.
Although the primary purposes of this document for practitioners are advisory and educational, these guidelines are enforceable under the Workers' Compensation Rules of Procedure, 7 CCR 1101-3. The Division recognizes that acceptable medical practice may include deviations from these guidelines, as individual cases dictate. Therefore, these guidelines are not relevant as evidence of a provider's legal standard of professional care.
To properly utilize this document, the reader should not skip or overlook any sections.
Section 1.b. Application of the Guidelines
The Division provides procedures to implement medical treatment guidelines (MTGs) and to foster communication to resolve disputes among the provider, payer, and patient through the Workers' Compensation Rules of Procedure. In lieu of more costly litigation, parties may wish to seek administrative dispute resolution services through the Division or the Office of Administrative Courts.
Section 1.c. Guidelines Recommendations and Inclusion of Medical Evidence
All recommendations are based on available evidence and/or consensus judgment. A Division staff methodologist (MD, MSPH) researched and adopted literature critique criteria for certain study designs (e.g., randomized controlled trial [RCT]). Literature critiques were performed in a manner congruent with national standards and were completed independent of the multidisciplinary task force group that drafted initial recommendations. The methodology is described in detail on the Division's MTGs page at cdle.colorado.gov/medical-treatment-guidelines. Please also refer to the Division's website for evidence tables and study critiques that provide details on the studies used to develop the evidence statements.
When possible, guidelines recommendations link to evidence tables that include the level of evidence supporting the treatment recommendation. An evidence summary is included in tables where multiple evidence statements address the same topic. It is generally recognized that early reports of a positive treatment effect are frequently weakened or overturned by subsequent research. When interpreting medical evidence statements in the guidelines, the following apply:
* "Some evidence" means the recommendation considered at least 1 adequate scientific study, which reported that a treatment was effective. The Division recognizes that further research is likely to have an impact on the intervention's effect.
* "Good evidence" means the recommendation considered the availability of multiple adequate scientific studies or at least 1 relevant high-quality scientific study, which reported that a treatment was effective. The Division recognizes that further research may have an impact on the intervention's effect.
* "Strong evidence" means the recommendation considered the availability of multiple relevant and high-quality scientific studies, which arrived at similar conclusions about the effectiveness of a treatment. The Division recognizes that further research is unlikely to have an important impact on the intervention's effect.
Recommendations not linked to evidence tables are based on consensus; consensus means the judgment of experienced professionals based on general medical principles.
All recommendations in the guidelines are considered to represent reasonable care in appropriately selected cases, irrespective of the level of evidence or consensus statement attached to them. Those procedures considered inappropriate, unreasonable, or unnecessary are designated in the guidelines as "not recommended."
Section 1.d. Recommended Citation for This Document
Colorado Division of Workers' Compensation. (2021). Low Back
Pain Medical Treatment Guidelines. Colorado Department of Labor and Employment.
Section 1.e. Glossary of Abbreviations
* ADLs - Activities of daily living
* ALIF - Anterior lumbar interbody fusion
* BBHI 2 - Brief Battery for Health Improvement, 2nd Edition
* BCIA - Biofeedback Certification International Alliance
* BDI-II - Beck Depression Inventory-II
* BHI-MV - Behavioral Health Index-Multimedia Version
* BMI - Body mass index
* BMP - Bone morphogenetic protein
* CBT - Cognitive behavioral therapy
* CES-D - Center for Epidemiological Studies Depression Scale
* COX-2 - Cyclooxygenase-2
* CT - Computed tomography
* DRAM - Distress and Risk Assessment Method
* DSM - Diagnostic and Statistical Manual of Mental Disorders
* ESI - Epidural steroid injection
* FCE - Functional capacity evaluation
* G6PD - Glucose-6-phosphate-dehydrogenase
* GAD-7 - Generalized Anxiety Disorder Scale
* GI - Gastrointestinal
* H2-blocker - Histamine H2-receptor antagonists
* MME - Morphine milligram equivalents
* MMI - Maximum medical improvement
* MRI - Magnetic resonance imaging
* MTGs - Medical treatment guidelines
* NMES - Neuromuscular electrical stimulation
* NRS - Numeric rating scale
* NSAIDs - Non-steroidal anti-inflammatory drugs
* ODI - Oswestry Disability Index, or Oswestry Low Back Pain Disability Questionnaire
* ORT - Opioid Risk Tool
* PDMP - Prescription Drug Monitoring Program
* PENS - Percutaneous electrical nerve stimulation
* PHQ - Patient Health Questionnaire
* PLIF - Posterior lumbar interbody fusion
* PMMA - Polymethylmethacrylate
* PRIME-MD - Primary Care Evaluation for Mental Disorders
* QPOP - Quality Performance and Outcomes Payments
* RCT - Randomized controlled trial
* RF - Radiofrequency
* rhBMP-2 - Recombinant human bone morphogenetic protein-2
* ROM - Range of motion
* SF-12 - 12-item Short Form Health Survey
* SF-36 - 36-item Short Form Health Survey
* SI - Sacroiliac
* SNRI - Serotonin norepinephrine reuptake inhibitor
* SSRI - Selective serotonin reuptake inhibitors
* TDR - Total disc replacement
* TENS - Transcutaneous electrical nerve stimulation
* TLIF - Transforaminal lumbar interbody fusion
* VAS - Visual analogue scale
