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 1101-3-17-01-6 - Essential First Line Treatment

Introduction. Education about low back pain and associated disability may involve the patient, patient's family, employer, insurer, policymakers, and community. Informed consent and shared decision making are 2 important components of patient education. Informed consent is an individual's autonomous authorization of a medical intervention that has resulted from a conversation between a patient and provider. It is also a formal process that healthcare institutions require before permitting procedures. Shared decision making involves an exchange of ideas between the patient and provider and collaboration in the decision itself.

Recommendations.

Core Requirements.

Recommendation 42. Patient education is required as a primary component of low back pain treatment, beginning with the expected natural history of low back pain, with and without radicular symptoms.

Recommendation 43. In the setting of benign clinical examination, it is strongly recommended that the provider educates and reassures the patient that there is a high likelihood their condition will improve and that it is essential to self-manage their symptoms.

Recommendation 44. Patient education should include a thorough discussion of how behavioral health evaluation and treatment is an essential component to support recovery from physical injury.

Recommendation 45. Shared decision making is required when 2 or more medically reasonable treatment choices exist, regardless of whether the degree of risk is high or low. Elements of shared decision making for spine interventions must include the following:

* the patient's experience with treatment;

* creation of individualized functional goals of treatment and anticipated barriers to success;

* documentation of expected results of diagnostic testing and possible plan of action in response to test results;

* a discussion of the continuum of treatment from the least invasive to the most invasive, with the intent of identifying a treatment along this continuum that most completely addresses the condition;

* expectation regarding the functional impact of the proposed treatment, including a discussion regarding return to work and expected timeframe for treatment;

* specific measurable and clinically meaningful criteria for determining treatment success or failure;

* confirmation of the patient's commitment to perform active therapy to optimize treatment outcomes; and

* documentation and consideration of the patient's unique risks and benefits based on comorbid medical conditions.

Shared decision making discussions should be tailored to the patient's health literacy.

Recommendation 46. Informed consent is required when a high risk treatment is under consideration. It includes the following elements:

* discussion of the proposed treatment's purpose;

* benefits and risks of the proposed treatment, alternative treatments, and nontreatment; and

* explicit patient agreement or refusal.

Evidence Tables. None. The above recommendations were based on consensus.