Regarding Norco 10/325 mg #60, CA MTUS Chronic Pain Medical Treatment Guidelines state that there should be documentation of the 4 A's (analgesic, activities of daily living, adverse side effects, and aberrant drug-seeking behaviors). Per ODG Guidelines, when considering on-going opioid management, several factors should be considered, including prescription from a single practitioner; lowest possible dose to improve pain; documentation of pain relief; functional status; appropriate medication use and side effects; documentation of misuse and continuing review of overall situation with regard to non-opioids means of pain control. The medication was within guidelines supported levels. However, there has been no documentation provided regarding
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Acetaminophen may be considered for initial therapy for patients with mild to moderate pain, and in particular, for those with gastrointestinal, cardiovascular or renovascular risk factors. NSAIDs appear to be superior to acetaminophen, particularly for patients with moderate to severe pain. 12/01/15 progress report documented about weaning the opioid and starting Naproxen for management of his pain. The patient has severe pain in the right shoulder, 5-6/10 on the pain scale. He feels less pain but now has some stiffness with certain movements. Recommendation of Naproxen 500 mg seems medically appropriate and necessary. Recommend certification.
Regarding Omeprazole 20mg #30, he MTUS Chronic Pain Medical Treatment Guidelines recommend either PPI’s or H2 blockers for patients who are using NSAID medication following determination of risk assessment for those patients found to be at moderate or high risk, and for patients who develop adverse GI side effects. 12/01/15 progress report documented continued right shoulder pain and decreased ROM. There is documentation of associated Naproxen request. The Naproxen was recommended so it appropriate to recommend Omeprazole concurrently. The guidelines have been met. Recommend
Acetaminophen may be considered for initial therapy for patients with mild to moderate pain, and in particular, for those with gastrointestinal, cardiovascular or renovascular risk factors. NSAIDs appear to be superior to acetaminophen, particularly for patients with moderate to severe pain. 12/01/15 progress report documented about weaning the opioid and starting Naproxen for management of his pain. The patient has severe pain in the right shoulder, 5-6/10 on the pain scale. He feels less pain but now has some stiffness with certain movements. Recommendation of Naproxen 500 mg seems medically appropriate and necessary. Recommend certification.
Regarding Omeprazole 20mg #30, he MTUS Chronic Pain Medical Treatment Guidelines recommend either PPI’s or H2 blockers for patients who are using NSAID medication following determination of risk assessment for those patients found to be at moderate or high risk, and for patients who develop adverse GI side effects. 12/01/15 progress report documented continued right shoulder pain and decreased ROM. There is documentation of associated Naproxen request. The Naproxen was recommended so it appropriate to recommend Omeprazole concurrently. The guidelines have been met. Recommend