This is a 58-year-old female with a 1/16/2015 date of injury. The IW was moving bottles of wine from cart to a center table when she slipped and landed on her left knee.
DIAGNOSIS: Lumbar facet arthropathy
12/07/15 progress note by Dr. Tarasenko indicates request for Tramadol and Butrans. The Diagnosis is lumbar facet arthropathy.
10/11/15 progress report by Dr. Kofoed indicated that the patient complains of significant anterior left knee pain. The pain is 7-8/10 on pain scale. She describes pain in the lower back and right knee. There is difficulty with walking. PE of the left knee was within normal limits. MRI does not demonstrate any significant pathology with no evidence of meniscal tears. Treatment plan includes Gabapentin trial, activity …show more content…
Treatment to date has included medications, activity modification, Orthovisc injections x3, cortisone injections, and physical therapy X 18 visits.
The request is for TREATMENT REQUEST: Butrans 10mcg/hr #4 and Tramadol 50mg #120.
CONCLUSION:
Regarding Tramadol 50mg #120, per CA MTUS Opioid analgesics and Tramadol have been suggested as a second-line treatment (alone or in combination with first-line drugs). Per ODG Guidelines when considering initiation of opioid therapy, several factors should be considered, including other options and whether or not opioids have been used before, likelihood of improvement and likelihood of use/abuse. The guidelines do indicate to start with a short-acting opioid trying one medication at a time. However, the patient has a history of opioid treatment in the past to address her left knee pain. She has been completely off of narcotics from 02/17/15. The pharmacy note provided indicated that her last Hydrocodone-Acetaminophen refill was on 02/17/15. 12/07/15 progress note by Dr. Tarasenko is not complete and only indicates request for Tramadol and Butrans. The Diagnosis is lumbar facet arthropathy. No clinical history or physical examination findings have been provided. Moreover, no documentation has been provided that indicates the use of non-naroctic means of pain control for the condition. Given no trial of non-narcotics to improve pain and 9 months long history being off opioids; Tramadol is not medically indicated for this patient. Recommend
DIAGNOSIS: Lumbar facet arthropathy
12/07/15 progress note by Dr. Tarasenko indicates request for Tramadol and Butrans. The Diagnosis is lumbar facet arthropathy.
10/11/15 progress report by Dr. Kofoed indicated that the patient complains of significant anterior left knee pain. The pain is 7-8/10 on pain scale. She describes pain in the lower back and right knee. There is difficulty with walking. PE of the left knee was within normal limits. MRI does not demonstrate any significant pathology with no evidence of meniscal tears. Treatment plan includes Gabapentin trial, activity …show more content…
Treatment to date has included medications, activity modification, Orthovisc injections x3, cortisone injections, and physical therapy X 18 visits.
The request is for TREATMENT REQUEST: Butrans 10mcg/hr #4 and Tramadol 50mg #120.
CONCLUSION:
Regarding Tramadol 50mg #120, per CA MTUS Opioid analgesics and Tramadol have been suggested as a second-line treatment (alone or in combination with first-line drugs). Per ODG Guidelines when considering initiation of opioid therapy, several factors should be considered, including other options and whether or not opioids have been used before, likelihood of improvement and likelihood of use/abuse. The guidelines do indicate to start with a short-acting opioid trying one medication at a time. However, the patient has a history of opioid treatment in the past to address her left knee pain. She has been completely off of narcotics from 02/17/15. The pharmacy note provided indicated that her last Hydrocodone-Acetaminophen refill was on 02/17/15. 12/07/15 progress note by Dr. Tarasenko is not complete and only indicates request for Tramadol and Butrans. The Diagnosis is lumbar facet arthropathy. No clinical history or physical examination findings have been provided. Moreover, no documentation has been provided that indicates the use of non-naroctic means of pain control for the condition. Given no trial of non-narcotics to improve pain and 9 months long history being off opioids; Tramadol is not medically indicated for this patient. Recommend