Regarding Gabapentin 100mg #30, CA MTUS Chronic Pain Medical Treatment Guidelines state that Gabapentin has been shown to be effective for the treatment of diabetic painful neuropathy and post-herpetic neuralgia and has been considered as a first-line treatment for neuropathic pain. The patient has chronic neuropathic lower back pain, which radiates down her right leg. Medical necessity of Gabapentin has been substantiated. Recommend certification.
Regarding Hydrocodone 5/325mg #90 and Ultracet 37.5/325mg #60, Norco 5/325mg #130 and Butrans Patch 120mcg #20, CA MTUS Chronic Pain Medical Treatment Guidelines do not support ongoing opioid treatment unless prescriptions are from a single practitioner and are taken as directed; are prescribed at the lowest possible dose; and unless there is an ongoing review and documentation of pain …show more content…
In addition, CA MTUS criteria for the use of epidural steroid injections include an imaging study documenting correlating concordant nerve root pathology; and conservative treatment. The patient reported lower back pain with radiation into the right leg. 05/04/15 MRI Lumbar Spine demonstrated a 4 mm disc bulge at the L5-S1 level with associated facet osteoarthrosis resulting in moderate to severe right-sided neuroforaminal stenosis at the requested level. Clinically, SLR test was positive on the right side. Pinprick was slightly decreased at the right L5 and S1 as well. Furthermore, it was reported that she was approved for Lumbar ESI in October, but she did not receive it as she took Naproxen before the appointment. In addition, the guidelines suggest that transforaminal approach may be particularly helpful in patients with large disc herniations, foraminal stenosis, and lateral disc herniations. Medical necessity of Lumbar ESI has been established. Recommend
Regarding Hydrocodone 5/325mg #90 and Ultracet 37.5/325mg #60, Norco 5/325mg #130 and Butrans Patch 120mcg #20, CA MTUS Chronic Pain Medical Treatment Guidelines do not support ongoing opioid treatment unless prescriptions are from a single practitioner and are taken as directed; are prescribed at the lowest possible dose; and unless there is an ongoing review and documentation of pain …show more content…
In addition, CA MTUS criteria for the use of epidural steroid injections include an imaging study documenting correlating concordant nerve root pathology; and conservative treatment. The patient reported lower back pain with radiation into the right leg. 05/04/15 MRI Lumbar Spine demonstrated a 4 mm disc bulge at the L5-S1 level with associated facet osteoarthrosis resulting in moderate to severe right-sided neuroforaminal stenosis at the requested level. Clinically, SLR test was positive on the right side. Pinprick was slightly decreased at the right L5 and S1 as well. Furthermore, it was reported that she was approved for Lumbar ESI in October, but she did not receive it as she took Naproxen before the appointment. In addition, the guidelines suggest that transforaminal approach may be particularly helpful in patients with large disc herniations, foraminal stenosis, and lateral disc herniations. Medical necessity of Lumbar ESI has been established. Recommend