The California Division of Workers’ Compensation (DWC) has proposed amendments related to the treatment guidelines for Chronic Pain and the use of Cannabis for the treatment of pain. The CA DWC has scheduled a public hearing on March 14, 2025, 10:00 A.M. PT to discuss the proposed amendments as listed below. Any written comments to the DWC on these amendments are due by that date.
• Amendment to Section 9792.24.2. Chronic Pain Guidelines. (ACOEM December 19, 2024)
• Adoption of Section 9792.24.8 Cannabis Guideline (ACOEM January 28, 2025)
The proposed amendments reference the latest evidence-based updates and adoption of the Medical Treatment Utilization Schedule (MTUS) as outlined by the American College of Occupational and Environmental Medicine (ACOEM).
Adopted MTUS medical treatment guidelines are presumed to be correct on the issue of extent and scope of medical treatment, and they are intended to guide treatment and authorization of it in the state’s workers’ compensation system.
Chronic Pain Guideline Updates
The ACOEM Chronic Pain guidelines include interventions regardless of FDA approval and are not an endorsement of their use. Many of the medications listed within the amendments are utilized off-label. Updates address regarding:
- Outdated language and definitions of pain
- Exercise for pain treatment
- Medications for regional pain, fibromyalgia treatment, and weight reduction
- Lidocaine patches and opioids
- Neuropathic pain medications
- Including, but not limited to, antidepressants, antipsychotic, antiviral, clonidine, dextromethorphan, muscle relaxants, magnesium, topical NSAIDS, Ketamine, topical capsaicin, lidocaine patches, memantine, vitamin B, and homeopathic treatments
- Medication complications
- Comorbidities
- Follow up care
A MyMatrixx clinical pharmacist reviewed the proposed updates to the Chronic Pain Guidelines and noted the inclusion of Topical Non-Steroidal Anti-inflammatories (NSAIDs) as a recommended treatment of Complex Regional Pain Syndrome (CRPS). Topical NSAIDs are also indicated as a second- or third-line adjunct to strengthening, conditioning, and aerobic exercises for treatment of CRPS that is severe enough to require medications. These updates will provide clinicians with an additional tool to expedite a successful recovery for those with complex medical conditions.
Cannabis Guideline Updates
The ACOEM Cannabis Guideline is focused on the treatment of pain resulting from disorders that are likely to be work-related (e.g., spine pain, chronic radicular pain, osteoarthrosis). Other conditions are out of scope. Within these pain disorders, the guidelines do not recommend cannabinoids for the treatment of chronic pain, acute pain, subacute pain, or postoperative pain. Additionally, acute, or chronic cannabinoid use is not recommended for individuals who perform safety-critical jobs.
Comments
The DWC is accepting written comments on these proposed updates until 11:59 P.M. on March 14, 2025. Written comments should be submitted to:
Maureen Gray
Regulations Coordinator
Department of Industrial Relations
Division of Workers’ Compensation
1515 Clay Street, 18th Floor
Oakland, CA 94612
Written comments may also be submitted by FAX, addressed to the above-named contact at (510) 286-0687, and via email to dwcrules@dir.ca.gov.
More details can be viewed on the DWC website here.
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