Friday, July 9, 2010

Epidural Opioid Administration

Epidural Opioid Administration

The intermittent or continuous administration of epidural opioids to treat severe chronic intractable pain of malignant or non-malignant origin is a Medi-Cal benefit, subject to prior authorization.  An implantable infusion pump may be reimbursed when used to administer opioid drugs intrathecally or epidurally in patients with severe chronic intractable pain when the following criteria are met:

•    Documentation that parenteral and/or oral administration of analgesia has been unsatisfactory in continuing to provide adequate analgesia for the patient

•    Documentation that the patient’s history indicates the patient did not respond to non-invasive methods of pain control such as attempts to eliminate the etiology of the pain and/or behavioral approaches to pain management

•    A preliminary trial of intraspinal opioid administration should be first undertaken with a temporary intrathecal or epidural catheter to substantiate adequately acceptable pain relief and tolerable degree of side effects.  This trial procedure may be performed during the same time period as the hospitalization for the implantation of the permanent catheter and reservoir/pump.

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