Dealing with Back Pain

It is one of the most common medical complaints in the USA.  It generates as many doctor visits as the common cold.  It effects all aspects of life from work to working-out.  It is back pain.  And almost everyone experiences it at some point in their lives.  The causes can vary, the symptoms can be different each time you experience it, but the treatment can initially be simple and easy.

Back pain can be mechanical: you did something to your back and now it hurts.  Lifting something too heavy, lifting in the wrong way (back bent and straight-legged), an awkward position for too long: all can stress or strain the back muscles.  Often this pain is not immediate, but makes getting out of bed the next day a painful experience.  Back spasms, or waves of severe muscle pain, can make it difficult to move around.  Your legs can sometimes feel as if they won’t hold you up.  Some people get such severe spasms they may feel nauseated.

Back pain can also be due to structural changes in the spinal cord: a herniated disc or spinal stenosis.  A disc herniation can result from result from lifting, but can also come from something as simple as a cough or sneeze.  Spinal stenosis can be more of a gradual onset of pain, but can also flare for no apparent reason.  Some of the time, these conditions can start off with back pain, but usually leg pain, numbness, tingling or weakness is the bigger complaint.

The good news is that initially, these conditions can be treated with the same types of modalities: anti-inflammatories, topicals and activity modification.  A visit to the doctor is not always necessary. If you can take medication like ibuprofen or naproxen, which are available over the counter, that’s a good place to start.  Ice your back for swelling and some numbing effect.  Try a medicated creme or gel; they can be effective.  Do not lay in bed for hours at a time.  Do not try to go through your normal work-out routine either.  Walking and gentle stretching is key.

Given a few days of the above mentioned treatments, you should start to feel better.  But residual pain may last several weeks.  If pain is not improving, if leg symptoms increase, if there is any change in the function of your bowels or bladder, then a doctor visit is needed.  Often, some stronger medications and physical therapy are all that may be necessary.  An MRI is not always needed before conservative measures are given a try.

For long-term back health, strength and flexibility are the mainstays of treatment.  Strength and movement not only in the back, but abdominal and leg muscles needs to become part of a regular exercise routine.  Listen to your body when it is tired or injured.  Try some nonsteroidal anti-inflammatory drugs (NSAIDS) and ice.  When in question, call OIP!

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MRI Upper Extremity (Shoulder, Upper Arm, Elbow, Forearm, Wrist, or Hand) Preauthorization Documentation Guidelines

1. Suspicious mass or tumor
      a. On initial evaluation or follow up
2. Staging of known cancer
3. Suspected or known infection (septic arthritis or osteomyelitis)
4. Suspected Osteonecrosis
5. Evaluation of Rheumatoid Arthritis or other autoimmune diseases
6. Evaluation of Post-op Complications
      a. Infection, delayed union, other
7. Suspected fracture with prior imaging non-diagnostic
8. Abnormal bones scan with non-diagnostic Xray
9. Significant injury with suspected ligament, cartilage, tendon, nerve or bone injury with non-diagnostic prior imaging
      a. Suspected massive rotator cuff tear
10. Evaluation of pain or more minor injury with initial imaging non-diagnostic:
      a. Pain lasting 3 months or greater
      b. Failed conservative therapy: Must include each one:
           i. Rest: modified activities or assistive devices/rigid splints or braces
           ii. Ice or heat
           iii. Medications and/or injections
           iv. Physical therapy or a physician directed home exercise program
           or chiropractic care
                1. Document instructions given
                2. Document compliance and results
                3. Document duration and dates

MRI Spine Preauthorization Documentation Criteria

1. Tumor, masses, or cancer: suspected or known
2. Neurological Deficits
3. Trauma or acute injury
       a. With neurological deficits
       b. With progressive symptoms during conservative treatment
4. Infection: known or suspected
5. Inflammation: Ankylosing Spondylitis
6. Pre-op Evaluation
7. Post-op Complications
8. Acute or Chronic Axial or radicular pain
       a. Pain lasting 6 weeks or greater
       b. ADLs must be affected
       c. Progressive neurological deficit or an abnormal EMG
             i. Must document specific dermatome, muscle weakness, reflex
abnormalities
       d. Failed conservative therapy: Must include each one:
             i. Rest: modified activities or bracing
             ii. Ice or heat
             iii. Medications, acupuncture or stimulators
                   1. Specific name of medication start date and duration and
                   results
             iv. Epidurals or other injections (not trigger point injections)
             v. Physical therapy or a physician directed home exercise program
             or chiropractic care
                   1. Document instructions given
                   2. Document compliance and results
                   3. Document duration and dates

MRI Pelvis Preauthorization Documentation Criteria

1. Musculoskeletal Pelvic MRI:
     a. Mass or tumor
    b. Significant injury to rule out fracture or other injury
    c. Osteonecrosis of hips
    d. Sacroiliitis
    e. Sacroiliac joint dysfunction
    f. Pain lasting 3 months or greater
    g. Failed conservative therapy: Must include each one:
            i. Rest: modified activities or assistive devices/rigid
            splints or braces
            ii. Ice or heat
            iii. Medications and/or injections
            iv. Physical therapy or a physician directed home
            exercise program or chiropractic care
                    1. Document instructions given
                    2. Document compliance and results
                    3. Document duration
    h. Persistent Pain not responsive to 4 weeks of conservative treatment

2. Prostate Cancer Evaluation, follow up, and surveillance

3. Mass or Tumors

4. Cancer detection, staging, or surveillance
    a. 3, 6, or 12 month follow up

5. Infection:
        a. Appendicitis
        b. Diverticulitis not responding to conservative care
        c. Inflammatory bowel disease
        d. Abscess suspected
        e. Fistula
        f. Abnormal fluid collection

6. Pelvic Floor failure

7. Uterine abnormalities

8. Undescended Testes

9. Pre-op Evaluation

10. Post-op Complication

MRI Lower Extremity (Hip, Knee, Leg, Ankle, or Foot) Preauthorization Documentation Guidelines

1. Suspicious Mass or Tumor
       a. On initial evaluation or follow up
2. Staging of known Cancer
3. Known or suspected infection
4. Suspected Osteonecrosis or Legg-Calve-Perthes Disease
5. Suspected SCFE, tarsal coaltion
6. Evaluation of Post-op complication:
       a. Infection, delayed union, other
7. Suspected fracture with prior imaging non-diagnostic
8. Abnormal bone scan with non-diagnostic xray
9. Significant injury with suspected ligament, cartilage, or bone injury
10. Evaluation of pain or more minor injury with initial imaging negative:
       a. Pain lasting 3 months or greater
       b. Failed conservative therapy: Must include each one:
             i. Rest: modified activities or assistive devices/rigid splints or braces
             ii. Ice or heat
             iii. Medications and/or injections
             iv. Physical therapy or a physician directed home exercise program orchiropractic care
                  1. Document instructions given
                   2. Document compliance and results
                   3. Document duration

MRI Chest Preauthorization Documentation Guidelines

1. Mediastinal or hilar mass
2. Myasthenia gravis with suspected thymoma
3. Brachial Plexus Dysfunction
4. Thoracic/Thoracoabdominal aneurysm
5. Suspected or confirmed Congenital Heart Disease
6. Thoracic Outlet Syndrome

MRI Brain Preauthorization Documentation Criteria

1. Suspected or known MS
2. Seizure disorder, known or suspected new or refractory
3. Suspected Parkinson’s disorder
4. Neurological symptoms or deficits
     a. Acute, new or fluctuating deficits
5. Mental status changes
6. Trauma to the head with neurological changes, vomiting, headache
7. Evaluation of headaches
      a. Chronic with change in pattern/character
      b. Sudden onset severe headache
      c. New onset headache in pregnancy
8. Suspected brain tumor or cancer
9. Known or suspected stroke
10. Suspected Infection
11. Suspected Congenital abnormality
12. New onset tinnitus or vertigo associated with visual changes

MRI Abdomen and MRCP Preauthorization Documentation Criteria

MRI
1. Suspicious Mass or Tumor
2. Surveillance of Mass, Tumor, or Cancer    
      a. 3, 6, 12 month follow up
3. Suspected infection:
      a. Appendicitis
      b. Peritonitis
      c. Pancreatitis
      d. Inflammatory bowel disease
      e. Cholecystitis
      f. Abscess
      g. Fistula
      h. Hepatitis C
4. Preoperative Evaluation
5. Post-op complication

MRCP
1. Suspected Congenital Abnormality
2. Chronic pancreatitis or related complications
3. Biliary tree symptoms
4. Pre-op Evaluation
5. Post-op complication or surveillance
6. Inconclusive abnormalities identified on other imaging