New Parameters Regarding Spinal Cord Stimulators

In early September 2014, new parameters went into effect regarding spinal cord stimulators. You can view the new guidelines on the website of The Office of the Revisor of Statues under Minn. Rules 5221.6305, Subp. 3.B.

The Minnesota Rules now explicitly state that spinal cord stimulators have very limited applications and are only indicated if certain conditions have been satisfied. Specifically, long-term use of a spinal cord stimulator is indicated only if the employee’s treating provider documents that there has been at least a 50 percent improvement in pain during a trial screening period of at least three days, when compared to the employee’s pain level immediately preceding the trial screening period.

In addition, there have been some changes regarding what is required before a spinal cord stimulator trial. First, the treating provider must find that the employee has intractable pain, is not a candidate for another surgical therapy, and that the employee has no untreatable major psychological comorbidity that would prevent the employee from benefitting from the treatment.

In this regard, one key change is that now, before there is a trial of a spinal cord stimulator, there must be a psychological evaluation to assess the employee for psychological and psychiatric comorbidities. In addition, the employee’s treating provider determines where to refer the employee for the psychological evaluation.

Another requirement that must be met before a trial of a spinal cord stimulator is that there must be a second opinion from a provider outside of the treating provider’s practice. The second opinion must confirm the treating provider’s findings that the employee has intractable pain, is not a candidate for another surgical therapy, and that the employee has no untreatable major psychological comorbidity that would prevent the employee from benefitting from the treatment. The second opinion must also confirm that the employee has no contraindications to a spinal cord stimulator.

In summary, there have been some major changes to the rules regarding spinal cord stimulators. There are certain standards for long-term use and new requirements before a trial of a spinal cord stimulator. The key new requirements are that a psychological evaluation and a second opinion (by a provider outside of the treating provider’s practice) need to take place before the trial. In addition, it is the treating provider that determines where the employee is referred to for the psychological evaluation.