New York State Medical Treatment Guidelines for Pharmacological Approaches in workers compensation patients

The guidelines provided by the New York State Workers Compensation Board offer fundamental principles for employing pharmacological approaches to address non-acute pain. These directives aim to assist healthcare professionals in identifying appropriate medication-based interventions within the context of comprehensive care.

Healthcare professionals with expertise in utilizing pharmacological approaches for non-acute pain can rely on the guidance outlined by the Workers Compensation Board to make well-informed decisions about the most suitable medication interventions for their patients.

It is essential to emphasize that these principles are not intended to replace clinical judgment or professional expertise. The use of pharmacological approaches for non-acute pain should involve collaboration between the healthcare provider and the patient, considering individual factors such as medical history, medication tolerance, and potential side effects.


Pharmacological Approaches

  • Pharmacological treatment for non-acute, non-malignant pain is not straightforward.
  • A comprehensive medication history, including the use of alternative and over-the-counter medications, should be conducted during the initial visit and periodically updated.
  • The appropriate use of pharmacological agents depends on factors such as the patient’s age, medical history (including substance abuse), drug allergies, and overall medical condition.



  • The primary objective of treatment is to enhance function, emphasizing the development of self-management skills.
  • Managing non-acute pain typically involves medication, but patients should understand that medications alone may not completely alleviate pain.
  • Alongside medications, ongoing participation in a self-management plan outlined in this guideline is crucial for effective pain management.


Pharmacological Principles

  • Physicians should have a thorough understanding of pharmacological principles, including knowledge of different drug families, their side effects, potential interactions, bioavailability profiles, and primary indications.
  • Side effects and potential secondary effects must be carefully monitored.
  • Consideration should be given to interactions between prescribed medications and over-the-counter drugs, as well as other medical conditions that could affect medication dosages and intervals.
  • All medications should undergo an appropriate trial period to assess their therapeutic effect, with the duration of the trial varying depending on the specific drug.
  • Patients with non-acute pain should ideally be prescribed medications with the least serious side effects.
  • For opioid medications, there should be ongoing consideration for tapering when feasible.
  • Close monitoring of the patient’s response to therapy is necessary, with flexibility from the physician to adjust treatment as needed.
  • While many medications discussed have indications beyond analgesia, evidence supports their effectiveness in controlling certain types of non-acute pain.
  • There is generally no evidence-based advantage for brand name medications, so they are not typically recommended unless specific medical documentation supports their use.
  • Nutraceuticals and topical, oral, or systemic compound medications are not recommended.


Neuropathic Pain

  • Various medications can be utilized to manage neuropathic pain.
  • It is advisable to start patients with neuropathic pain on a trial of tricyclic medication initially, as low doses of this medication type are often well-tolerated and effective.
  • If tricyclic medication proves ineffective or if the patient experiences intolerable side effects, or if medical conditions prohibit the use of this drug class, alternative medications can be explored.
  • Second-line treatment options include anti-convulsants like gabapentin and pregabalin.
  • Third-line options encompass Serotonin Norepinephrine Reuptake Inhibitors (SNRI) and topical lidocaine.
  • Opioids, tramadol, and tapentadol are considered fourth-line treatments.
  • While there are other medications with limited supporting clinical evidence, they may still provide benefit for certain patients.
  • Simultaneous use of multiple drugs from the same class is not advised.
  • Drug dosages should be limited to the FDA-approved recommendations.
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