New York State Medical Treatment Guidelines for Injection Therapy in workers compensation patients

The New York State Workers Compensation Board provides general principles for administering injection therapy. These directives aim to assist healthcare professionals in determining appropriate approaches for administering therapeutic injections as part of a comprehensive treatment plan.

Healthcare practitioners specializing in injection therapy can rely on the guidance from the Workers Compensation Board to make well-informed decisions about the most suitable methods for administering therapeutic injections to their patients.

It is important to emphasize that these guidelines are not intended to replace clinical judgment or professional expertise. The ultimate decision regarding injection therapy should involve collaboration between the patient and their healthcare provider.

Radiofrequency Neurotomy

This is suggested for individuals who experience temporary relief after three occipital nerve blocks with fluoroscopic guidance for Cervicogenic Headache. It is recommended specifically for patients who exhibit positive outcomes in a diagnostic block, where they report a 50% or greater reduction in pain from baseline, correlated with functional improvement. Additionally, patients should pinpoint daily activities hindered by their pain, and physicians should observe and document enhanced functionality in a clinical setting. The suggested frequency is twice a year, based on improvements in pain and function. A successful neurotomy typically grants relief for six to nine months.


Occipital Nerve Blocks 

Recommended for specific patients dealing with cervicogenic and migraine headaches resulting from traumatic brain injury (TBI). This procedure is suitable for cases of unilateral cervicogenic headaches triggered by neck movement or pressure on the greater occipital nerve, coupled with restricted neck range of motion. It can also be considered for post-traumatic migraine headaches when other treatments like NSAIDs, acetaminophen, stress reduction, and exercise have proven ineffective. The potential benefits include a decrease in headache intensity, frequency, and duration, as well as a possible reduction in the use of other medications. The local anesthetic takes around 30 minutes to take effect, while corticosteroids may take 48 to 72 hours. After each injection, patients should be reassessed for a documented 50% improvement in pain.

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