Implantable Pain Therapy Policy

WorkSafe can pay the reasonable costs of Implantable Pain Therapy (IPT) procedures for work-related injuries or illnesses.

What is Implantable Pain Therapy (IPT)?

 

Implantable Pain Therapy (IPT) procedures involve the use of implantable devices to address persistent pain and may be considered when a range of alternatives for managing persistent pain have been fully explored. 

IPT procedures aim to reduce an injured worker’s pain levels. Details of the procedures, what conditions can be treated by the procedures and the potential benefits and risks can be found under the WorkSafe Evidence Reviews.  Any IPT procedures remain non-established or experimental. 

IPT procedures include:

  • intrathecal morphine infusion and other analgesic infusions (also known as intraspinal pumps); and
  • neurostimulation techniques such as:
    • spinal cord stimulation
    • subcutaneous electrical stimulation
    • peripheral nerve stimulation
    • deep brain stimulation
    • motor cortex stimulation
    • other implanted neurostimulation devices for pain.

This policy does not apply to implantable devices or neurostimulation techniques used for reasons other than pain control, such as the management of incontinence.

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Who can provide IPT procedures?

IPT procedures can be provided by specialist medical physicians who have developed expertise in the area of implantable pain therapy.

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When can WorkSafe pay for IPT procedures?

 

WorkSafe can pay the reasonable costs of an IPT procedure where:

  • the persistent pain condition has resulted from a work-related injury or illness and is thought to respond to an IPT
  • alternative options for managing persistent pain, such as pharmaceutical management, review by medical specialists and pain management programs, have been fully explored and have not been successful
  • it is requested by a specialist medical physician with expertise in the area of implantable pain therapy
  • the request is supported by an Independent Medical Examiner where clinically required
  • the request is supported by the worker's treating psychologist or psychiatrist
  • it is clinically justified based on the worker’s physical, psychological and functional status
  • the condition being treated is the main source of pain and thought to respond to IPT (see WorkSafe Evidence Reviews)
  • it is listed on the Medicare Benefits Schedule (MBS)
  • the anticipated implantable prosthesis is listed on and provided in accordance with the Department of Health and Ageing (DoHA) Prostheses List  and the WorkSafe Prosthesis policy, and it is required for a technical purpose, such as a battery replacement, reprogramming or a refill.

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What IPT procedures can WorkSafe pay for?

WorkSafe can pay the reasonable costs of the following:

  • an assessment for suitability for an IPT procedure
  • an independent medical examination
  • an IPT procedure, if approved following extensive clinical review and /or an independent medical examination   
  • a limit of one IPT per worker unless a subsequent procedure is required for technical purposes, eg battery replacement
  • hospital and theatre fees – in accordance with the WorkSafe fee schedule; and
  • prosthetic items – as listed in the Department of Health and Ageing’s Prostheses List.

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When can't WorkSafe pay for IPT procedures?

WorkSafe cannot pay the costs of an IPT procedure where:

  • it is requested by a specialist medical physician without expertise in the area of implantable pain therapy
  • it is not required for the management of persistent pain resulting from work-related injury or illness
  • the procedure is contraindicated on physical, psychological or functional grounds
  • it is part of a clinical trial
  • there is no published evidence that a treatment or service is safe and effective for the condition being treated
  • it is not listed on the Medicare Benefits Schedule (MBS)
  • the anticipated implantable prosthesis is a gap-permitted item, or is not listed on the DoHA Prostheses List (any exceptions to this must be with prior written approval from the Agent)
  • the independent medical examiner with expertise in IPT does not support the IPT procedure
  • alternative options for managing persistent pain, such as pharmaceutical management, review by medical specialist and pain management programs, have not been fully explored, or
  • it is performed outside Australia without prior written approval from the WorkSafe Agent.

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Is prior approval required for an IPT procedure?

Prior written approval for an IPT procedure should be sought from the WorkSafe Agent. The Agent will consider whether payment for the procedure is a reasonable cost in the circumstances.

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What information does the WorkSafe Agent require to consider an IPT procedure?

The Agent requires the following information to consider an IPT procedure request:

Information from the requesting medical practitioner

1.      Evidence of the expertise of the doctor proposing to perform the procedure

  1. The condition(s) being treated
  2. The relationship between the condition(s) being treated and the work-related injury or illness.
  3. A brief description of the IPT procedure, including:
  • the MBS item number(s), and
  • prostheses details, including a clinical rationale for the use of any gap-permitted items on the Department of Health and Ageing’s Prostheses List.
  1. The clinical indication for the IPT procedure, including:
  • pain map and pain scores
  • a summary of the previous surgical and conservative treatments that have been tried and their outcomes  
  • the psychological preparedness of the worker, and
  • a list of all current medications taken by the worker including any medication dependency issues.
  1. An indication of how the published evidence supports the IPT procedure for this condition. 
  2. Any psychological risk factors that may negatively impact on the success of the IPT procedure.
  3. Whether a psychologist or psychiatrist is involved
  4. Information relating to a trial of the IPT procedure:
  • Will a trial of the procedure take place?
  • If a trial has already taken place, what was the response (include outcome measure scores if used and how these changed)?
  1. Anticipated effects of the IPT procedure on the worker’s participation in activities of daily living and work, mobility, pain levels and mood, and medication use (e.g. expected reductions).
  2. The outcome measures that will be used to measure the effectiveness of the procedure.
  3. Anticipated treatment plan following the IPT procedure, including:
  • the medications expected to be required
  • who will be responsible for the worker’s short and long term care
  • who will be responsible for changing batteries, refills and reprogramming (where required)
  • other therapists to be involved to maximise functional gains following IPT, eg physiotherapist, occupational therapist, return to work specialist, and
  • other treatments being considered if the procedure is not successful.

Information from the worker’s treating psychologist or psychatrist and/or a psychiatry IME

The WorkSafe Agent requires a report from the worker’s treating psychologist or psychiatrist. The report must include an assessment of the worker’s psychological function and recommendation of whether it is appropriate for the worker to have an IPT procedure.  A report may also be requested by the WorkSafe Agent from an independent medical examiner (psychiatrist).

The report from a psychologist or psychiatrist should provide the following information:

  1. An assessment of the worker’s psychological function
  2. Any psychiatric conditions (e.g. substance abuse disorder or incompatible psychological disorder) or psychological risk factors that may impact on the effectiveness of the IPT procedure and/or exclude the worker from having an IPT procedure
  3. A summary of the psychological effects of any previous treatments used by the worker to manage persistent pain
  4. The worker’s expectations of the procedure – are they realistic?
  5. An opinion about the worker’s understanding of the procedure, its implications and the level of commitment that is required after the implant   
  6. The anticipated effects of the IPT procedure on the worker’s mood, medication and participation in activities of daily living and work
  7. The anticipated mental health treatment plan following the IPT procedure, and
  8. Whether it is recommended that it is appropriate the worker undergoes the procedure based on their psychological status

Outcome report from requesting medical practitioner

If the Agent approves payment of the reasonable costs of the IPT procedure, they will request an outcome report from the medical practitioner who performed the procedure approximately three months after the procedure.

The outcome report should include the following details:

  1. The effects the IPT procedure has had on the worker’s participation in activities of daily living and work, mobility, pain levels and mood, and medication use
  2. The outcome measurement scores regarding the effectiveness of the procedure
  3. The current treatment plan, including the name of the healthcare professional providing long-term care and refills and programming for the worker  

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Are there any exceptions?

WorkSafe will consider requests for IPT procedures which are not listed on the MBS as an exception. These requests will be reviewed on a case by case basis.

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WorkSafe Evidence Reviews

Evidence Reviews are created to promote best practise among providers and better health outcomes for injured Victorians.

Download a copy of the following Evidence Reviews:

Implantable Pain Therapies

  • Intrathecal infusions
  • opiates (opioids, narcotics)
  • baclofen
  • ziconotide

Neurostimulation

  • Spinal cord stimulation
  • Subcutaneous Electrical Stimulation
  • Peripheral nerve Stimulation
  • Motor Cortex Stimulation
  • Deep brain stimulation

For more information about Evidence Reviews visit WorkSafe Evidence Reviews.

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