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Formatting changes in the Revised Medical Treatment Guidelines
January 19, 2010 revisions

The draft Medical Treatment Guidelines – revised January 19, 2010 contain two major sets of changes. This document walks through the changes due to formatting. The content changes are discussed in the Substantive changes in the Proposed Medical Treatment Guidelines January 19, 2010 revision document. The reformatting changes are designed to make guidelines easier to use and more consistent.

Changes Due to Reformatting:

In order to make the Medical Treatment Guidelines (Guidelines) easier to use they have been reformatted from the December 2007 Draft Medical Treatment Guidelines, which will be referred to as the 2007 Guidelines. The reformatted guidelines will be referred to as the Jan 2010 Guidelines. The following changes were made to all of the 2007 Guidelines.

All Guidelines

  1. The general principles for the Guidelines were added at the beginning of each Guideline.
  2. An Index of key words was added to each Jan 2010 Guideline.
  3. Each Jan 2010 Guideline has been revised to include the following:
    1. History Taking
    2. "Red Flags" – Certain findings, "red flags," raise suspicion of potentially serious and urgent medical conditions. Assessment (history and physical examination) should include evaluation for red flags. Each body part includes a listing of the "red flags" for that body part. The Guidelines note when a "red flag" is present a different treatment path may be indicated.

Low Back:

The original structure of the 2007 Low Back Treatment Guideline was significantly different from the structure of the other three 2007 Guidelines due to its basis. The other three 2007 Guidelines were based on the State of Colorado's medical treatment guidelines, the low back was based on the American College of Occupational and Environmental Medicine guidelines. The general structure of the Jan 2010 Low Back Guideline is much closer to the other three body parts.

  1. History Taking Section has been added based on background in the ACOEM guidelines.
  2. The information from the 2007 Guidelines "General Summary of Recommendations" has been incorporated into the Guideline. For example, – # 1 in General Summary of Recommendations, "The initial assessment of patients with low back problems focuses on detecting indications of potentially serious disease, termed 'red flags' (i.e., fever or major trauma)", was moved to section B.1.f. – Red Flags. Other aspects of the "General Summary" are included in the General Principals.
  3. Section B from the 2007 Guidelines "Anatomical Tests" – is in section C of the Jan 2010 "Diagnostic studies – Imaging studies or other tests".
  4. Section C Medications from the 2007 Guidelines was moved under section D of the Jan 2010 Guidelines "Therapeutic Procedures-Non Operative – part 12."

    The medications are listed alphabetically by groups:
    1. Acetaminophen is listed separate from NSAIDs
    2. Antidepressants
    3. Anti-seizure
    4. Colchicine
    5. Complementary and alternative methods.
      1. Herbal treatments, Willow bark and Vitamins were dropped because the 2007 Guidelines had no recommendation for or against.
      2. Harpagoside
      3. Capsaicin, Sports Creams and other creams and ointments
    6. NSAIDS
    7. Opioids
    8. Skeletal Muscle Relaxants
    9. Steroids
    10. Tramadol
    11. Tumor Necrosis Factor-A Inhibitors
  5. 2007 Section D "Physical Methods – Appliances, Acupuncture and Neuroflexotherapy" is included in Section D of the Jan 2010 Guidelines "Therapeutic Procedures – Non-Operative"
    • D.1 Acupuncture
    • D.2 Appliances
    • D.14 Neuroflexotherapy -The 2007 Guidelines (p.34) recommended for moderate to severe chronic LBP and was not recommended for acute, subacute or radicular pain syndromes.  2009 Guidelines (p.38) Recommended for moderate to severe chronic LBP.  Jan 2010 (p.53) Not recommended for acute, subacute or radicular pain; or moderate to severe chronic LBP.
  6. Section E (Modalities), F (Electrical Therapies), G (Acupuncture), I (Activity Modification and Exercise), and J (Injection therapies) from 2007 Guidelines are now included in Section D "Therapeutic Procedures – Non-Operative". These procedures are listed alphabetically under their group heading.
    1. Under injection therapy Botulinum Injections were dropped because the 2007 Guidelines had no recommendation for or against.
  7. Section K (Surgical Considerations) from the 2007 Guidelines is in Section E "Therapeutic Procedures: Operative".