653—13.9 (147,148,272C) Standards of practice—interventional chronic pain management. This rule establishes standards of practice for the practice of interventional chronic pain management. The purpose of this rule is to assist physicians who consider interventional techniques to treat patients with chronic pain.
	 13.9(1) Definition. As used in this rule:
“Interventional chronic pain management” means the diagnosis and treatment of pain-related disorders with the application of interventional techniques in managing subacute, chronic, persistent, and intractable pain. Interventional techniques include percutaneous (through the skin) needle placement to inject drugs in targeted areas. Interventional techniques also include nerve ablation (excision or amputation) and certain surgical procedures. Interventional techniques often involve injection of steroids, analgesics, and anesthetics and include: lumbar, thoracic, and cervical spine injections, intra-articular injections, intrathecal injections, epidural injections (both regular and transforaminal), facet injections, discography, nerve destruction, occipital nerve blocks, lumbar sympathetic blocks and vertebroplasty, and kyphoplasty. Interventional chronic pain management includes the use of fluoroscopy when it is used to assess the cause of a patient’s chronic pain or when it is used to identify anatomic landmarks during interventional techniques. Specific interventional techniques include: SI joint injections; spinal punctures; epidural blood patches; epidural injections; epidural/spinal injections; lumbar injections; epidural/subarachnoid catheters; occipital nerve blocks; axillary nerve blocks; intercostals nerve blocks; multiple intercostals nerve blocks; ilioinguinal nerve blocks; peripheral nerve blocks; facet joint injections; cervical/thoracic facet joint injections; lumbar facet injections; multiple lumbar facet injections; transforaminal epidural steroid injections; transforaminal cervical steroid injections; sphenopalatine ganglion blocks; paravertebral sympathetic blocks; neurolysis of the lumbar facet nerve; neurolysis of the cervical facet nerve; and destruction of the peripheral nerve.
	 13.9(2) Interventional chronic pain management. The practice of interventional chronic pain management shall include the following:
	  a.   	 Comprehensive assessment of the patient;
	  b.   	 Diagnosis of the cause of the patient’s pain;
	  c.   	 Evaluation of alternative treatment options;
	  d.   	 Selection of appropriate treatment options;
	  e.   	 Termination of prescribed treatment options when appropriate;
	  f.   	 Follow-up care; and
	  g.   	 Collaboration with other health care providers.
	 13.9(3) Practice of medicine. Interventional chronic pain management is the practice of medicine.
[ARC 8918B, IAB 6/30/10, effective 8/4/10]