Diagnosis: Chronic low back pain
Treatment: Pain Management ('trigger point injections' to lower back), Pre-service
The insurer denied the Pain Management ('trigger point injections' to lower back), Pre-service.
The denial is overturned.

The patient is a male with chronic low back pain who underwent trigger point injections greater than six weeks prior with good results. He returned with low back pain. Trigger point injections have been recommended.

Yes, the pain management ('trigger point injections' to lower back) is medically necessary.

The patient is a male with chronic low back pain who underwent trigger point injections greater than six to eight weeks prior with good results, and who returns with low back pain. Trigger point injections have been recommended and have given him 80% relief. He has done conservative treatment including taking muscle relaxants, as well as opiates. Increasing opiate medications are not without risk. Trigger point injections (TPIs) are a minimally invasive treatment used when the patient's pain, or at least component of their pain, is muscular and has failed conservative treatment. Given the above, the requested TPI is medically necessary.

Please see above. The patient has had over 80% relief with the previous treatments. Withholding the treatment will lead to other more invasive procedures, and potentially increasing opiate medications, which carry an inherent risk.