Infusion Therapy for Pain Management

The TAC  Medical Excess  may apply to these services  

 

 

Policy

The TAC can fund the reasonable cost of infusion therapy for injuries sustained in a transport accident.

Transport Accident Act 1986 reference: s.3 'medical service' and s.60

Definition

In this policy, infusion therapy refers to various medications such as ketamine, lignocaine, fentanyl, phentolamine, morphine, clonidine (or combinations of these) when used to treat persistent pain following an injury. Infusions can be intravenous, subcutaneous or epidural, and usually require admission to hospital either as a day patient or for several days. See also the Hospitals policy.

Background

Persistent pain develops for a variety of reasons following an injury. An infusion may be considered when "first line" treatments are not successful at reducing disability due to pain or when strong analgesics may be contributing to disability.

Not all infusions are successful. However, when infusion therapy is successful, the client's use of strong analgesics and the need for healthcare and support can be significantly reduced. Sometimes a reduced level of pain persists. It is not yet possible to predict which type of persistent pain will respond, so the first infusion is usually a trial and may involve the use of a placebo (non-active medication).

There is low quality research evidence supporting the use of infusions and there are often side-effects. As a result, infusions are not considered as "first line" treatments.

It is up to the treating practitioner and patient to determine if "first line" treatments have been exhausted for the client's particular pain condition.

Guidelines

Who is eligible to receive infusion therapy?

Clients who have transport accident injuries leading to persistent pain may be eligible for infusion/s where conservative measures have not been successful and other alternative options have been fully explored.

What information does the TAC require to fund an infusion?

In order to consider a request for funding of infusion therapy, the requesting medical practitioner will need to provide the following details:

  • The condition(s) or symptoms being treated
  • How the condition/s relate to the transport accident injuries
  • The medications to be infused, the route and duration of the planned infusion and expected length of hospital admission
  • The details of any planned placebo-controlled trial. If a placebo trial will not be used, the specialist must provide reasons for this
  • Previous "first line" medications/treatments/surgery that have been trialled
  • Current medications and the expected changes to current medications after the infusion
  • The outcome measures to be used, e.g. real time pain charts and pain diaries and expected outcomes, e.g. specific functional gains, return to work, etc.
  • The proposed treatment plan/rehabilitation following infusion. This inlcudes the modality of therapy, if any
  • Details of the client's expectations regarding the outcome of the infusion.

Following the infusion, the requesting medical practitioner should forward either as a discharge summary or as a report, the outcome of the therapy and future plans for the client's treatment. This should include:

  • Discharge summary from the previous infusion
  • The medication/s infused, the route and duration of infusion and details of the hospital admission (length of admission)
  • Outcome measures nd scores used in the previous infusion, including the placebo responses
  • Details of the client's previous infusion discharge medications
  • Details of ongoing rehabilitation plans aimed at facilitating increased function and/or return to work.

Can the TAC fund infusion therapy performed by a member of a client's immediate family?

Refer to the Funding Treatment by a Member of a Client's Immediate Family policy.

In relation to infusion therapy for pain management what will the TAC not fund?

The TAC will not fund:

  • services for a person other than the injured client
  • treatment, services and/or travel to treatment for a condition that existed before the transport accident or that is not a direct result of the transport accident
  • treatment or services where there is no objective evidence that a treatment or service is safe and effective
  • treatment, services and/or travel to treatment where there is no clinical justification for this service
  • infusion therapy for conditions not directly related to transport accident injuries
  • Infusion therapy for minor pain which is not a major source of the client's disability
  • infusion therapy where "first line" therapy has not been appropriately trialled
  • repeat infusion pain therapy where the previous infusion was effective for less than 3 months
  • repeat infusion pain therapy where outcome measures and outcomes from the previous infusion have not been provided
  • Epidural ketamine due to the potential for spinal cord injury. See also the Non Established, New or Emerging Treatments and Services policy
  • infusions of medications other than those listed here. See also the Non Established, New or Emerging Treatments and Services policy
  • treatment, services or travel to services provided more than 2 years prior to the request for funding except where the request for payment is made within 3 years of the transport accident. Refer to the Time Limit to Apply for the Payment of Medical and Like Expenses policy.

For further information see also Hocking G, Cousins MJ. Ketamine in Chronic Pain Management: An Evidence-Based Review. Anesth Analg 2003; 97:1730-9 and Hocking G, Visser EJ, Schug SA, Cousins MJ. Ketamine: Does Life Begin at 40? Pain Clinical Updates, IASP, Vol XV, Issue 3, June 2007.