A reasonable trial of chiropractic care has been accomplished; all further care will be ONLY for exacerbations of this patient's chronic pain, which as been deemed reasonable by a recent WCAB Panel decision (Casillas vs. The County of San Luis Obispo (2005) 33 CWCR 217).

Since ACOEM is silent with respect to exacerbations of a chronic condition [Hamilton v. State Compensation Insurance Fund (2004) 32 CWCR 249 WCAB Panel Decision & Los Angeles Times v. WCAB (2005) (Herbinger) 70 CCC 504 WCAB Writ Denied Decision], Labor Code section 4604.5(e) proclaims authorized medical treatment “shall be in accordance with other evidence based medical treatment guidelines generally recognized by the national medical community and that are scientifically based." (Bold added.)

Therefore, I shall present the Guidelines for Chiropractic Quality Assurance and Practice Parameters ("Mercy Guidelines") to support my recommended care. The Mercy Conference Guidelines are both nationally recognized and based upon scientific medical evidence. In fact, Chapter 8 alone was developed using 67 peer-review quality investigations, text book citations and/or other state treatment guidelines. With regard to reasonable chiropractic treatment frequency for acute injuries, page 125; chapter 8, subsection "E" of said Mercy Conference Guideline, entitled “Acute Episode,” allows the following treatment frequency for an "exacerbation of a chronic condition":

(1) "three to five treatments per week" during the first "10-14 days,"

(2) “up to three treatments per week” for “six to eight weeks.”

Thus a maximum of 34 chiropractic treatments are allowable per Mercy for acute exacerbations of a chronic condition.

Furthermore, noteworthy is the fact that a recent WCAB panel decision (Casillas vs. The County of San Luis Obispo (2005) 33 CWCR 217 WCAB Panel decision) used the Mercy Guidelines to support chiropractic treatment for exacerbations of a chronic condition. In pertinent part, the commissioners stated:

"We find in this case that the presumption would be rebutted by the reasoned opinion of the examining QME, the Mercy Guidelines, and the applicants experience in obtaining pain relief from acute exacerbations of her symptoms through the use of chiropractic care.”

Therefore, the request for six chiropractic visits to quell the effects of the recent exacerbation of the patient's chronic pain would certainly seem reasonable.

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(1) PRN Chiropractic Care: since ACOEM is silent with respect to exacerbations of a chronic condition, Labor Code section 4604.5(e) proclaims authorized medical treatment “shall be in accordance with other evidence based medical treatment guidelines generally recognized by the national medical community and that are scientifically based." (Bold added.) Therefore, I shall present the Guidelines for Chiropractic Quality Assurance and Practice Parameters ("Mercy Guidelines") to support my recommended care. The Mercy Conference Guidelines are both nationally recognized and based upon scientific medical evidence. In fact, Chapter 8 alone was developed using 67 peer-review quality investigations, text book citations and/or other state treatment guidelines. With regard to reasonable chiropractic treatment frequency for acute injuries, page 125; chapter 8, subsection "E" of said Mercy Conference Guideline, entitled “Acute Episode,” allows the following treatment frequency for an "exacerbation of a chronic condition":

(1) "three to five treatments per week" during the first "10-14 days,"

(2) “up to three treatments per week” for “six to eight weeks.”

Thus a maximum of 34 chiropractic treatments are allowable, per Mercy, for acute exacerbations of a chronic condition. I shall report if the need for said care arises. Furthermore, noteworthy is the fact that a recent WCAB panel decision (Casillas vs. The County of San Luis Obispo (2005) 33 CWCR 217 WCAB Panel decision) used the Mercy Guidelines to support chiropractic treatment for exacerbations of a chronic condition. In pertinent part, the commissioners stated, "we find in this case that the presumption would be rebutted by the reasoned opinion of the examining QME, the Mercy Guidelines, and the applicants experience in obtaining pain relief from acute exacerbations of her symptoms through the use of chiropractic care.”