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QME MTUS Chronic Pain Medical Treatment Guidelines

by William W. Deardorff, Ph.D, ABPP 12 Credit Hours

This course begins with an overview of the purpose of the medical treatment utilization schedule (MTUS).  The overview is contained in the following and is largely paraphrased from the DWC website.  The full text of this overview is on the DWC website and can be found here.  The course then specifically covers the MTUS for chronic pain.  To complete the course you will need to first read the following overview. Second, download the MTUS Chronic Pain Medical Treatment Guidelines (instructions for doing so are contained in the last section below).  This is a 127 page document that is available in PDF format.  The most efficient method is to print the guidelines for review and to take the test; although, they can also be reviewed on your computer.  The Appendix to the Chronic Pain Treatment Guides (Appendix D) includes 559 pages of references and is not necessary to download or review for this course, or to take the test.

Learning Objectives

  • Discuss the history and purpose of the MTUS
  • Describe the difference between nociceptive and neuropathic pain
  • Explain the biomedical versus biopsychosocial models of pain
  • List 10 treatments for chronic pain that are “recommended”
  • List 10 treatments for chronic pain that are “not recommended”


The medical treatment utilization schedule (MTUS) provides medical treatment guidelines for utilization review and an analytical framework for the evaluation and treatment of injured workers. It helps medical providers understand which evidenced-based treatments have been effective in providing improved medical outcomes to those workers. The MTUS is promulgated by the DWC administrative director under Labor Code sections 5307.27 and 4604.5, and can be found in sections 9792.20 et seq. of Title 8, California Code of Regulations.

The MTUS lays out treatments scientifically proven to cure or relieve work-related injuries and illnesses. It also deals with how often the treatment is given (frequency), extent of treatment (intensity), and for how long (duration), among other things.


Jan. 1, 2004 – The Legislature charged the DWC administrative director (AD) with adopting an MTUS that would be presumed correct on the issue of extent and scope of medical treatment, and made the American College of Occupational and Environmental Medicine Practice Guidelines, 2nd Edition, (ACOEM) the standard until the adoption of an MTUS by the AD.

June 15, 2007 – The date the MTUS became effective. Among other provisions, the MTUS regulations incorporated the American College of Occupational and Environmental Medicine’s Occupational Medicine Practice Guidelines (ACOEM Practice Guidelines) and acupuncture guidelines. The rules also laid out the strength of evidence rating methodology by which specific medical treatments or diagnostic services are evaluated. The rules also established the medical evidence evaluation advisory committee (MEEAC).

July 18, 2009 – The date the MTUS was updated. The current version of the MTUS added new guidelines for chronic pain and postsurgical physical medicine treatment. The MTUS was also reorganized to restructure the MTUS into a clinical topics format, which will allow for easier updates of the guidelines.

General Approaches 

The DWC administrative director adopts and incorporates specific guidelines into the MTUS set forth from the ACOEM Practice Guidelines for the chapters on prevention, general approach to initial assessment and documentation, initial approaches to treatment, cornerstones of disability prevention and management. The general approaches section of the MTUS are set forth in § 9792.22 of Title 8, California Code of Regulations and are based on chapters 1, 2, 3, and 5 as adopted from the ACOEM Practice Guidelines, 2nd edition (2004).

Clinical Topics

The clinical topics apply to the initial management and subsequent treatment of presenting complaints specific to the body part as set forth in § 9792.23.1 et seq. of Title 8, California Code of Regulations.

  • Neck and upper back complaints
  • Shoulder complaints
  • Elbow disorders
  • Forearm, wrist, and hand complaints
  • Low back complaints
  • Knee complaints
  • Ankle and foot complaints
  • Stress related conditions
  • Eye

Special Topics

The special topics of the MTUS addresses issues in common across the clinical topics and are set forth in § 9792.24.1 et seq. of Title 8, California Code of Regulations.

  • Acupuncture medical treatment guidelines
  • Postsurgical treatment guidelines
  • Chronic pain medical treatment guidelines

The chronic pain guidelines are set forth in § 9792.24.2 of Title 8, California Code of Regulations. The chronic pain guidelines (May 2009) consist of two parts and one appendix.

The Chronic pain medical treatment guidelines document includes the information for this course.  More information about accessing the guidelines will be discussed subsequently.

Appendix D contains the scientific literature references used in the chronic pain medical treatment guidelines.  This document is not necessary to review for this course and is primarily the reference section for the chronic pain treatment guidelines.

Presumption of Correctness

The MTUS is presumed to be correct on the issue of extent and scope of medical treatment and diagnostic services it addresses. However, that presumption can be set aside by a preponderance of scientific medical evidence using strength of evidence criteria to show that a variance from the schedule is reasonably required to cure or relieve the injured worker from the effects of his or her injury. For all conditions or injuries not addressed by the MTUS, authorized treatment and diagnostic services must be in accordance with other scientific, evidence-based medical treatment guidelines that are nationally recognized by the medical community as set forth in § 9792.25 of Title 8, California Code of Regulations.

1. Download & Read the Course – View for Free before Purchase

To take the course, review the MTUS Chronic Pain Medical Treatment Guidelines.  These Guidelines, adopted July, 18, 2009, update the ACOEM Practice Guidelines and are presumed correct.  At any time, you can take the test.  For this course, the individual Help-Feature for each question is not available.  However, you can take the test as many times as you like, until you pass.  You will receive feedback each time you submit the test for scoring, until you pass. We hope you enjoy the course and reviewing this valuable information.

To access a copy of the Chronic Pain Treatment Guidelines from the DWC website, click here for PDF format.

2. Take the Test

Please purchase this course before starting the test.