Yellow

I suggest that you first approach the doctor who would be carrying out the blocks to explain the issue and ask him/her if they are able to supply you with supportive information/clinical evidence you need to try and appeal the decision. This can't be the first time this doctor has had a patient whose insurance company has refused to approve this modality for CRPS (unless they rarely either treat CRPS or do these blocks in which case I might be concerned).

The information I found below might be the reasoning that an insurance company would use to refuse the treatment. The text is taken from Aetna's Clinical Policy Bulletin for treating CRPS (as at 30 Aug 2012). Beir blocks have been subject to a Cochrane Review and as you can see the evidence base for their efficacy is not up to much. Cochrane Reviews are highly reputable and carry very powerful weight. I've included the details below as a start point. There may be more recent clinical evidence which could overturn this position but remember Aetna reviewed their document last summer so should have picked anything else up.

Its important to bear in mind that nobody is saying bier blocks don't work for certain people, what the Cochrane Review comments on is the quality of the available evidence base. It might give you somewhere to start though.


Aetna Clinical Policy Bulletin number 0447
Last reviewed 30 Aug 2012

In a Cochrane systematic review, Cepeda et al (2005) reviewed the evidence supporting the use of intravenous regional anesthesia (Bier blocks) for CRPS. The investigators identified 2 small randomized double-blind cross-over studies that evaluated 23 subjects. The combined effect of the 2 trials produced a relative risk (RR) to achieve at least 50 % of pain relief 30 mins to 2 hrs after the sympathetic blockade of 1.17 (95 % confidence interval [CI]: 0.80 to1.72). The investigators stated that it was not possible to determine the effect of sympathetic blockade on long-term pain relief because the 2 randomized controlled trials (RCTs) evaluated different outcomes. Cepeda et al (2005) concluded that this systematic review revealed the scarcity of published evidence to support the use of local anesthetic sympathetic blockade as the "gold standard" treatment for CRPS. The 2 randomized studies that met inclusion criteria had very small sample sizes; therefore, no conclusion concerning the effectiveness of this procedure could be drawn. The investigators concluded that there is a need to conduct RCTs to address the value of sympathetic blockade with local anesthetic for the treatment of CRPS.

Cepeda MS, Carr DB, Lau J. Local anesthetic sympathetic blockade for complex regional pain syndrome. Cochrane Database Syst Rev. 2005;(4):CD004598