Did you get the Utilization Reveiw form back from them ? What reason did it give for the denial ?

Peer review of the information presented and/or discussion with a contracted Physician Advisor and the medical provider, it has been determined that the above health care service does not meet established treatment standards of medical necessity. End quote. Really do not know what to do next. I do not seem to be getting much relief from my meds and things seem to be getting worse fast. Hope you are all having a good evening and wish a good night's sleep to all!! Lisa

I found this at http://www.painmed.org/pdf/medical_t...guidelines.pdf

Standard of Care/Medical Necessity

Indications for SCS


• Failed back syndrome (persistent pain in patients who have undergone at least one previous back
operation), more helpful for lower extremity than low back pain, although both stand to benefit,
40-60% success rate 5 years after surgery. It works best for neuropathic pain. Neurostimulation
is generally considered to be ineffective in treating nociceptive pain. The procedure should be
employed with more caution in the cervical region than in the thoracic or lumbar.
• Complex Regional Pain Syndrome (CRPS)/Reflex sympathetic dystrophy (RSD), 70-90%
success rate, at 14 to 41 months after surgery. (Note: This is a controversial diagnosis.)
• Post amputation pain (phantom limb pain), 68% success rate
• Post herpetic neuralgia, 90% success rate
• Spinal cord injury dysesthesias (pain in lower extremities associated with spinal cord injury)
• Pain associated with multiple sclerosis
• Peripheral vascular disease (insufficient blood flow to the lower extremity, causing pain and
placing it at risk for amputation), 80% success at avoiding the need for amputation when the
initial implant trial was successful