Muscle Spam Case Study

This is a 42-year-old male with a 7/14/2012 date of injury. The patient reported an injury to his mid back, low back and right shoulder that occurred when he repetitively ducked under a beam. Diagnosis: Other intervertebral disc displacement, lumbar region

11/26/15 note states an appeal to the denial of request for Valium. At his most recent visit on 11/25/15; psychological treatment had recently been authorized. The note reports that the patient continued to have back spasms. His medication regimen had been continued at that time. The note states that Valium was prescribed as a short-acting pain medication. In this case, muscle spams have been noted that interfere with the function. Medication dependence or abuse issues have not been noted.

They are not recommended for long-term use because long-term efficacy is unproven and there is a risk of dependence. Most guidelines limit use to 4 weeks. Additionally, ODG states that benzodiazepines are not recommended as muscle relaxants, due to rapid development of tolerance and dependence. There appears to be little benefit for the use of this class of drugs over nonbenzodiazepines for the treatment of spasm. The patient has chronic low back pain. 10/28/15 progress report described that the patient has pain with positive bilateral lumbar facet loading. The patient also complained of unprovoked occasional back spasms. There was little or no improvement in sleep and pain from Trazodone and Tramadol, so the patient had been prescribed Valium 5 mg, Mortin 600 mg, and Cyclobenzaprine. 10/28/15 progress report noted that the Valium was prescribed for insomnia. However, 11/26/15 note states an appeal to the denial of Valium and noted that it was being prescribed to address the muscle spams. The patient is already taking a muscle relaxant Cyclobenzaprine. As the guidelines do not support use of benzodiazepines for the treatment of muscle spasms; and there is a risk of significant dependence with long-term use, starting Valium is not supported. The request for Valium 5 mg#30 is not medically necessary and appropriate at this time. Recommend