General Guideline Principles for Injection Therapies

for workers compensation patients

The New York State workers compensation board has developed these guidelines to help physicians, podiatrists, and other healthcare professionals provide appropriate treatment for Injection Therapies.

These Workers Compensation Board guidelines are intended to assist healthcare professionals in making decisions regarding the appropriate level of care for their patients with ankle and foot disorders.

The guidelines are not a substitute for clinical judgement or professional experience. The ultimate decision regarding care must be made by the patient in consultation with his or her healthcare provider.

Injection Therapies

  1. Botulinum Injections for CRPS

    Botulinum Injections for CRPS is not recommended in the management of CRPS.


  2. Intrathecal Baclofen for CRPS

    Intrathecal Baclofen for CRPS is recommended selectively for treatment of dystonia associated with CRPS.

    Indications: Highly limited indication of severe dystonia accompanying severe CRPS.


  3. Intrapleural Bupivacaine Infusions for CRPS

    Intrapleural Bupivacaine Infusions for CRPS is not recommended in the management of CRPS.


  4. Lidocaine Infusion for CRPS

    Lidocaine Infusions for CRPS is not recommended in the management of CRPS.


  5. Stellate and Other Ganglion Blocks

    Stellate and Other Ganglion Blocks for CRPS is recommended corresponding to the body region affected by CRPS are recommended for treatment of acute or an acute flare-up of CRPS as an adjunct to a functional restoration approach.

    Indications: Acute CRPS or an acute flare-up of CRPS that is unresponsive to or insufficiently treated by drugs, progressive strengthening, graded exercise, physical therapy, and occupational therapy Should be carried out when it is included in a thorough treatment plan that has a focus on functional restoration.

    Frequency/Dose/Duration:Following injection for the second block, the temperature should have changed by at least 1 degree. Almost always, benefits are contained in a block of one to three. If there is clear evidence of ongoing, gradual functional improvement, blocks after that. Generally speaking, should also show a reduction in opioids of three to five blocks, if applicable.


  6. Guanethidine Bier Blocks for CRPS

    Guanethidine Bier Blocks for CRPS is not recommended in the management of CRPS.


  7. Phentolamine Bier Blocks

    Phentolamine Bier Blocks for CRPS is not recommended in the management of CRPS.


  8. Bretylium Bier Blocks for CRPS

    Bretylium Bier Blocks for CRPS is recommended for treatment of severe cases of CRPS.

    Indications: severe CRPS unresponsive to or insufficiently treated by progressive exercise, bisphosphonates, glucocorticoids, NSAIDs, active exercise, physical therapy/occupational treatment, and maybe mirror therapy.

    Before taking bretylium into consideration, it may be reasonable to try controlling the condition with clonidine, anticonvulsants, tricyclic antidepressants, or hyperbaric oxygen. should be carried out as a supplement to a functional rehabilitation programme to enhance physical capacities.

    Frequency/Dose/Duration: Lidocaine 40 ml with 1.5 mg/kg bretylium Should show at least a 1-degree shift in measured temperature postinjection for the second block. Benefits are almost often found inside a block of one to three.

    Blocks after that if there is unmistakable proof of continuous, gradual functional progress. If relevant, should also generally demonstrate a three to five block reduction in opioids. Blockades should only be added if there is concrete proof that conditions are getting better.


  9. Methylprednisolone Bier Blocks for CRPS

    Methylprednisolone Bier Blocks for CRPS is not recommended in the management of CRPS.


  10. Reserpine Bier Blocks for CRPS

    Reserpine Bier Blocks for CRPS is not recommended in the management of CRPS.


  11. Brachial Plexus Blocks and Infusions for CRPS

    Brachial Plexus Blocks and Infusions for CRPS is not recommended in the management of CRPS. Phentolamine, or Reserpine Bier Blocks


  12. Intrathecal Drug Delivery Systems for Chronic Persistent Pain

    Intrathecal Drug Delivery Systems for Chronic Persistent Pain is recommended when all other (often more conservative and less invasive) methods have failed to relieve the symptoms of CRPS in a particular patient group.

    Targeted drug delivery (Pain Pumps) is not included on the list of pre- authorized procedures.


    • Before carrying out the operation, providers that wish to do so must obtain pre-authorization from the carrier.


    • In consultation with the primary treating physician, the patient must undergo evaluation and get the recommendation of at least one physician qualified in chronic pain management.


    • A doctor with verified experience performing this technique must execute the procedure.


    • Indications: In CRPS patients with severe, persistent, intractable pain who have failed to respond to all conservative therapy approaches, targeted medication delivery with an intrathecal pump may be considered as a last resort. The tiny qualifying subgroup of patients must satisfy each of the requirements listed below:


    • On the basis of objective data, a diagnosis of CRPS has been determined; all appropriate surgical and nonsurgical treatments, including active and/or passive therapy, medication management, or therapeutic injections have failed; and


    • There are no practical concerns (such as severe cognitive impairment, morbid obesity, or body sizes insufficient to sustain the size and weight of the implanted device) that would prevent the installation, maintenance, or assessment of the device;

      As with SCS, a pre-trial psychiatric or psychological evaluation should show that the following:


      • no primary psychiatric warning signs or risk factors;


      • a drive to follow through on treatment recommendations;


      • As opioid dependency and tolerance are not addictive behaviours, they do not rule out implantation. There is no proof of present addictive behaviour.


      • Encourage the patient to receive care at a functional restoration programme, if one is offered, before a pain pump trial is taken into consideration. Before a screening trial is scheduled, all evaluation requirements must be satisfied.


  13. Pain Pump Screen Trial

    To determine efficacy and confirm there are no side effects, a successful trial of continuous infusion by a percutaneous spinal infusion pump for at least 24 hours or a bolus trial as an outpatient is needed.

    An effective screening test is one in which the patient:

    Notices a 50% reduction in pain, which VAS may validate, and

    Shows measurable functional improvements or reduces use of painkillers,

    Prior to and before the trail’s termination, objective functional gains should be assessed and documented.


  14. Pain Pump Implantation

    The treating physician must ask the carrier for preauthorization before implanting a permanent pain pump if the screening trial is successful.

What our office can do if you have workers compensation Injuries

We have the experience to help you with their workers compensation injuries. We understand what you are going through and will meet your medical needs and follow the guidelines set by the New York State Workers Compensation Board.

We understand the importance of your workers compensation cases. Let us help you navigate through the maze of dealing with the workers compensation insurance company and your employer.

We understand that this is a stressful time for you and your family. If you would like to schedule an appointment, please contact us so we will do everything we can to make it as easy on you as possible.

Call Us Now!

Based on 96 reviews
No one likes going to the doctor. But these people make it painless. I go for knees, hips and shoulders. At almost 70 Complete Orthopedics keeps my active life style running smoothly. Whether chasing my Grandson and even surfing again, I highly recommend them!!
Thomas Slavin
15:02 02 Mar 23
Dr. Kuo knowledgeable and competent surgeon- very good experience and more importantly great result.
Joseph McCoy
21:23 25 Feb 23
Dr Vaksha was so kind and helpful. He took extra time with us and explained things so thoroughly. Highly recommend. Office very clean.
Susan Bosinius
20:20 19 Feb 23
Dr Vaksha, is a great doctor very professional knows what he talking about. Treat patient with upmost respect. Thank You
Troy Spencer
16:46 19 Jan 23
Dr. Karkare is an amazing doctor, very caring and attentive, the girl at the front desk is very kind and helpful. .elizabeth .thank you so much .
blanca ventura
21:32 26 Oct 22
Been going to this place before my accident and after I had my knee surgery. So happy how I been treated and how well I am getting. Thank you all and specially Dr. VAKSHA for everything and getting back on track.
Ita Opico
19:01 25 Oct 22
Love this place From the minute I called I was treated kindly. When I arrived The Dr saw me right away he was compassionate and ordered the appropriate tests for me. I came back in for my follow up and had the same great experience.
Christine Rostock
21:28 23 May 22
Dr Vaksha and Dr karkare are 2 of the best orthopedic doctors around my wife Susan had a very serious broken ankle in March of 2019 she didn't think she was going to walk again Dr vaksha did an excellent surgery on her ankle he said it was his toughest he ever did he put a lot of hardware in her ankle and told her she would be alright she made remarkable recovery thanks to his surgery as of now she regained 100 percent use of her ankle she would highly recommend him to anyone. My own experience with Dr karkare has been wonderful he takes his time with you listens to what you have to say and prescribes various treatments and is very caring I would highly recommend him to anyone I would give both doctors a 10 plus rating we are very happy with them the best.
Harry Jones
23:31 19 May 22
Complete orthopedics is a wonderful place to go when you hurt or injured a great staff and wonderful doctors very knowledgeable and helpful I would recommend this place to all of my family and friends that is in me of orthopedic care I give them 10 thumbs up
Wayne Pemberton
17:39 18 May 22
The staff is very professional and helpful. Dr. Vaksha is excellent. He takes time to listen and offer suggestions to help you get better. I’m very thankful and happy to be a patient here at Complete Orthopedics.
Phoenix Rising
19:54 16 May 22
Dr.Karkare is the best. He listens to everything and explains everything I recommend him to everyone. I am so happy he is my doctor.
Myrna James
00:48 13 May 22
Dr.Kuo is amazing very attentive,caring,and passionate and staff is awsome too.Thank you for everything Dr.kuo.
Erick Murillo
23:17 12 May 22
I was in a car accident November 1 I was referred to Dr. Vaksha For shoulder surgery . I he was amazing he made me feel very comfortable and explained everything that was going to happen from surgery all the way through my physical therapy highly recommend Dr. Vaksha
Yolanda Ojeda
19:37 09 May 22
My appointment with Dr. Vaksha was amazing. Dr. Vaksha was very thorough and kind. I would refer this office to anyone who needs a great orthopedic doctor.
John Senechal
19:54 05 May 22
Scheduling my appointment was quick and easy. The staff was super friendly and down to earth. I was seen on time. The appropriate test, “x-rays” were taken before the conversation with doctor, something I really liked, test for analysis and conversation was done upfront. Dr. V had a great personality and was no BS, straight forward diagnosis and a play on next steps. I am happy I found them and would refer them to friends and family.
00:46 03 May 22
I have seen Dr. Kuo two times already and he's awesome along with his staff. Very friendly office and I'm glad to be a patient here.
Camaris A
20:01 28 Apr 22
Amazing team!! Very caring, profesional, and friendly!! Dr. Kevin Kuo, you are the best, very passionate, caring, and helping thank you for getting me better and being so kind to me! Elizabeth you the best thank you for you help always and you big smile and positive actitud❤️🙏🏼
breidy valerio
19:01 22 Apr 22
The staff is truly exceptional, they make you feel comfortable and welcomed. The doctors are amazing,always professional, compassionate and great listeners.
Elizabeth Collado
03:25 09 Apr 22
What a great place! The place is clean and organized.The staff is wonderful. Setting up physical therapy is right there as well.I'm so glad I found this place.
Donna Anne
22:45 05 Apr 22
This was my 1st time breaking something in my 27 years on this planet. I was recommended here by a friend Dr. Vashka helped me from day 1 and still continues to check in on me and my healing ankle. Would highly recommend
tyron davis
16:06 01 Apr 22
Brand new office, same great doctors! Rooms are clean, plenty of parking, physical therapy attached, Dr. Karkare and his staff are awesome. Thank you!
Emily B
02:49 24 Mar 22
Dr.VAksha is the best, I love the way he treats me as his patient, he is caring,understanding and very attentive to my needs
Mirna Caballero
14:53 03 Mar 22
Great staff. Dr. Vaksha is awesome and takes the time to listen to his patients. He is very compassionate. I would highly recommend this office.
Bebe Doyle
01:24 23 Feb 22
After suffering from a severe ankle injury Dr. V was able to help me heal and return back to work completely to a job where I stand for 12 hours a day. The office is very clean and I appreciated the reminders of my appointments via phone call and through text. The patient portal made it easy for me to access all my documents including work notes. The office staff is wonderful and Rebecca was able to schedule me with a busy schedule and awesome at answering all of my questions including referring me to a great physical therapy office. I highly recommend this office to anyone who’s looking for knowledgeable and kind orthopedic office.
Elizabeth Birchwell
21:31 28 Jan 21
The staff here are great, I was seen at the time of my appointment and was well taken care of!
Shaun Berry
18:14 07 Jan 21
They are an excellent practice. The front and back office people are amazing and so helpful. Rebecca is such a kind and understanding person. I had an issue with paperwork and she cleared it right up. Dr. Karkare is very knowledgeable, helpful, and caring.
Matt S.
19:31 18 Nov 20
Rebecca K. - What a true burst of sunshine. Very friendly and definitely an asset to the practice!
Laura Aston
18:17 17 Nov 20
Great experience, the Doctor is nice but the staff is incredible. I worked with Linda, who was profession and assisted me beyond what any person has done at other practices. Complete Ortho should be complimented for having such a person on their staff.I highly recommend this place!!!
Joe Allen
17:26 17 Nov 20
Linda and Becca they are so good ever time I come they are very nice I would tell everyone I no to come to this office..
Barbara Victor
16:45 17 Nov 20
I was rear ended in an auto accident , Dr Vashka was recommended by a friend of mine .I was experiencing Back , neck , and shoulder pain . After a thorough examination and given exercises to do at home , I am feeling much better , and I ended up avoiding surgery . The staff at Complete Ortho is extremely attentive and show great care when making an appointment and are very friendly and i never waited more than 5 minutes for my appointment . So I would strongly recommend Complete Orthopedics for any aches and pains that one might be experiencing.....
Bill Becht
04:44 17 Nov 20
It was the afternoon of Friday Sept. 24. We were in Pt. Jefferson and my wife, Mary Ann, broke her hip. We went to Mather Hospital and it was determined that she would have to have an operation to have it repaired. This would be her third time under the knife in the past year. It just so happened that we were very fortunate enough to have Dr. Karkare, who was on standby, perform the surgery. He put in a rod and two screws in her hip. She spent a few days in the hospital and then went to Gurwin rehabilitee for another few weeks.It has now been almost six weeks and we both worked the election the other day. If it wasn’t for Dr. Karkare’s expertise she never would have been able to work. She is able to walk with a walker and is doing physical therapy three times a week.We can not thank the doctor enough for the compassion and dedication that he puts into his work. It allows Mary Ann do the things that she likes to do, even on a limited basis for a while. I know that with her will, perseverance and the great work that the surgeon performed she will be back on her feet in no time.Sincerely:John V. PlumpEast Northport, NY 11731
Jack Harris
14:36 06 Nov 20
In the year of 2018 I was referred to Dr. Karkare because I was experiencing severe knee joint pain. After exhausting physical therapy and trying to labor through the pain, I had to make a quality of life decision. Total knee replacement was the only viable option. Dr. Karkare made my decision easy as he walked me through the whole process from surgery to recovery.On 12/13/19 ( Friday the 13th) I enter Lenox Hill Hospital in great hands. From the time I entered Dr. Karkare’s office for the first time until now, his staff has been amazing. Andrea the medical coordinator walked me through all the paper work and necessary preparations for the surgery. Courtesy and kind would be an understatement. Dr. Karkare went over and beyond from the wellness checks and phone calls all to assure me that I was important to him. This was the right decision no pain and no limp. Complete Orthopedics should be your choice!
Kenneth Randolph
22:18 25 Sep 20
Dr. Vadshka has a great bedside manner. He really takes his time and explains treatment options.
T Lee
12:33 09 Sep 20
I suffered with pain in both knees for years. My orthopedic doctor kept recommending knee replacement . I fought it for years, as I was just afraid. When I had no choice and could barely walk , it was recommended I see Dr. Karkare. We set up a consultation and my wife and I left his office feeling totally confident and comfortable with moving ahead with the surgery. He explained everything to us, and the office staff set everything up for us and made the process easy. So about one month after our initial meeting I had the first knee done. I was up walking mere hours after the surgery, and on the workout machines the next morning. I went home two days after the surgery, and yes walked my daughter down the aisle at her wedding only one week after the surgery without even a cane! Three months later I had the other knee done and went home the very next day. Dr. Karkare put my fears to rest . I would highly recommend him. His expertise gave me my life back. Thank you Dr. Karkare.SincerelyVito Congro
Ethel Congo
23:58 12 Aug 20
Dr Rhodin really cares for his patients. When I see him he makes sure to review my progress in detail.
Micki Cahill
15:03 08 Feb 20
My mom had a total hip replacement by dr karkare. He is the BEST orthopedic doctor.Her incision is almost invisable.She is going back for her other hip next week. The office staff is the best, love Andrea.You wont find a better doctor.
Ryan Brigandi
21:06 13 Jul 18
There is no better Orthopedic doctor you will find. Broke my ankle three places on a Saturday. Called Dr. Karkare. He had is team ready at the hospital and operated on me within 6 hours after my injury. Now After 3 months of great care by him and his staff, I am walking to normalcy.
Spacecom Tel
04:13 23 Mar 18


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I am fellowship trained in joint replacement surgery, metabolic bone disorders, sports medicine and trauma. I specialize in total hip and knee replacements, and I have personally written most of the content on this page.

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