Adult patients (>17) with musculoskeletal injuries to the extremity and/or pelvis. As necessary, clinicians can and should consult with the appropriate specialty teams for medical treatment or procedural intervention.


  1. Pathologic, musculoskeletal tumors fracture 
  2. Patients with hands, spine, rib, toes and forefoot injuries
  3. Patients taking daily opioids regularly (as prescribed and/or illicit) for more than 3 mos.- CDC Long-term opioid therapy is defined as use of opioids on most days for >3 months.
  4. Patients with a history of substance use disorder


Pain is the unpleasant thoughts, emotions, and behaviors that can accompany nociception. "Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage"- International Association for the Study of Pain (IASP)

Substance use disorder- The persistent use of drugs (including alcohol) despite substantial adverse consequences


Volunteer physicians from multiple medical specialties created and categorized these Appropriate Use Criteria. These Appropriate Use Criteria are not intended to be comprehensive or a fixed protocol, as some patients may require more or less treatment or different means of diagnosis. These Appropriate Use Criteria represent patients and situations that clinicians treating or diagnosing musculoskeletal conditions are most likely to encounter. The clinician’s independent medical judgment, given the individual patient’s clinical circumstances, should always determine patient care and treatment. Practitioners are advised to consider management options in the context of their own training and background and institutional capabilities when selecting recommended treatment options.

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