Diabetes
29 de março de 2021Male Hypogonadism
29 de março de 2021Checklist for Therapeutic Use Exemption (TUE) Application:
Neuropathic Pain
Prohibited Substances: Narcotics, cannabinoids
This Checklist is to guide the athlete and their physician on the requirements for a TUE application that will allow the TUE Committee to assess whether the relevant ISTUE Criteria are met.
Please note that the completed TUE application form alone is not sufficient; supporting documents MUST be provided. A completed application and checklist DO NOT guarantee the granting of a TUE. Conversely, in some situations a legitimate application may not include every element on the checklist.
| • | TUE Application form must include: | |
| • | All sections completed in legible handwriting | |
| • | All information submitted in [language] | |
| • | A signature from the applying physician | |
| • | The Athlete’s signature | |
| • | Medical report should include details of: | |
| • | Medical history: exact injury to the central or peripheral nervous system and resulting pain (e.g., central, phantom limb, regional pain syndrome), character of pain, additional pharmacologic and non-pharmacological treatment approaches | |
| • | Findings on neurological examination | |
| • | Summary of diagnostic test results relevant to the clinical description of the pain | |
| • | Interpretation of symptoms, signs and test results by physician (where available, ideally neurologist, physical medicine or pain specialist) | |
| • | Diagnosis | |
| • | Narcotic or cannabinoid prescribed (both are prohibited in-competition only, all prohibited substances in these classes are explicitly named on the Prohibited List) including dosage, frequency, administration route | |
| • | Response to treatment | |
| • | Explain why alternatives (e.g., antidepressants, anticonvulsants, tramadol, capsaicin, lidocaine) were
or could not be used |
|
| • | Diagnostic test results should include copies of: | |
| • | Imaging findings: CT or MRI results if applicable | |
| • | Other test results: electromyography, nerve conduction studies if applicable | |
| • | Additional information included | |
| • | Specialist opinion as per specification by the ADO | |
