Search for other papers by Robert J. Barth in
Current site
Google Scholar
PubMed
Abstract
In the AMA Guides to the Evaluation of Permanent Impairment, (AMA Guides), Fifth Edition, two chapters claim relevance for pain complaints that lack an objectively demonstrable general medical basis: Chapter 14, Mental and Behavioral Disorders, and Chapter 18, Pain. Parts 1 and 2 of this four-part series examined forms of mental illness that commonly invoke complaints of pain; Part 2 also evaluations using the mental/behavioral chapter vs the pain chapter, and Part 3 noted the self-negating nature of the pain chapter's rationale (ie, the pain chapter presents a rationale that, taken literally, indicates it should not be used). A detailed case example illustrates how the decision about using the mental/behavioral chapter or the pain chapter often can be clarified by simply performing a thorough clinical evaluation (see Part 2 of this series). Examiners should be aware of the role of thoughts, behavior, and environmental contingencies on presentations of chronic pain even when no scientifically credible and objective general medical findings explain the pain. For example, the AMA Guides points out that in as much as 85% of low back pain cases, no explanatory physical pathology can be identified; therefore, readers are encouraged to be mindful of the professional literature. The authors of this series deny any attempt to move all instances of chronic pain into the category of mental illness but report little reason not to do so.
-
1.
Barth RJ, Brigham CR. Chapter 14 or 18 for pain complaints? Avoiding the common but mistaken dichotomy of psychological vs organic. The Guides Newsletter. January-February 2005: 1-3, 10–11.
-
2.
Barth RJ. Chapter 14 or 18 for pain complaints? Guidance from Chapter 14 and other mental health resources. The Guides Newsletter. March-April 2005: 4-5, 8–9.
-
3.
Barth RJ. Chapter 14 or 18 for pain complaints? Guidance from chapter 18 and other pain resources. The Guides Newsletter. May-June 2005: 1-3, 10–12.
-
4.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed, text rev. Washington, DC: American Psychiatric Association; 2000.
-
5.
Brigham CR, Ensalada LH, Talmage JB. The Guides Casebook. 2nd ed. Chicago, Ill: American Medical Association; 2002.
-
6.
Demeter SL, Andersson GBJ. Disability Evaluation. 2nd ed. Chicago, Ill: Mosby/American Medical Association; 2003.
-
7.
Mersky H, Bogduk N. Classification of Chronic Pain. 2nd ed. Seattle, Wash: International Association for the Study of Pain Press; 1994.
-
8.
Hales RE, Yudofsky SC. The American Psychiatric Publishing Textbook of Clinical Psychiatry. 4th ed. Washington, DC: American Psychiatric Publishing; 2002.
-
9.
Nachemson AL, and Jonsson E. Neck and Back Pain. Philadelphia, Pa: Lippincott, Williams, and Wilkins; 2000.
| All Time | Past Year | Past 30 Days | |
|---|---|---|---|
| Abstract Views | 1300 | 1141 | 27 |
| Full Text Views | 19 | 1 | 0 |
| PDF Downloads | 0 | 0 | 0 |
