Impairment Rating for Non-Specific Back Pain Under the AMA Guides, Sixth Edition: Medical Perspective
James B. Talmage
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Jay Blaisdell
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Marjorie Eskay-Auerbach
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Christopher R. Brigham
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Abstract

Low back pain and disability are common and evaluating a patient with non-specific spinal pain may be challenging, including determining impairment. The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, provides ratable impairment for the diagnosis of “non-specific chronic, or chronic recurrent low back pain (also known as chronic sprain/strain, symptomatic degenerative disc disease, facet joint pain,” and others. The evaluator should consider the diagnosis of non-specific chronic back pain only when no category of specific diagnosis fits the case (eg, no fracture, no spinal stenosis) or when “no reliable physical examination or imaging findings” but the patient's history of pain is felt to be reliable. According to the AMA Guides, primary determinant between a class 0 and class 1 rating for non-specific chronic back pain is whether the evaluator gives credibility to the patient's subjective reports of pain and interference with activities of daily living (ADLs). An evaluator may choose to use the Pain Disability Questionnaire (reproduced in the article) and Table 17-6, Functional History Adjustment, Spine, to determine the Functional History Grade Modifier (GMFH). The diagnosis of non-specific chronic or chronic recurrent low back pain yields a positive impairment only when the evaluator feels the patient's pain, as quantified by the GMFH, is reliably reported. Because there are no diagnostic objective findings on physical examination or clinical studies, these modifiers are excluded.

  • 1.

    Melhorn JM, Ackerman WE, Talmage JB, Hyman MH. AMA Guides to the Evaluation of Disease and Injury Causation, 2nd ed. Chicago, IL: American Medical Association; 2013.

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  • 2.

    Barth RJ. Examinee-Reported History Is Not a Credible Basis for Clinical or Administrative Decision Making. Guides Newsletter. September/October 2009.

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