Assessing impairment and/or disability in the pain patient often is difficult due to both administrative and clinical issues; in addition, the terms impairment and disability are misunderstood. Chronic pain complaints may be associated with significant disability, but typically the physician defines clinical issues, functional deficits, and, when requested, impairment; disability most often is an administrative determination. The biopsychosocial approach currently is viewed as most appropriate perspective for understanding, assessing, and treating chronic pain disorders and acknowledges a complex and dynamic interaction among biological, psychological, and social factors. The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, discusses the assessment of pain and eligibility requirements for pain-related impairment (PRI). Some physicians feel that the AMA Guides’ approach to PRI does not adequately address the “disability” and functional loss caused by some chronic pain states, but the AMA Guides is limited, mostly, to describing measurable objective changes or impairment. The AMA Guides is not intended to be used for direct estimates of loss of work capacity (disability), and impairment percentages derived according to the AMA Guides criteria do not measure work disability. Impairment ratings in the AMA Guides already have accounted for impairment-associated pain, including that experienced in areas distant to the specific site of pathology.
Aronoff GM. Chronic pain and the disability epidemic. Clin J Pain. 1991; 7:330–338.
Gatchel RJ, Okifuji A. Evidence-based scientific data documenting the treatment- and cost-effectiveness of comprehensive pain programs for chronic nonmalignant pain. J Pain. 2006; 7:779–793.
Brown A. Chronic pain rates shoot up until Americans reach late 50s. Gallup Wellbeing Web site, April 27, 2012. http://www.gallup.com/poll/154169/chronic-pain-rates-shoot-until-americans-reach-late-50s.aspx. Accessed July 13, 2015.
Turk DC, Gatchel RJ, eds. Psychological Approaches to Pain Management: A Practitioner's Handbook, 2nd ed. New York: Guilford; 2002.
Turk DC, Monarch ES. Biopsychosocial perspective on chronic pain. In: Turk DC, Gatchel RJ, eds. Psychological Approaches to Pain Management: A Practitioner's Handbook, 2nd ed. New York: Guilford; 2002.
Robinson JP, Turk DC, Loeser JD. Pain, impairment, and disability in the AMA Guides. Guides Newsletter. November–December 2004.
Barth RJ. Chronic pain: fundamental scientific considerations, specifically for legal claims. Guides Newsletter. January–February 2013.
Diagnostic and Statistical Manual of Mental Disorders, 4th ed, Text Rev. Washington, DC: American Psychiatric Association; 1994.
Diagnostic and Statistical Manual of Mental Disorders, 5th ed. Washington, DC: American Psychiatric Association; 2013.
Ensalada LH, Brigham C. Somatization. Guides Newsletter. July–August 2000.
Lipowski ZJ. Somatization: The concept and its clinical application. Am J Psychiat. 1988; 145:1358–1368.
Lipowski ZJ. Somatization and depression. Psychosomatics. 1990; 31:13–21.
Gatchel RJ. Comorbidity of chronic mental and physical health disorders: The biopsychosocial perspective. Am Psychol. 2004; 59:792–805.
Gatchel RJ. Clinical Essentials of Pain Management. Washington, DC: American Psychological Association; 2005.
Merskey H, Bogduk N. Classification of Chronic Pain: Descriptions of Chronic Pain Syndromes and Definitions of Pain Terms, 2nd ed. Seattle, WA: IASP Press; 1994.
Rondinelli R, ed. AMA Guides to the Evaluation of Permanent Impairment, 6th ed. Chicago: American Medical Association; 2007.
Waddell G. The Back Pain Revolution, 2nd ed. Churchill Livingstone, 2004.
Pain and disability: clinical, behavioral, and public policy perspectives. In: Osterwsis M, Kleinman A, Mechanic D, eds. Institute of Medicine's Committee on Pain and Disability and Chronic Illness Behavior. Washington, DC: National Academy Press; 1987, p. 28.
Collie J. Malingering and Feigned Sickness. London: Edward Arnold Ltd; 1913.
Brigham C, Ensalada LH. Nonorganic findings. Guides Newsletter. September–October 2005.
Waddell G, McCulloch JA, Kummel E, Venner, R. Nonorganic physical signs in low-back pain. Spine. 1980; 5:117–125.
Rogers R, ed. Clinical Assessment of Malingering and Deception, 2nd ed. New York: Guilford Publications; 1997
Meyerson A. Malingering. In: Kaplan H, Sadock B, eds. Textbook of Psychiatry, 7th ed. New York: Williams & Wilkins; 2000.
Barth RJ, Brigham CR. Who is in the better position to evaluate, the treating physician or an independent examiner? Guides Newsletter. September–October 2005.
Sullivan MD, Loeser, JD. The diagnosis of disability. Arch Intern Med. 1992; 152:1829–1835.
World Health Organization. International Classification of Functioning, Disability and Health: ICF. Geneva, Switzerland: World Health Organization; 2001.
https://www.ssa.gov/disability/professionals/bluebook/general-info.htm Accessed 2/6/16.
http://www.dol.gov/general/topic/disability/ada Accessed 2/6/16.
Talmage JB, Melhorn JM, Hyman MH. AMA Guides to the Evaluation of Work Ability and Return to Work, 2nd ed. Chicago: American Medical Association; 2011.
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