Assessment of impairment and disability experienced by patients with chronic pain is challenging. The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) assesses impairment primarily based on objective findings, but pain is subjective. The sixth edition of the AMA Guides provides a pain-related impairment (PRI) of up to 3% in rare situations. Otherwise, pain is considered to be reflected in the conventional impairment rating system. There are still many unanswered questions.