...Steven D. Feinberg, MD; Christopher R. Brigham, MD; Charles N. Brooks, MD 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...

...Robert J. Barth, PhD Scientific findings have indicated that psychological and social factors are the driving forces behind most chronic benign pain presentations, especially in a claim context, and are relevant to at least three of the AMA Guides publications: AMA Guides to Evaluation of Disease...

...Steven D. Feinberg, MD; Christopher R. Brigham, MD; Lee Ensalada, MD, MPH 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...

... 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...

... Pain is the most common presenting complaint at an impairment evaluation. In the AMA Guides to the Evaluation of Permanent Impairment ( AMA Guides ), the term chronic pain is synonymous with chronic pain syndrome . The AMA Guides differentiates between pain of longstanding duration, termed...

...Steven Feinberg, MD The treatment of chronic pain conditions is difficult, time consuming, expensive, and, all too often, unsuccessful. An effective alternative is chronic pain rehabilitation or functional restoration (FR). An FR team works together to help patients achieve better outcomes...

... a protocol for assessing impairment associated with chronic pain, including the Impairment Impact Inventory (I 3 ) that consists of 26 items that assess the burden of illness in three domains: pain intensity, interference with activities of daily living, and emotional distress. A study was performed...

... that the examiner can name. The diagnosis of “intervertebral disc herniation” cannot be made, and instead the “nonspecific chronic pain” diagnosis can be used. Nor can the diagnosis of alteration of motion segment integrity be used because the case lacks radiographically documented instability. © 2016 American...

... discussions address disorders of consciousness and awareness; sleep and arousal disorders; alterations in metal status, cognition, and highest integrative function; aphasia or dysphagia; emotional or behavioral disorders resulting from CNS causation (fifth edition only); chronic pain; and others. One...

... ratings caused by pain and suffering but at the same time to forestall actually assigning a number. One hopes for refinements in our understanding of chronic pain treatment and outcomes; in the interim, knowledgeable raters should guide nonmedical personnel toward a reasonable understanding...

...Christopher R. Brigham, MD Rating the impairment related to various chronic painful conditions, including headaches, is challenging and is addressed in the AMA Guides to the Evaluation of Permanent Impairment ( AMA Guides ) in a section of the chapter on pain. Primary headache disorders include...

... with chronic pain (eg, rheumatoid arthritis) because of an error in a previous study (the Alabama fibromyalgia research group). The author of the letter asserts that 27 studies show excess psychopathology in fibromyalgia patients; the few articles that support a diagnosis of fibromyalgia are dated and somewhat...

... in the AMA Guides to make impairment rating more uniform and consistent. The IAIABC Guides has been developed to address impairment of the musculoskeletal system and impairment due to chronic pain with the goal of minimizing or eliminating the need for multiple independent medical evaluations and “dueling...

... for a physician to serve in both a treating and an impairment evaluation role for the same patient when the focus of treatment is chronic pain. They explained there are fundamental differences between the physician-patient relationship and the evaluator-examinee relationship. Inherent in this discussion...

... is rated according to the directions on pages 163–164 in chapter 5, “The Respiratory System.” Question: How do I rate for impairment due to chronic pain? Answer: In general, the impairment percentages in the chapters that consider the various organ systems allow for the pain that may...

... Spinal cord (dorsal column) stimulation (SCS) and intraspinal opioids (ISO) are treatments for patients in whom abnormal illness behavior is absent but who have an objective basis for severe, persistent pain that has not been adequately relieved by other interventions. Usually, physicians...

... critiques chronic pain models and presents a useful construct based on well-validated psychiatric diagnoses. The AMA Guides to the Evaluation of Permanent Impairment ( AMA Guides ) attempts to evaluate pain in the context of the underlying, objectively defined impairment and considers pain...

... of the activities of daily living (ADL). Chapter 13 of the AMA Guides, Fifth Edition, considers causalgia and RSD in Section 13.8, Criteria for Rating Impairments Related to Chronic Pain, and defines chronic pain as the diagnoses of causalgia, posttraumatic neuralgia, and reflex sympathetic dystrophy...

... exist without pain. Pain, chronic pain, and impairment from pain are largely, even primarily, psychological phenomena. Accordingly, the determination whether to rely on the pain chapter or the mental/behavioral chapter in the evaluation of a pain presentation cannot be reduced to a misleading dichotomy...

... of impairment. Chapters 3, 14, and 15 regarding the musculoskeletal system, mental and behavioral disorders, and pain, respectively, may be relevant in evaluating an individual's pain following musculoskeletal injury. The eight diagnostic characteristics of chronic pain are duration, dramatization, diagnostic...