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Robert J. Barth
and
Christopher R. Brigham

-Oncology, 13 “definitive diagnosis” for a meningioma requires “histological classification, grading, and molecular profiling.” Therefore, expert testimony should establish whether and how the meningioma was diagnosed before the accident (histology or just imaging), or whether it was first recognized on post-injury imaging. For the hypothetical scenario, a diagnostic claim of “[b]rain meningioma. Pre-existing asymptomatic with probable post-traumatic malignant transformation” implies that a pre-existing nonmalignant meningioma transformed into a malignant meningioma, ie

in AMA Guides® Newsletter
Robert J. Barth

psychological presentations. Part 1 also reviewed literature regarding the primacy of psychological considerations in the definition of pain, in the origins and maintenance of chronic nonmalignant pain presentations, and in the development of claims of permanent impairment subsequent to pain. Parts 1 and 2 both discussed forms of mental illness that commonly involve complaints of pain. Part 2 of this series reviewed information from Chapter 14 and other mental health re s, which was relevant for making the distinction between presentations that should be evaluated

in AMA Guides® Newsletter
Robert J. Barth

psychological factors into the evaluation process. Consideration of psychological factors will also prove fruitful for the generation of treatment/rehabilitation recommendations that might actually improve patient outcomes and minimize claims of general medical impairment. Undiagnosed Mental Illness as the Cause of Chronic Pain Claims The scientific literature in regard to non-malignant chronic pain serves as a model for this entire discussion, because such claims have been researched extensively. This section reviews some examples of the findings from that research

in AMA Guides® Newsletter
Stephen L. Demeter

initial management of nonmalignant disease related to asbestos . Am J Respir Crit Care Med 2004 ; 170 : 691 - 715 . 3. Miller A. Application of pulmonary function tests to the evaluation of asbestosis . Annals of the New York Academy of Sciences 1991 ; 643 : 145 - 148 . 4. Cocchiarella L , Andersson GBJ ( eds .) Guides to the Evaluation of Permanent Impairment . 5th ed . Chicago : American Medical Association , 2001 . 5. ATS/ACCP Statement on cardiopulmonary exercise testing . Am J Respir Crit Care Med 2003 ; 167 : 211 - 277 ; 2003

in AMA Guides® Newsletter
Robert J. Barth
and
Tom W. Bohr

. Amer J Pain Management. 1992 ; 2 : 198 – 204 . 6. Mailis A , Papagapiou M , Umana M , Cohodarevic T , Nowak J , Nicholson K . Unexplainable nondermatomal somatosensory deficits in patients with chronic nonmalignant pain in the context of litigation/compensation: a role for involvement of central factors? J Rheumatol. 2001 ; 28 : 1385 – 93 . 7. van de Vusse AC , Stomp-van den Berg SGM , de Vet HCW , Weber WEJ . Clinical reliability of diagnosis in complex regional pain syndrome (CRPS) . Neurology . 2000 ; 53 ( suppl 3 ): A177

in AMA Guides® Newsletter
Robert J. Barth

- 282 . 8. Katz N , Mazer NA. The impact of opioids on the endocrine system . Clin J Pain . 2009 ; 25 ( 2 ): 170 - 175 . 9. Daniell HW. Hypogonadism in men consuming sustained-action oral opioids . J Pain . 2002 ; 3 ( 5 ): 377 - 384 . 10. Daniell HW. Opioid endocrinopathy in women consuming prescribed sustained-action opioids for control of nonmalignant pain . J Pain . 2008 ; 9 ( 1 ): 28 - 36 . 11. Merza Z. Chronic use of opioids and the endocrine system . Horm Metab Res . 2010 ; 42 ( 9 ): 621 - 626 . 12. Aloisi AM , Aurilio C

in AMA Guides® Newsletter
Steven D. Feinberg
,
Christopher R. Brigham
, and
Lee Ensalada

pain and the disability epidemic. Clin J Pain. 1991 ; 7 : 330 – 338 . 2. 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 . 3. 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. 4. Turk DC , Gatchel RJ , eds

in AMA Guides® Newsletter