Hostname: page-component-cd9895bd7-mkpzs Total loading time: 0 Render date: 2024-12-26T08:49:46.108Z Has data issue: false hasContentIssue false
  • English
  • Français

Pain, Impairment, and Disability in the AMA Guides

Published online by Cambridge University Press:  01 January 2021

James P. Robinson ,
Dennis C. Turk  and
John D. Loeser
Get access Rights & Permissions [Opens in a new window]

Extract

Back injuries have a bad reputation. The workman looks upon them with apprehension, the insurance company with doubt, the medical examiner with suspicion, the lawyer with uncertainty. The medical examiner is faced with the difficulty of estimating the true value of the subjective symptoms in the comparative absence of physical signs. His suspicion is born of the frequent disparity between these two.

This prophetic statement made almost 100 years ago highlights an ongoing problem - how people who are incapacitated by painful conditions such as chronic low back pain can be evaluated consistently and equitably for purposes of disability compensation. We confronted this vexing problem when we participated in writing the chapter devoted to impairment associated with pain (Chapter 18) of the American Medical Association s Guides to the Evaluation of Permanent Impairment, 5th edition AMA Guides 5th Our purposes in this essay are to clarify several important conceptual issues associated with the assessment of pain among disability applicants, and to articulate reasons why pain should be considered in impairment and disability ratings.

Type
Article
Information
Journal of Law, Medicine & Ethics , Volume 32 , Issue 2 , Summer 2004 , pp. 315 - 326
Copyright
Copyright © American Society of Law, Medicine and Ethics 2004

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

McKendrick, A., Back Injuries and their Significance (Edinburgh: E. & S. Livingstone, 1916): at v.Google Scholar
Turk, D.C. Robinson, J.P. Loeser, J.D. Covington, E. Lippe, P., “Pain,” in Cocchiarella, L. Andersson, G.B.J., eds., Guides to the Evaluation of Permanent Impairment, 5th ed. (Chicago, Illinois: AMA Press, 2001): 565–591.Google Scholar
Cocchiarella, L. Andersson, G.B.J., eds., Guides to the Evaluation of Permanent Impairment, 5th ed. (Chicago, Illinois: AMA Press, 2001).Google Scholar
Cocchiarella, L. Lord, S.J. Turk, D.C. Robinson, J.P., “Pain,” in Cocchiarella, L. Lord, S.J., eds., Master the AMA Guides Fifth (Chicago: AMA Press, 2001): 277–325; Robinson, J.P. Turk, D.C. Loeser, J.D., “Pain Evaluation: Fifth Edition Approaches,” AMA Guides Newsletter, (January/February, 2002): 1–5, 9–11.Google Scholar
Spieler, E.A. Barth, P.S. Burton, J.F. Jr Himmelstein, J. Rudolph, L., “Recommendations to Guide Revision of the Guides to the Evaluation of Permanent Impairment,” JAMA 283 (2000): 519–23; Rondinelli, R.D. Duncan, P.W., “The Concepts of Impairment and Disability,” in Rondinelli, R.D. Katz, R.T., eds., Impairment Rating and Disability Evaluation (Philadelphia: W.B. Saunders, 2000): 17–33.CrossRefGoogle Scholar
Hunt, D.G. Zuberbier, O.A. Kozlowski, A.J. Robinson, J Berkowitz, J Schultz, I.Z. Milner, R.A. Crook, J.M. Turk, D.C., “Reliability of the Lumbar Flexion, Lumbar Extension, and Passive Straight Leg Raise Test in Normal Populations Embedded within a Complete Physical Examination,” Spine 26 (2001): 2714–2718; Nitschke, J.E. Nattrass, C.L. Disler, P.B. Chou, M.J. Ooi, K.T., “Reliability of the American Medical Association Guides’ Model for Measuring Spinal Range of Motion,” Spine24 (1999): 262–268; McCarthy, M.L. McAndrew, M.P. MacKenzie, E.J. Burgess, A.R. Cushing, B.M. Delateur, B.J. Jurkovich, G.J. Morris, J.A. Swiontkowski, M.F., “Correlation Between the Measures of Impairment, According to the Modified System of the American Medical Association, and Function,” The Journal of Bone and Joint Surgery: American Volume 80 (1998): 1034– 2; Rondinelli, R.D. Dunn, W. Hassanein, K.M. Keesling, C.A. Meredith, S.C. Schulz, T.L. Lawrence, N.J., “A Simulation of Hand Impairments: Effects on Upper Extremity Function and Implications toward Medical Impairment Rating and Disability Determination,” Archives of Physical Medicine and Rehabilitation 78 (1997): 1358–63.Google Scholar
Robinson, J.P., “Pain and Disability”, in Jensen, T Wilson, P. Rice, A, eds., Clinical Pain Management: Chronic Pain. (London: Edward Arnold Limited, 2002): 39–61.Google Scholar
Osterweis, M. Kleinman, A. Mechanic, D. D., eds. Pain and Disability (Washington, D.C.: National Academy Press, 1987).Google Scholar
Rating Permanent Impairment [Provider Bulletin 02–12]. (Olympia, Washington: Health Services Analysis Section, Department of Labor and Industries, 2002).Google Scholar
Fabrega, H., Evolution of Sickness and Healing (Berkeley: University of California Press, 1997).Google ScholarPubMed
Ranavaya, M.I. Rondinelli, R.D., “The Major U.S. Disability and Compensation Systems: Origins and Historical Overview,” in Rondinelli, R.D. Katz, R.T., eds., Impairment Rating and Disability Evaluation (Philadelphia: W.B. Saunders, 2000): 3–16.Google Scholar
Williams, C.A., An International Comparison of Workers’ Compensation (Boston: Kluwer, 1991); Ritter, G.A., Social Welfare in Germany and Britain (New York: Berg, 1983).CrossRefGoogle Scholar
Social Security Administration Office of Research, Evaluation and Statistics. Social Security Programs throughout the World [SSA Publication No. 13–11805] (Washington, D.C: Government Printing Office, 1999).Google Scholar
Disability Evaluation under Social Security (SSA Pub. No. 64=039, ICN 468600, January, 2003).Google Scholar
See Cocchiarella, Andersson, , supra note 3.Google Scholar
Committee on Medical Rating of Physical Impairment, “A Guide to the Evaluation of Permanent Impairment of the Extremities and Back,” JAMA 167 (1958).Google Scholar
See Cocchiarella, Andersson, , supra note 3.Google Scholar
World Health Organization. International Classification of Functioning, Disability and Health (Geneva: World Health Organization, 2001); See Robinson, , supra note 7.Google Scholar
See Cocchiarella, Andersson, , supra note 3.Google Scholar
See Osterweis, et al. , supra note 8Google Scholar
Robinson, J.P., “Evaluation of Function and Disability,” in Loeser, J.D. Butler, S.D. Chapman, C.R. Turk, D.C., eds., Bonica’s Management of Pain, 3rd ed. (Philadelphia: Lippincott Williams & Wilkins, 2001): 342–362.Google Scholar
See Cocchiarella, Andersson, , supra note 3.Google Scholar
See Cocchiarella, Andersson, , supra note 3.Google Scholar
We relied on this conceptual ambiguity in the rationale we provided for assessing pain-related impairment in Chapter 18 of the Guides 5th;. That is, we reasoned that since severity of impairment could be measured by the extent to which an individual’s ability to perform ADLs was diminished, limitations associated with pain could be combined with limitations imposed by derangement of organs or body parts (i.e., by impairment in the usual sense) to determine the overall severity of the individual’s impairment. On further reflection, however, we believe that the meaning of “impairment” should be circumscribed, so that it refers only to derangement of organs or body parts. Pain and other subjective experiences of individuals cannot be construed as contributors to impairment when this narrower construction of “impairment” is used.Google Scholar
See Cocchiarella, Andersson, , supra note 3.Google Scholar
See Cocchiarella, Andersson, , supra note 3.Google Scholar
Schlesinger, G., “Operationalism,” in Edwards, P. ed., The Encyclopedia of Philosophy, vol. 5(New York: Macmillan, 1967): 543–547.Google Scholar
See Cocchiarella, Andersson, , supra note 3.Google Scholar
See Cocchiarella, Andersson, , supra note 3.Google Scholar
Some monographs — including the AMA Guides — distinguish between an inability to perform fairly concrete behaviors (e.g., inability to walk) and an inability to perform social roles (e.g., inability to maintain employment). See Cocchiarella, Andersson, , supra note 3; Nagi, S.Z., “Disability Concepts Revisited: Implications for Prevention,” in Pope, A.M. Tarlov, A.R., eds., Disability in America (Washington, D.C.: National Academy Press, 1991):309–327; World Health Organization, International Classification of Impairments, Disabilities and Handicaps: A Manual of Classification Relating to the Consequences of Disease (Geneva, Switzerland: World Health Organization, 1980); World Health Organization, supra note 18. The authors have called the former “functional limitations” or “activity limitations’, and have reserved the term “disability” for an inability to perform social roles such as work. We believe that the key distinction is between limitations at the level of organs/body parts and limitations in activities at a whole person level, and that the term “disability” should be used to describe the latter limitations. Thus, we view both limitations in the ability to work and limitations in the ability to perform concrete activities as types of disability. We note that this is the way “disability” is routinely used in biomedical research. See McAfee, P.C. Fedder, I.L. Saiedy, S. Shucosky, E.M. Cunningham, B.W. Charité, S.B., “Disc Replacement: Report of 60 Prospective Randomized Cases in a U.S. Center,” Spine 28 Suppl (2003): 424–33; Deyo, R.A. Battie, M. Beurskens, A.J. Bombardier, C. Croft, P. Koes, B. Malmivaara, A. Roland, M. Von Korff, M. Waddell, G., “Outcome Measures for Low Back Pain Research. A Proposal for Standardized Use,”Spine 23 (1998): 2003–13.Google Scholar
International Labour Office, The Evaluation of Permanent Incapacity for Work in Social Insurance. [Studies and Reports Series M #13]. (Washington D.C.: The International Labour Office, 1937).Google Scholar
See Cocchiarella, Andersson, , supra note 3.Google Scholar
Butler, R.J., “Workers’ Compensation Concepts and Economics,” in Mayer, T.G. Gatchel, R.J. Polatin, P.B., eds., Occupational Musculoskeletal Disorders (Philadelphia: Lippincott Williams & Wilkins, 2000): 9–23.; Loeser, J.D. Henderlite, S.E. Conrad, D.E., “Incentive Effects of Workers’ Compensation Benefits: A Literature Synthesis,”Medical Care Research and Review 52, no. 1 (1995): 34–59.Google Scholar
See McAfee, et al. Deyo, et al. , supra note 30.Google Scholar
Social Security Administration Office of Research, Evaluation and Statistics. Social Security programs in the United States. [SSA Publication No. 13–11758], (Washington, D.C.: U.S. Government Printing Office, 1997).Google Scholar
See Cocchiarella, Andersson, , supra note 3.Google Scholar
See Cocchiarella, Andersson, , supra note 3.Google Scholar
Enoka, R.M., “Neural Adaptations with Chronic Physical Activity,” Journal of Biomechanics 30 (1997): 447–455.CrossRefGoogle Scholar
Fordyce, W.E., “Environmental Factors in the Genesis of Low Back Pain,” in Bonica, J.J. Liebeskind, J. Albe-Fessard, D.D., eds., Advances in Pain Research and Therapy, Vol. 3 (New York: Raven Press; 1979): 659–666.Google Scholar
See Osterweis, et al. , supra note 8Google Scholar
Cox, M.E. Asselin, S. Gracovelsky, S.A. Richards, M.P. Newman, N.M. Karakusevic, V. Zhong, L. Fogel, J.N., “Relationship between Functional Evaluation Measures and Self-assessment in Nonacute Low Back Pain,” Spine 25 (2000): 1817–1826.; Deyo, R.A. Andersson, G. Bombardier, C. Cherkin, D.C. Keller, R.B. Lee, C.K. Liang, M.H. Lipscomb, B. Shekelle, P. Spratt, K.F.K.F. et al. “Outcome Measures for Studying Patients with Low Back Pain,”Spine 19 (1994): 2032S–2036S.; Lee, C.E. Simmonds, M.J. Novy, D.M. Jones, S., “Self-reports and Clinician-measured Physical Function among Patients with Low Back Pain: A Comparison,” Archives of Physical Medicine and Rehabilitation 82 (2001): 227–231; Severeijns, R. Vlaeyen, J.W.S. van den Hout, M.A. Weber, W.E.J., “Pain Catastrophizing Predicts Pain Intensity, Disability, and Psychological Distress Independent of the Level of Physical Impairment,” Clinical Journal of Pain 17 (2001): 165–172; Waddell, G., “A New Clinical Model for the Treatment of Low-back Pain,” Spine 12 (1987): 632–44; Boden, S.D. Davis, D.O. Dina, T.S. Patronas, N.J. Wiesel, S.W., “Abnormal Magnetic-resonance Scans of the Lumbar Spine in Asymptomatic Subjects,”The Journal of Bone and Joint Surgery, American Volume 72-A (1990): 403–408; Jensen, M.C. Brant-Zawadski, M.N. Obuchowski, N. Modic, M.T. Malkasian, D. Ross, J.S., “Magnetic Resonance Imaging of the Lumbar Spine in People with Back Pain,”New Engl J Med 331 (1994): 69–73; Boos, N. Semmer, N. Elfering, A. Schade, V. Gal, I. Zanetti, M. Kissling, R. Buchegger, N. Hodler, J. Main, C.J., “Natural History of Individuals with Asymptomatic Disc Abnormalities in Magnetic Resonance Imaging,” Spine 25 (2000): 1482–1492; Borenstein, D.G. O’Mara, J.W. Jr Boden, S.D. Lauerman, W.C. Jacobson, A. Platenberg, C. Schellinger, D. Wiesel, S.W., “The Value of Magnetic Resonance Imaging of the Lumbar Spine to Predict Low-back Pain in Asymptomatic Subjects: A Seven-year Follow-up Study,” The Journal of Bone and Joint Surgery, AmericanVolume 83-A (2001): 1306–11; Wiesel, S.W. Tsourmas, N. Feffer, H. Citrin, C.M. Patronas, N.N., “A Study of Computer-assisted tomography: 1. The Incidence of Positive CAT Scans in an Asymptomatic Group of Patients,”Spine 9 (1984): 549–551; Jarvik, J.J. Hollingworth, W. Heagerty, P. Haynor, D.R. Deyo, R.A., “The Longitudinal Assessment of Imaging and Disability of the Back (LAIDBack) Study: Baseline Data,” Spine 26 (2001): 1158–1166.CrossRefGoogle Scholar
Rosenhan, D.L., “On Being Sane in Insane Places,” Science 179 (1973): 250–258.CrossRefGoogle Scholar
Nathan, P.E. Langenbucher, J.W., “Psychopathology: Description and Classification,” Annual Review of Psychology 50 (1999): 79–107; Widiger, T.A., ed., DSM-IV Sourcebook (American Psychiatric Press, 1994); Williams, J.B. Gibbon, M. First, M.B. Spitzer, R.L. Davies, M. Borus, J. Howes, M.J. Kane, J. Pope, H.G. Jr Rounsaville, B. et al. , “The Structured Clinical Interview for DSM-III-R (SCID). II. Multisite Test-retest Reliability,” Archives of General Psychiatry 49 (1992): 630–6; Zanarini, M.D. Skodol, A.E. Bender, D. Dolan, R. Sanislow, C. Schaefer, E. Morey, L.C. Grilo, C.M. Shea, M.T. McGlashan, T.H. Gunderson, J.G., “The Collaborative Longitudinal Personality Disorders Study: Reliability of Axis I and II Diagnoses,”Journal of Personality Disorders 14(2000): 291–9.Google Scholar
Grannemann, T.W., ed., Review, Regulate or Reform? What Works to Control Workers’ Compensation Medical Costs (Cambridge, MA: Workers Compensation Research Institute, 1994); Moscovitch, E. Chelius, J.R., “The Massachusetts Experience with Workers’ Compensation Reform,” in Burton, J.F., ed., 7596” Workers’ Compensation Yearbook (Horsham Pennsylvania: LRP Publications, 1995).Google Scholar
See Cocchiarella, Robinson, et al. , supra note 4.Google Scholar
See Spieler, et al. Rondinelli, Duncan, , supra note 5Google Scholar
See Nagi, , supra note 30.Google Scholar
See World Health Organization, 1980, supra note 30.Google Scholar
See World Health Organization, 2001, supra note 18.Google Scholar