Pain, Impairment, and Disability in the AMA Guides

Abstract

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 sGuides to the Evaluation of Permanent Impairment, 5thedition AMA Guides 5thOur 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.