The Evaluation of Permanent Impairment Arising from Chronic Pain
 
For the first time, it is possible to assess permanent impairment due to chronic pain utilizing the American Medical Association Guides to the Evaluation of Permanent Impairment.  Until the 5th edition of the Guides, an examiner using the American Medical Association Guides to the Evaluation of Permanent Impairment could rate pain primarily as a function of the various organ systems.  Assessment of impairment due to chronic pain depended on using a grid that took into account 4 levels of frequency and 4 levels of intensity to arrive at a conclusion about impairment due to chronic pain.  The table did little to quantify permanent impairment based on chronic pain.  In the 5the edition of the Guides, guidelines are set forth that allow chronic pain to be rated as a separate and distinct entity, and advances the process for rating permanent impairment from chronic pain in a more quantifiable fashion.
 
Pain is an unpleasant sensory or emotional experience associated with actual or potential tissue damage, or is a sensation described in terms of tissue damage.  Pain perception is influenced by cognitive, behavioral, environmental and cultural factors.  In chronic pain, there may be no obvious patho-physiologic changes (American Medical Association Guides to the Evaluation of Permanent Impairment, 5th edition, Page 566).
 
  • Chronic pain is not simply an extension of acute pain.
  • There may be no positive underlying objective diagnostic test that accounts for the pain.
  • Pain can exist without tissue damage, conversely tissue damage can exist without pain.
  • Pain is one of the most common reasons for seeking medical attention, and is the most common cause of disability (American Medical Association Guides to the Evaluation of Permanent Impairment, 5th edition).
  • People are incapacitated by a variety of unbearable sensations when they try to work (Institute of Medicine Committee on Pain and Disability and Chronic Illness Behavior, Washington, DC, National Academy Press 1987: 28).
Recent advances suggest that there are behavioral, psychological and neurophysiologic considerations regarding chronic pain.  Recent studies have demonstrated that pain need not be a symptom of a disease or injury, but can in fact become a disease unto itself..
 
Pain can become independent of the organ or body part that was responsible for the individual's pain.  The spinal cord and sensory cortex can become sensitized, so that the pain is a disease unto itself.  There is no way to document the phenomenon of sensitization.  With the American Medical Association Guides to the Evaluation of Permanent Impairment, 5th edition, permanent impairment due to chronic pain can now be assessed.  For more information, please call or write!!!
 

Robert N. Phelps, Jr. MD

Fellow, American Academy of Orthopedic Surgery

Diplomate, American Board of Orthopedic Surgery

1-888-373-6388