Preventing iatrogenic disability from chronic pain

This article reviews the AMA guidelines for judging impairment that involves anatomic or physiologic deficits and should be evaluated objectively based upon current biomedical knowledge. Disability, in contrast, is a biopsychosocioeconomic phenomena based upon many nonmedical demands. Chronic pain syndrome is examined as a disabiling condition best conceptualized and treated with such a multisystems model, while the underlying impairment needs to be assessed and rated by a biomedical model.The wide range of "central processes" relevant to chronic pain are reviewed. It argues that patients should not be viewed as reaching MMI unless they have been treated at a comprehensive chronic pain rehabilitation program, or are unable or unwilling to do so. A balanced, direct yet compassionate approach is recommended in treating these patients: the source of pain and that it will not cause harm is carefully explained and a clear expecatation that the patient’s condition is not disabling and that he or she can return to work is conveyed.The need to change the compensation and disability systems so that they encourage early intervention with incentives toward rehabilitation and return to work is emphasized.