AMA Guides® Newsletter - Issue Archive

Articles

1. Chapter 14 or 18 for Pain Complaints? Guidance From Chapter 18 and Other Pain Resources

   Robert J. Barth

   Pages 1–3, 10-12

   DOI: 10.1001/amaguidesnewsletters.2005.MayJun01

   Abstract

   This article is part three of a four-part series that examines the rating of pain complaints and mental illness using the AMA Guides to the Evaluation of Permanent Impairment, (AMA Guides). Chapter 18 provides physicians with a method for evaluating impairment associated with “chronic pain states” for which there may be “no demonstrable active disease or unhealed injury,” and Chapter 14 should be considered when symptoms are out of proportion to physical findings. This article focuses on the directions from Chapter 18 and other pain resources. The authors note that Chapter 18 specifically addresses the issue of distinguishing between uses of Chapters 18 and 14, but the directions are contradictory with respect to the key question, Do “psychological factors” play a “major role” in the presentation of pain? Resources such as Bonica's Management of Pain point out that “[t]issue damage and nociception are neither necessary nor sufficient for pain,” suggesting that psychological factors are nearly always present and obviating the use of Chapter 18. A potential solution would be to ask, “Is the presentation of pain consistent with any mental illness as defined in the American Psychiatric Association's Diagnostic and Statistical Manual?” The decision rule then would be if the presentation of pain is consistent with any mental illness, then the mental and behavior chapter should be used.
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2. Left Page: Rating Total Ankle Replacement

   Charles N. Brooks

   Pages 4–5

   DOI: 10.1001/amaguidesnewsletters.2005.MayJun02

   Abstract

   Total ankle replacement (TAR), also known as total ankle arthroplasty, has been used since the early 1970s, but, because of improvements in both techniques and materials, the procedure is used more frequently, and examiners are asked to rate permanent impairment resulting from TAR. The AMA Guides to the Evaluation of Permanent Impairment, (AMA Guides) is silent about rating ankle impairment following arthroplasty but does provide a two-step method to rate the results of total hip and knee replacements. Using tables in the AMA Guides, examiners can rate disability associated with TAR. To provide a standard method for reporting the clinical status of the ankle and foot, the American Orthopaedic Foot and Ankle Society (AOFAS) published rating scales for four anatomic regions, one of which (the ankle-hindfoot scale), can be used to rate the clinical status of ankle, subtalar, talonavicular, and calcaneocuboid joints before and after treatment. The AOFAS scale includes neither patient satisfaction nor many other functional, physical, and radiographic findings, and the AOFAS ankle-hindfoot scale is not and never was intended to be comprehensive. Examiners can follow the same procedures for rating hip and knee replacements, substituting the AOFAS scale for rating clinical outcomes. [Two Quick References in this issue of The Guides Newsletter provide tables and figures relevant to rating upper extremity sensory and motor deficits and to measuring impairments of the hand and digits.]
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3. Quick Reference: Rating Upper Extremity Sensory and Motor Deficits

   Pages 6–7

   DOI: 10.1001/amaguidesnewsletters.2005.MayJun03

4. Quick Reference: Measuring Impairments of the Hand and Digits

   Pages 8–9

   DOI: 10.1001/amaguidesnewsletters.2005.MayJun04