AMA Guides® Newsletter - Issue Archive

Articles

1. Challenges in the Diagnostic Conceptualization of CRPS-1 (Formerly Conceptualized as RSD)

   Robert J. Barth, Tom W. Bohr

   Pages 1–3, 9-12

   DOI: 10.1001/amaguidesnewsletters.2006.MarApr01

   Abstract

   From the previous issue, this article continues a discussion of the potentially confusing aspects of the diagnostic formulation for complex regional pain syndrome type 1 (CRPS-1) proposed by the International Association for the Study of Pain (IASP), the relevance of these issues for a proposed future protocol, and recommendations for clinical practice. IASP is working to resolve the contradictions in its approach to CRPS-1 diagnosis, but it continues to include the following criterion: “[c]ontinuing pain, which is disproportionate to any inciting event.” This language only perpetuates existing issues with current definitions, specifically the overlap between the IASP criteria for CRPS-1 and somatoform disorders, overlap with the guidelines for malingering, and self-contradiction with respect to the suggestion of injury-relatedness. The authors propose to overcome the last of these by revising the criterion: “[c]omplaints of pain in the absence of any identifiable injury that could credibly account for the complaints.” Similarly, the overlap with somatoform disorders could be reworded: “The possibility of a somatoform disorder has been thoroughly assessed, with the results of that assessment failing to produce any consistencies with a somatoform scenario.” The overlap with malingering could be addressed in this manner: “The possibility of malingering has been thoroughly assessed, with the results of that assessment failing to produce any consistencies with a malingering scenario.” The article concludes with six recommendations, and a sidebar discusses rating impairment for CRPS-1 (with explicit instructions not to use the pain chapter for this purpose).
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2. Special Feature: Use of the AMA Guides–2006 Update

   Christopher R. Brigham, Jenny Walker

   Pages 4–8

   DOI: 10.1001/amaguidesnewsletters.2006.MarApr02

   Abstract

   The AMA Guides to the Evaluation of Permanent Impairment, (AMA Guides), Fifth Edition, is the most widely used basis for determining impairment and is used in state workers’ compensation systems, federal systems, automobile casualty cases, and personal injury cases. The AMA Guides is used in most state workers’ compensation jurisdictions: 25 states use the fifth edition; 10 use the fourth edition, 1 state uses a hybrid of the fourth and fifth editions, and 2 states use the third edition, revised; 6 states use their own state-specific guidelines, and 6 do not indicate a specific guideline. Statutes may or may not specify which edition of the AMA Guides to use nor how to use them. In addition, many states use a statutory schedule for amputations, hearing loss, visual loss, hernias, and disfigurement, and other states use the AMA Guides for nonscheduled injuries. The AMA Guides often is used to quantify the extent of injuries resulting from an automobile casualty or personal injury. Insurers may use an impairment rating as a factor in setting reserves and determining the settlement value of a claim, and attorneys may use this information to quantify the effects of an injury. A four-page table displays uses of the AMA Guides in state workers’ compensation plans, including the edition most commonly used, the statute/code, comments, and relevant websites.
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