AMA Guides® Newsletter - Issue Archive

Articles

1. Impairment Rating Insights

   Christopher R. Brigham, W. Frederick Uehlein, Craig Uejo, Leslie Dilbeck

   Pages 1–5

   DOI: 10.1001/amaguidesnewsletters.2008.JulAug01

   Abstract

   This article addresses a number of issues regarding impairment evaluation and the use of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides). First, impairment is not synonymous with disability, and, as noted in the sixth and previous editions of the AMA Guides, no direct correlation exists between impairment and work restrictions or loss of earning capacity. An impairment rating does not directly equate to a permanent disability rating and does not solely determine compensation. The AMA Guides creates the opportunity for consistency of impairment ratings among physicians, but impairment ratings must be performed according to standards defined in the AMA Guides. Impairment rating values and methods in the AMA Guides can change between editions based on medical reasons. It is too early to determine the effects of changes in the sixth edition of the AMA Guides pending the accumulation of adequate experience using this edition, until impairment ratings associated with specific diagnoses can be compared, and until an adequate sample of cases can be evaluated and compared using the fifth and sixth editions. Use of the sixth edition may result in some lower impairment ratings, but this edition also expands the number of ratable conditions compared to previous versions. Finally, impairment determination is a medical issue, and more reasonable approaches should be developed to translate impairment into financial rewards.
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2. Pain Disorders, Part II: Evaluating the Difficult Pain Patient

   Richard T. Katz, Stacey Lee Smith

   Pages 6–14

   DOI: 10.1001/amaguidesnewsletters.2008.JulAug02

   Abstract

   In the conclusion of this two-part article, the authors present the notion of psychiatric confounders to assist non–psychiatric physicians in assessing the “difficult pain patient.” Non–psychiatric physicians need not have a detailed understanding of all psychiatric diagnoses, but an understanding of certain diagnoses will assist in evaluating patients with enduring pain complaints. Psychosocial factors have important effects on the relationship between pain and disability. In one study, job satisfaction was a predictor of future disability in low back pain patients; in another study, psychiatric morbidity in a pain-free population predicted the development of back pain over a defined period. In many patients with persistent somatic and/or pain complaints, unrecognized psychiatric diagnoses drive or complicate symptoms and may precede the onset of low back pain. Mood, anxiety, and substance abuse disorders are common and can be associated with physical and pain complaints. Somatic symptoms often are the core feature of the depressed patient who presents to a primary care physician. Somatoform disorders are a spectrum of psychiatric disorders in which physical complaints are driven or aggravated by psychological factors; somatizing patients have chronic problems, many of which are pain-related and involve recurrent physical symptoms, often in different bodily systems, that wax and wane over time. Physicians who evaluate patients with pain complaints must understand the complexity of the challenge, including the probability that pain complaints indicate underlying psychopathology.
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3. Guides Case Exercise I: Lumbar Radiculopathy, Resolved

   Pages 15–17

   DOI: 10.1001/amaguidesnewsletters.2008.JulAug03

   Abstract

   Case exercises are an effective way to increase one's understanding of the appropriate applications of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides). The examples presented here are among the more than seventy cases included in the new edition of The Guides Casebook. The first case involves a 31-year-old woman who experienced acute low back and left leg pain while lifting and twisting at work. Diagnostic evaluation included MRI of the lumbar spine, which showed a herniated nucleus pulposus at L3-4, impinging on the left L4 nerve root. The diagnosis of lumbar radiculopathy was confirmed with electromyography. The AMA Guides, Fourth Edition, awarded 10% whole person impairment; the Fifth Edition awarded 5% (from a recommended range of 5% to 8%); and the Sixth Edition awarded 7%. The second case involves a 26-year-old woman whose stopped car was struck at 5 miles-per-hour in a rear-end collision. She described neck and low back pain but denied radicular symptoms and showed no signs of either neurologic or musculoskeletal impairment; her cervical spine and lumbar spine flexion and extension plain films were normal. Ten months after the accident, she had not returned to work, and consultation with a rheumatologist led to a diagnosis of fibromyalgia. The article discussed evaluation using the fourth, fifth, and sixth editions of the AMA Guides, each of which recommended 0% impairment.
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4. Guides Case Exercise II: Fibromyalgia

   Pages 18–20

   DOI: 10.1001/amaguidesnewsletters.2008.JulAug04