AMA Guides® Newsletter - Issue Archive

Articles

1. Rating Opioid Use Disorder for Permanent Impairment

   James B. Talmage

   Pages 3–11

   DOI: 10.1001/amaguidesnewsletters.2020.JanFeb01

   Abstract

   The duration of opioid therapy after surgery is the strongest known predictor of ultimate misuse, and researchers have reported that the number of days for which medication was prescribed and the total number of postoperative prescriptions each predicts long-term use. This article addresses the question of rating the impairment for an individual with no history of substance use disorder before a work injury, who is prescribed opioids for this injury, and who subsequently develops opioid use disorder (OUD). The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, should be used in conjunction with the AMA Guides to the Evaluation of Permanent Impairment, (AMA Guides), Sixth Edition. A person who is prescribed opioids is not yet at maximum medical improvement (MMI) and cannot be rated. Referral for substantiation of the diagnosis and for initiation of treatment are necessary before OUD is confirmed and the patient is at MMI. The AMA Guides is based on impairments of activities of daily living (ADL), so a patient's MMI should result in a happy outcome and no impairment, although the burden of treatment compliance may be a relevant consideration. The article concludes with an extensive literature review, including abstracts of published articles regarding OUD in various settings.
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2. The Medical Benefits of Work and the Health “Cost” of Unemployment

   James B. Talmage

   Pages 12–14

   DOI: 10.1001/amaguidesnewsletters.2020.JanFeb02

   Abstract

   In 2011, the American Medical Association published the AMA Guides to the Evaluation of Work Ability and Return to Work (AMA's Return to Work), Second Edition, which began with a review of consensus statements attesting that, in general, work is good for a person's health and well-being. Since publication of AMA's Return to Work, the Australian Royal College of Physicians has issued a consensus statement about the negative health consequences of becoming unemployed and the health benefits of returning to work. Key points include: for most individuals, working improves general health and well-being and reduces psychological distress; even musculoskeletal and mental health conditions attributed to work can benefit from activity-based rehabilitation and an early return to suitable work; long-term work absence is harmful to physical and mental health and well-being; the negative effects of remaining away from work include stress on the worker's families, including children. Of the potential consequences of unemployment in mid-adult life, the worst is premature death. In causation research, unlike medical treatment studies, individuals cannot be randomly assigned to a group that is forced to remain at work and a group that is forced to be unemployed. Even so, causation research has found strong evidence for a protective effect of employment on depression and general mental health. In performing evaluations, physicians must accurately assess work ability and recognize the healthy benefits of work.
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3. Q&A: T12: Thoracic or Lumbar Vertebra?

   James B. Talmage, Christopher R. Brigham

   Pages 15–15

   DOI: 10.1001/amaguidesnewsletters.2020.JanFeb03