AMA Guides® Newsletter - Issue Archive

Articles

1. Fifth Edition: Causalgia, RSD, CRPS Impairment Evalaution

   Leon H. Ensalada

   Pages 1–4, 11, 12

   DOI: 10.1001/amaguidesnewsletters.2001.JulAug01

   Abstract

   In the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fifth Edition, the methods for rating impairment to causalgia, reflex sympathetic dystrophy (RSD), and complex regional pain syndromes (CRPS) differ from the approaches found in previous editions. Methods for evaluating impairment due to causalgia, RSD, and CRPS can be described as having anatomic or functional bases. The physical evaluation determines the anatomic impairment and is based on history and a detailed examination; the functional evaluation measures the individual's performance of the activities of daily living (ADL). Chapter 13 of the AMA Guides, Fifth Edition, considers causalgia and RSD in Section 13.8, Criteria for Rating Impairments Related to Chronic Pain, and defines chronic pain as the diagnoses of causalgia, posttraumatic neuralgia, and reflex sympathetic dystrophy. In contradistinction to Chapters 16 and 17 and the Glossary, the new term CRPS is not used here. Chapter 16 considers CRPS, RSD (now CRPS I), and causalgia (now CRPS II) and notes that, “contrary to previous suggestions, regional sympathetic blockade has no role in the diagnosis of CRPS.” Chapter 17 uses a functional approach for assessing impairment due to causalgia, RSD, and CRPS. Pending further guidance, evaluators should ensure that their methods for rating lower extremity impairments due to causalgia, RSE, and CRPS are internally consistent.
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2. Feature II: Lower Extremity Impairment Evaluation: Fifth Edition Revisions

   Christopher R. Brigham

   Pages 5–7

   DOI: 10.1001/amaguidesnewsletters.2001.JulAug02

   Abstract

   Chapter 17, The Lower Extremities, in the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fifth Edition, continues to provide three means of assessing impairment: anatomic, diagnostic, and functional. Changes from the AMA Guides, Fourth Edition, include the following: The principles of assessment have been expanded to clarify when the different evaluation methods should be used (eg, less specific functional methods typically should not form the basis for a rating if more specific anatomic or diagnostic methods are available). A new cross-usage chart, Guide to the Appropriate Combination of Evaluation Methods (Table 17-2), indicates which methods can and cannot be appropriately used in combination. The evaluation of causalgia and complex regional pain syndrome now follows the same principles used to evaluate central nervous system lesions, and additional case examples are provided. Corresponding tables from the AMA Guides, Fourth and Fifth Editions, are compared. Guidance is provided about how to approach range-of-motion deficits in multiple directions in the same joint, and additional tests are discussed. Finally, the chapter provides Figure 17-10, Lower Extremity Impairment Evaluation Record and Worksheet, a useful template to simplify making the assessment and recording the evaluation, along with six case examples.
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3. Clinical Update: Fibromyalgia Syndrome: Impairment and Disability Issues

   Christopher R. Brigham, Norma J. Leclair

   Pages 8–11, 12

   DOI: 10.1001/amaguidesnewsletters.2001.JulAug03

   Abstract

   Fibromyalgia is a perplexing, controversial syndrome with many unanswered questions regarding both etiology and manifestations and impairment and disability issues. This article reviews controversies attending this diagnosis, examines the debates concern etiology, explains why this diagnosis is unratable by the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fifth Edition, and explore issues of disability. Health care professionals debate whether the diagnostic criteria actually define a distinct clinical disorder, but the American College of Rheumatology published, for research purposes, classification criteria for Fibromyalgia Syndrome (FMS) that since have been widely used: FMS has been defined as a complex, chronic condition characterized by widespread noninflammatory musculoskeletal pain, severe fatigue, and sleep disturbances. Many health care professionals maintain that FMS is best understood from a biopyschosocial perspective because of the absence of visible clinical signs and inability to confirm the condition by laboratory tests. FMS may affect between 3 and 6 million people in the United States, with a 10:1 predominance in women, most between 35 and 60 years of age. Section 18.3b, When This Chapter Should Not Be Used to Rate Pain-Related Impairment, advises that “the pain of individuals with ambiguous or controversial pain syndromes is considered unratable” and provides three discriminatory questions.
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