AMA Guides® Newsletter - Issue Archive

Articles

1. Pain Evaluation: Fifth Edition Approaches

   James Robinson, Dennis C. Turk, John D. Loeser

   Pages 1–5, 9, 11

   DOI: 10.1001/amaguidesnewsletters.2002.JanFeb01

   Abstract

   The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fifth Edition, stresses that impairment assessment should be based on objective evidence of organ dysfunction. Using this model, pain-related impairment (PRI) such as migraine headache not associated with definable organ dysfunction is difficult to reconcile with patients’ reports of limitations in their activities of daily living (ADL). Chapter 18 of the AMA Guides, Fifth Edition, systematically addresses PRI and differs from previous editions by allowing examiners to award both quantitative and qualitative impairments. PRI is challenging to integrate with other chapters of the AMA Guides, which provide conventional impairment ratings (CIR) based on objectively measurable organ dysfunction. Examining physicians should consider PRI when performing an impairment evaluation on an individual who has a condition associated with pain, including almost any orthopedic condition and most neurological conditions. The examiner must determine if an individual's PRI should be considered as incorporated in the CIR or if the PRI increases the burden of illness above that acknowledged in the CIR—and only in the latter case should the physician use Chapter 18. This chapter distinguishes ratable vs unratable PRI, but better terminology may be uncontroversial and controversial PRI, respectively. Ten steps are involved in a PRI assessment and require the examining physician to use a multiaxial approach, synthesize information from multiple sources, and carefully assess the individual's credibility and pain behavior.
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2. Clinical Update: Chronic Fatigue Syndrome

   Leon H. Ensalada, Christopher R. Brigham

   Pages 6–9

   DOI: 10.1001/amaguidesnewsletters.2002.JanFeb02

   Abstract

   Chronic fatigue syndrome (CFS) is a term applied to individuals who report severe chronic fatigue out of proportion to their efforts, but the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fourth and Fifth Editions, are clear that no ratable impairment is linked to CFS. Chronic fatigue is not synonymous with CFS; only a small fraction of persons who present with chronic fatigue symptoms meet the criteria for CFS; and CFS, like fibromyalgia and multiple chemical sensitivity, is poorly understood. CFS may be associated with disability but primarily is based on psychological rather than physical symptoms. No tests confirm the diagnosis of CFS, and routine laboratory testing is reserved for excluding other medical conditions. CFS is an illness without a disease and often is characterized by illness behavior expressed as somatization. To date, no convincing evidence supports the notion that CFS is an infectious, neuroendocrine, or immunologic disorder. Thus, sophisticated behavioral assessment is critical and may include a fatigue rating scale, a depression scale, and psychological and personality inventories. No specific treatment has been recommended for CFS treatment, but cognitive and behavioral interventions may be useful to address psychological symptoms; medication is reserved for specific symptoms indicative of depression or anxiety.
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