Pain and Disability Clinical, Behavioral, and Public Policy Perspectives (1987) / Chapter Skim
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Pages 1-11
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Further, in recent years there has been considerable tension between the SSA system and the federal courts over the subject of chronic pain; claimants who had been denied benefits by the SSA often were later awarded them by the courts to which they appealed. In response to these problems, the 1984 amendments to the Social Security Act included the first statutory standard defining the way in which pain should be evaluated by the SSA in determining eligibility for disability benefits.
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CHRONIC PAIN Everyone suffers severe pain from time to time; for most of us, each episode ends with the resolution of the symptom or the disorder producing it. A small but significant proportion of individuals treated may get less than optimal relief, have recurrences, and develop chronic pain.
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Many patients have affective disorders, particularly depression; others suffer from substance abuse, personality disorders, and various somatoform disorders, such as hypochondriasis and somatization disorder. In some patients these disorders may be secondary to chronic pain, but in others they predate the pain or reflect alternative expressions of the same underlying psychobiological disorder.
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SOCIAL SECURITY ADMINISTRATION DISABILITY PROGRAMS The SSA administers two disability compensation programs. The Social Security Disability Insurance (SSDI)
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Information gathered by this office (which usually includes medical records from the cIaimant's personal physician) is forwarded to the disability determination service (DDS)
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Problems In the System Historically, many forces came together to produce the Social Security disability programs. These forces continue to operate, some functioning to keep the program within the established boundaries and others pushing against these boundaries, such that there is continual tension among the various elements within the program as well as from various external forces interacting with the program.
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Although many factors are known to cot relate with chronic disabling pain, predictive models have not been developed and tested. Epidemiological studies suggest that fewer than 10 percent of people with acute back pain develop chronic pain.
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Although the committee acknowledges the value of these terms in certain contexts, they should not be used for SSA disability purposes. There has been no demonstration of a common etiology, a predictable natural history, a clearly defined constellation of symptoms, or a specific treatment for the various pain conditions that would suggest a basis for positing a single chronic pain syndrome.
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Under the current system, such assessments are conducted late in the evaluation process, if at all. The committee believes there is potential for using careful descriptions and measures of functional disturbances in performance and activities of living as surrogate variables for the severity of chronic pain conditions.
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and the optimal timing of interventions to prevent chronic disabling pain; methodological studies to develop and validate measures of clinical phenomena, psychosocial variables, and pertinent outcomes relevant to chronic pain and disability; and health services research to elucidate the contributions of important sociocultural variables to the course of illness and illness behavior, and to study the interactions of the health care delivery system and disability programs with patient/claimant behavior.
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From page 11... ...
be aware of commonly overlooked physical and psychiatric disorders that may account for the pain or contribute to it; (3) be able to make appropriate referrals of chronic pain patients to practitioners in other disciplines; and (4)
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