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From page 293... ... , 134-135, 172 Analgesics for back pain, 203 opioid, 135,172,173, 203 Antidepressants, analgesic erects of, 175-176, 203 Antipsychotic drugs, analgesic effects of, 175 Anxiety relation to chronic pain, 131, 133134, 140-142, 166-168 role in maintenance of pain, 3, 140141 Anxiolytic drugs electiveness in treating pain, 176 Appeals (SSA) before ALJs, 5, 47, 67 federal district court, 76-78 process for denied claims, 5-6, 46~0, 60 Read the entire page →
From page 294... ... Schweiker, pain as legitimate disability, 56 B Back pain age, race, and sex correlations with, 113-114 alcoholism correlated with, 177 bed rest and restricted activity for, 202-203 behavior associated with, 218 causes of, 2, 13, 114 - 115, 196-200 clinical manifestations, 115 diagnosis of, 190-195, 204 drug therapy for, 20~203 incidence, 110-111, 113 marital status and recurrence of, 114 measurement of, 129, 179, 218-219, 222, 226 medical care for, 111-112 medical model for, 190-194, 196 nerve damage in, 140 outcomes of treatment, 194, 202-205 pain processes in, 126 physiotherapy for, 112 prevalence of, 104 - 108, 110-111, 113 progression to chrorucity, 109-110 psychosocial factors in, 116 sickness impact of, 221 socioeconomic status and, 115-116 surveys of, 10~108, 110-112 treatment modalities, 111-112, 193 195, 202-205, 241 work disability from, 109-113, 222- Chronic pain 223, 246 workplace factors in, 116 Baerga v. Richardson, standard for evaluating pain, 56 Barbiturates, treatment of pain with, 176 Behavior modification for treatment of pain, 175, 201-202, 238-239, 243244, 250 Beneficiary Rehabilitation Program, 253 Benefits, see Disability benefits; Compensation Benzodiazepines, 173, 176, 203 Ber v. Read the entire page →
From page 295... ... INDEX costs associated with, 98 definitions, 18,102, 109 depressive disorders and, 3, 133, 157, 166-168, 172-173 diagnosis of, 195-196, 200-201 epidemiology of, 101-119, 266, 277278 experience of, 3, 12, 15, 27, 69, 132134, 141, 146, 159 from failure of pain suppression system, 135 family influences on, 156-158, 168, 172, 178-179, 202 federal court handling of, 7~78 gaps in knowledge on, 7-8, 26~265 genetic predisposition to, 157 kinds of, 109-110 measures of, 10~103, 118-119; see also Measurement of pain models for, 124, 212 neurobiological mechanisms of depression and, 171-172 personality factors and, 3, 178-180 physical factors associated with, 11= 115 prevalence, 113-114 progression to, 109-110 psychiatric aspects of, 3, 165-181 psychosocial factors associated with, 116-117, 141, 196, 200-201 research recommendations on, 8-10, 117-119, 139, 180-181, 206-207, 265-266, 281 socioeconomic status and, 115-116 somatization disorder and, 3, 168-169 syndrome, characterization of, 13; see also Myofascial pain syndrome treatment recommendations for, 201205, 265 trends over time, 112 Chronic pain patients chiropractic care for, 153 rehabilitation of, 16, 79, 97; see also Rehabilitation substance abuse among, 3, 177-179 treatment of depressive disorders in, 174-177 Claims, see Disability claims Cognitive therapy electiveness, 201, 238, 244 for outpatient treatment of depression,174-175 recommended approach to, 201-202 Compensation effects on outcomes of treatment, 245, 248-252,273-274 295 European programs, 33, 64 neurosis, 249 See also Disability benefits Continuing Disability Investigations, 30,31 Conversion disorder, 169-170 Coping Scale Questionnaire, use in pain measurement, 225-226 Cordotomy, 205 Cornell Medical Index, assessment of chronic pain with, 180 Cultural/ethnic influences on disability, 33 on illness behavior, 158-160 D Dartmouth Pain Questionnaire, 215 Demonstration projects, recommendations for, 9-10, 255-257, 265, 270277 Depression (clinical) characteristics, 167 chronic pain and, 3, 133, 157,168, 172~173 in families of pain patients, 157, 168, 172 instruments for measuring, 167 neurobiological mechanisms of pain and, 171-172 prevalence in pain patients, 167 substance abuse associated with, 177 Depressive disorders psychopharmacological treatment, 175-177 psychotherapeutic treatment, 174175, 180 Depressive symptoms association between chronic pain and, 167, 168 caused by drug therapy, 173 Diagnosis of pain controversial, 197-198 difficulties in, 13-14, 195-200 expanded model, 19~195 history-taking, 191, 201 laboratory tests, 192 physical examination, 191-192,201 psychosocial factors in, 200-201 recomrr~ended improvements in, 200201 special techniques, 192 traditional medical model, 190-194 Dictionary of Occupational Titles, 46 Disability assessment, see Disability determina Read the entire page →
From page 296... ... , 30, 38, 40~1, 58, 69, 88-89, 95 cash payments, 38, 50, 88-89 coverage period, 60 eligibility, see Disability determinations; Eligibility for benefits expenditures for, 8~98 levels of, 95 negative effects of, controversy, 7881, 156, 245, 248-252 payments by SSDI/SSI, 37~8, 40-41, 50, 60, 89, 91-93, 95 private insurance, 60, 63, 89 rehabilitation and, 70-71, 78-81, 255-256, 274 after return to work, 51 simultaneously, SSDI and SSI, 38 termination of, 1, 30, 31, 56~7 types, 60 Veterans Administration, 58-61,8990 Workers' Compensation, 59-60,62, 89 See also Compensation Disability Benefits Reform Act of 1984 criteria for determining eligibility, 33-34 scope of, 31 standard for evaluating pain, 1, 21, 51~2, 76 Disability claims annual number filed, 42 application process, 42-46,52-53,60 disposition at all levels, 47-49 economic conditions and, 92,99 evaluation process, 5,42-46, 52, 5355, 59 growth of, 30, 69, 81, 91-93 incentives for, 95 most common bases of, 25 pain as a basis for, 55~7 tort settlements, 90 for vertebral disorders, 110 Disability definitions ambiguity in, 68 European, 33 medical condition linked to employability, 68 medical vs. functional concept, 69-70 private sector, 61, 63 restrictiveness of, 70 SSA, 4-5, 14-15, 22, 32-33, 38-42, 61,69-70,256,264,273-274 variation in, 93 Veterans A`lministration, 61 Workers' Compensation, 61 World Health Organization, 17 Disability determinations ability to work considered in, 45, 6970 age considerations in, 46 by ALJs, 5, 47,67,74-76,264 appeals of, 5-6, 46~0, 60, 67, 76-78 burden of proof, 57 case law inconsistencies in, 29,5557,67,77-78 criteria for, 14, 23, 29~0, 33-34, 57 differential impact of nature of impairment, 73 early, 10, 256,270-273 employment opportunities considered in, 2~30,81 evidence required for, 63-64,69,269 face-to-face, 5, 9, 47,64,264,272 federal district court, 7~78 functional approach to, 2,4, 5, 8-9, 45-46,69-70,220,223-224,254, 256,265,268-270,272-273 information gathering for, 8, 5~53, 103-109,265-267 institutional perspectives, 67 Read the entire page →
From page 297... ... SSA, history of, 22-24 Disabled persons direct services for, 90-91 discrimination against, 34, 81 employment opportunities for, 28~0, 34, 81, 93 labor force participation, 80 medical care payments for, 90 motivation for recovery and rehabilitation, 10, 25, 78-81, 273 number and characteristics of, 94 work continuation by, 70, 95 Disc herniation education correlated with, 115 pain from, 197 surgery for, 204 work absence from, 112 Discrimination against disabled persons, 34, 81 Doctors, see Physicians Dopamine, role in pain modulation, 172, 176-177 Dorsal column stimulation, 205 Drug abuse among chronic pain patients, 156, 173, 177, 179 disability determinations and, 68 Drug therapy antidepressants, 175-176, 203 antipsychotics, 175 for back pain, 202-203 for chronic pain, recommended improvements in, 203-204 depressive symptoms caused by, 173 opioids, 135,172, 173, 203 in pain management programs, 239, 241 polypharmacy, 156, 173, 227, 241 for somatization disorder, 169 See also Psychopharmacology E Education and training back pain correlated with, 115 considerations in disability determinations, 46 disability correlated with, 94 of health care professionals to treat pain, 10-11, 266, 280-283 See also Patient education Electromyography for diagnosis of back pain, 192 Eligibility for benefits criteria for determining, 14, 23, 26, 29~0, 32~4, 69; see also Disability determinations Medicaid and Medicare, 50 periodic review to confirm, 50 SSDI/SSI, 37~8, 248 Veterans Administration, 58 Workers' Compensation, 61-62 Employment effects on outcomes of treatment, 245-248; see also Return to work; Unemployment; Work disability opportunities for disabled persons, 28-30, 81, 93 substantial gainful activity, 45, 253 End Stage Renal Disease Program, payments for, 90 Endogenous opioid system, 135, 176, 177 Epidemiology of chronic pain, 101-119, 266, 277278 of psychiatric disorders, 166-167 Epidural steroid injections for low back pain, 241 Experience of pain description of, 133, 146 individual variables in, 12, 15, 27, 133 Read the entire page →
From page 298... ... 298 SEX threshold, 132,133, 159 tolerance, 3, 69, 133-134, 141 F Factitious disorder, 171 Families of pain patients depression and alcoholism in, 157, 168, 172 influences on illness behavior, 156158, 178-179, 238-240 involvement in treatment, 202, 233, 238-240 Federal courts, handling of chronic disabling pain by, 76-78 Federal Republic of Germany, disability definition, 33 Fibromyalgia/fibrositis, 197,199-200, 236, 241 Folk healers, 153 Functional impairment assessment of, 2, 4,5,8-9,220,254, 265, 268-270, 27~273 definition, 17 description, 27 imposed by pain, 54 G Glut~mic acid, role in pain processes, 131 H Handicap definition, 34 See also Disability Headaches illness behavior associated with, 134, 218 work days lost because of, 110 Health Belief Model, pain measurement with, 225 Health care services, alternative therapies, 153, 206 Heart attack, referred pain during, 129 HHS Co - mission on the Evaluation of Pain, definitions of acute pain, chronic pain, and impairment, 1718 recommended rehabilitation demonstration project, 274 Histamine, release in pain processes, 126 Holistic health care, 153, 206 Hopkins Symptom Checklist-90 (SCL90) , assessment of chronic pain with, 180, 252 Hyperactivity of sympathetic nervous system, 13~138 Hypnosis, 240 Hypnotic drugs, depressive symptoms from, 173 Hypochondriasis, 3, 170, 171,250 Hysteria, see Somatization disorder I Iatrogenesis, 156,202-205,223,282 mness/pain behavior in absence of diagnosable disease, 152-153 abnormal, 148, 170 avoidance of intimacy, 158 in back pain patients, 218 compensatory mechanisms, 152 conditioning, 157 coping responses, 151-154,156,225226,239,243,251 cultural/ethnic influences on, 3, 158160 definition, 13 expression/communication of pain, 133,146,151,155-156,159-160, 224-227 factors shaping, 147 family influences on, 15~158,178179,238-240 help seeking, 151-154 individual variation in, 147 judgments of, by health care providers, 217 malingering, 15~153 measurement of pain through, 217220 modeling, 157 observational data on, 217-219 operant learning, 157, 250 overuse syndromes, 152 pain tolerance factor in, 3, 133-134, 141 personality and, 15~156 processes of, 148-154 psychosocial factors in, 3,112,147, 155, 160 Seclusiveness, 152 reduced physical activity, 152 self-reports of, 219-220 somatization, 155-156,158,168,178 Read the entire page →
From page 299... ... Flemming, consideration of job opportunities in disability determinations, 29 L fedora, analgesic erects of, 177 Labor force participation by disabled persons, 80 employment opportunities as a determinnnt of, 81 Legal decisions on disability determinations, inconsistencies in, 67, 77-78 on pain cases, inconsistency in, 31 See also Appeals; Case law on disability determinations Leukotrienes, release in pain processes, 126 Levine-Pilowsky Depression Questionnaire, 252 Listing of Impairments, SSA, 5, 8, 39, 45, 54, 69, 265, 267-268 Lithium, analgesic effects of, 177 M Malingering, 15~153, 171 Marcus v. Califano, pain as legitimate disability, 56 McGill Pain Questionnaire (MPQ3, 215-216, 251 Measurement of disability instruments for, 220-222 pain relation to functional status, 2, 4, 5, 8-9, 45-46, 69-70, 220, 223224, 254, 256, 265, 268-270, 272273 rehabilitation-focused tests, 222 sickness impact, 221-222 surveys, 93-94, 103 work performance assessment, 222223 Read the entire page →
From page 300... ... Secretary, standard for evaluating pain, 56 Modeling/models acute pain, 124, 212 animal, applied to human pain studies, 124, 131, 137 biopsychosocial, for chronic pain, 27 chronic pain, 124, 212 expanded, of low back pain, 194-195 illness/pain behavior, 157 medical contrasted with nonmedical, 212-213 medical, of disability, 26 traditional medical, of low back pain, 190-194, 196 of unemployment-disability relationship, 91 Multidimensional Health Locus of Control Scale, pain measurement with, 224-225 Muscle atrophy from sustained pain, 137 Muscle contraction pain-associated, 138 stimulation of primal afferent nociceptors, 126 Muscle relaxants for back pain, 203 Myelography for diagnosis of back pain, 192, 204 Myelotomy, 205 Myofascial pain syndrome characteristics of, 286 diagnosis, 288-290 historical background, 286-287 natural history, 287-288 overlap between fibrositis and, 200 perpetuating factors, 138, 290 prevalence of, 240-241, 285-286 psychogenic pain disorder and, 170 treatment, 200, 241, 290-291 Myofascial trigger points in arthritis patients, 286 in back pain, 192, 197, 198-199 characteristics of, 288-290 development of, 198-199 referred pain from, 130, 192, 198199, 286-289 N Naltrexone, treatment of pain patients with, 178 National Institute of Mental Health Epidemiological Catchment Area project, 166 Nerve blocks to treat chronic pain, 234, 241, 250 conduction tests for diagnosis of back pain, 192 damage from back pain, 140 Netherlands, disability definition, 33 Read the entire page →
From page 301... ... experimentally induced, 126, 134 cognitive and affective aspects of, 134, 201 common types, 109-110; see also Back pain consideration in disability determinations, 51~7, 61-63 of deep somatic and visceral structures, pathways of, 132 definitions, 18, 102, 104-109 description of, 133, 146 diagnosis, see Diagnosis of pain disproportionate to injuries, 136 economics of, 98 effects on central nervous system, 140 enhancement through physiological processes, 136-141. evaluation of, 53~5, 127-129; see also Diagnosis of pain evidence of, 53, 54 experience of, see Experience of pain expression and communication of, 133, 146, 151, 155-156, 159-160, 22~227 functional status and, 2, 4, 5, 8-9, 220, 254, 265, 268-270, 272-273 impaired sensation of, 131, 132 incidence, 110-111 indicators of, 151-152; see also mnesslpain behavior; Measurement of pain information gathering on, 5243; see also Surveys of pain/disability intensity, 127-128 joint, 110, 136, 218 key court cases, 55~7 from lesions of central nervous system, 139 management, see Pain management programs/pain clinics meaning attributed to, 149-151, 224225 measurement of, see Measurement of pain memory of, 226 muscle contraction associated with, 138 neurological mechanisms and structures, 13, 125, 171-172; see also Pain processes neuropathic, 139-140 Read the entire page →
From page 302... ... 141 treatment, see Pain management programslpain clinics; Rehabilitation; Treatment of pain trigger points, see Myofascial trigger points VA consideration in disability assessments, 59,61 work disability due to, 103, 109-113, 222-223,246 Workers' Compensation consideration in disability determinations, 61-63 See also Acute pain; Back pain; Chronic pain Pain management programs/pain . Read the entire page →
From page 303... ... , pain measurement by, 141-142 Potassium release in pain processes, 126 Primary adherent nociceptors activation of, 4, 124-126, 137-139 axons of, 126-127, 131-132 chemical releases by, 131 damage to, 139-140 mechanisms of, 123, 131 monitoring pain intensity through, 127-128, 141 muscle contraction from, 126, 138 peripheral branching of, 130 regeneration of, 139 sensitization through repeated stimulation of, 136 Private disability insurance, 60-64, 89-90 Prostagland~ns, release in pain processes, 126 Psychiatric disorders in chronic pain patients, 166-167, 169; see also Depression (clinical) ; Depressive disorders Psychogenic pain disorder, 170, 171 Psychological factors in maintenance of pain, 140-141 Psychopharmacology for depressive disorders in pain patients, 175-177 Psychosocial factors affecting chronic pain, 116-117, 141, 196, 200-201 in illness behavior, 3, 112, 147, 155, 160 Psychotherapy for pain patients, 169, 174-175, 180, 240 Psychotropic drugs, analgesic effects of, 175-177 Purpose in Life Scale, pain measurement with, 224 R Race back pain correlated with, 113-114 relationship between disability and, 94 Recommendations, see Research recommendations Recovery, motivation for, 25, 78-81 Referred pain, 130, 192, 198-199, 286289 Reflex sympathetic dystrophy, 137-138 Rehabilitation of chronic pain patients, 16, 79, 97; see also Pain management programs/pain clinics costs, 235 disability benefits and, 70-71, 78-81, 255-256, 274 early, 10, 273-276 eligibility for (SSA) Read the entire page →
From page 304... ... amount of monthly payments, 50, 51, 95 appeals process, 5-6, 46-50, 60 application and evaluation process, 5, 42~46, 52~55, 60; see also Disability determinations benefits paid by, 37~8, 40-41, 50, 60, 89, 91-93, 95; see also Disability benefits conflicts and contradictions, 6-7, 6682, 263-264 contributions during disability, 23 definition of disability, 4 5, 14-15, 22, 32~3, 38-42, 61, 69-70, 256, 264, 273-274 disposition of claimants, 48-49 efficacy, 96-97 eligibility, 37-38, 248 funding reallocation to prevention, 97-98 growth in, 95-96 incentives for rehabilitation and return to work, 50~1 income support vs. rehabilitation, 7071 lengths and types of benefits, 60 problem of pain for, 21~5, 37-64, 6~82 purpose, 99 rehabilitation requirements and provisions, 61, 70 rules affecting return to work, 80-81 sequential evaluation process, 5-6, 43~7, 53-55, 69, 268-269 stay and offices involved with reviews, 67 state-level (DDS) Read the entire page →
From page 305... ... , 234,237 Treatment of pain in alcoholics and drug abusers, 177178 bed rest and restricted activity, 202203,223 chronic low back, 111-112,193-195, 202-205,241 cognitive-behavioral approach, 175, 201-202,238-239,243-244,250 collaborative approach, 202 compensation status as a factor in, 248-252 difficulties in, 13-14 through distraction and meaningful activity, 149 electrical stimulation of homologous brain regions, 134-135 employment as a factor in, 246-248 expanded model for, 194-195 frontal lobotomies, 134 multimodal approaches, 244-245, 254,255 negative erects of, 156,202-205,223, 282 operant conditioning, 178,238,243, 251 outcomes, see Outcomes of treatments physical modalities, 223-224,237238 psychopharmacological, 175-177 psychotherapeutic, 17~175, 240 recommended improvements in, 201205,265 relaxation therapy, 238,240,243 stress management, 240 surgery, 20~205 transcutaneous electrical stimulation (TENS) , 234, 237 vibration, 237 work simulation techniques, 223 See also Drug therapy Trial work period disability payments during, 10, 51, 257 disincentives to use, 80-81, 274 purpose, 252-253 U Unemployment, disability and, 27,8081, 91 V Vertebral disorders claims associated with, 110 classified as disabling by SSA, 42 physiotherapy for, 112 work absence from, 112 Veterans Administration cash disability transfers, 89-90 disability compensation programs, 58-61 Visual Analog Scale (VAS) Read the entire page →
From page 306... ... 306 INDEX West Haven-Yale Multidimensional Pain Inventory, 215-216 Work absenteeism, major causes of, 12 continuation by disabled persons, 70, 95 environment, factors related to back pain, 116 experience, considerations in disability determinations, 46 performance, assessment of disability through, 222~223 See also Return to work; Trial work period Work disability from arthritis, 115, 205 from back pain, 109-113, 222-223, 246 consideration in disability determinations, 69-70 frequency, from pain, 103 from joint pain, 110 relation of impairment to, 27 social predictors of, 80 Workers' Compensation cash disability transfers, 89-90 disability categories, 62 disability compensation programs, 59-63, 89 expenditures for rehabilitation, 97 World Health Organwation, definitions of disability, functional limitation, impairment, 17 X X rays for diagnosis of pain, 192, 201 Read the entire page →

From page 293...

... , 134-135, 172 Analgesics for back pain, 203 opioid, 135,172,173, 203 Antidepressants, analgesic erects of, 175-176, 203 Antipsychotic drugs, analgesic effects of, 175 Anxiety relation to chronic pain, 131, 133134, 140-142, 166-168 role in maintenance of pain, 3, 140141 Anxiolytic drugs electiveness in treating pain, 176 Appeals (SSA) before ALJs, 5, 47, 67 federal district court, 76-78 process for denied claims, 5-6, 46~0, 60

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From page 294...

... Schweiker, pain as legitimate disability, 56 B Back pain age, race, and sex correlations with, 113-114 alcoholism correlated with, 177 bed rest and restricted activity for, 202-203 behavior associated with, 218 causes of, 2, 13, 114 - 115, 196-200 clinical manifestations, 115 diagnosis of, 190-195, 204 drug therapy for, 20~203 incidence, 110-111, 113 marital status and recurrence of, 114 measurement of, 129, 179, 218-219, 222, 226 medical care for, 111-112 medical model for, 190-194, 196 nerve damage in, 140 outcomes of treatment, 194, 202-205 pain processes in, 126 physiotherapy for, 112 prevalence of, 104 - 108, 110-111, 113 progression to chrorucity, 109-110 psychosocial factors in, 116 sickness impact of, 221 socioeconomic status and, 115-116 surveys of, 10~108, 110-112 treatment modalities, 111-112, 193 195, 202-205, 241 work disability from, 109-113, 222- Chronic pain 223, 246 workplace factors in, 116 Baerga v. Richardson, standard for evaluating pain, 56 Barbiturates, treatment of pain with, 176 Behavior modification for treatment of pain, 175, 201-202, 238-239, 243244, 250 Beneficiary Rehabilitation Program, 253 Benefits, see Disability benefits; Compensation Benzodiazepines, 173, 176, 203 Ber v.

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From page 295...

... INDEX costs associated with, 98 definitions, 18,102, 109 depressive disorders and, 3, 133, 157, 166-168, 172-173 diagnosis of, 195-196, 200-201 epidemiology of, 101-119, 266, 277278 experience of, 3, 12, 15, 27, 69, 132134, 141, 146, 159 from failure of pain suppression system, 135 family influences on, 156-158, 168, 172, 178-179, 202 federal court handling of, 7~78 gaps in knowledge on, 7-8, 26~265 genetic predisposition to, 157 kinds of, 109-110 measures of, 10~103, 118-119; see also Measurement of pain models for, 124, 212 neurobiological mechanisms of depression and, 171-172 personality factors and, 3, 178-180 physical factors associated with, 11= 115 prevalence, 113-114 progression to, 109-110 psychiatric aspects of, 3, 165-181 psychosocial factors associated with, 116-117, 141, 196, 200-201 research recommendations on, 8-10, 117-119, 139, 180-181, 206-207, 265-266, 281 socioeconomic status and, 115-116 somatization disorder and, 3, 168-169 syndrome, characterization of, 13; see also Myofascial pain syndrome treatment recommendations for, 201205, 265 trends over time, 112 Chronic pain patients chiropractic care for, 153 rehabilitation of, 16, 79, 97; see also Rehabilitation substance abuse among, 3, 177-179 treatment of depressive disorders in, 174-177 Claims, see Disability claims Cognitive therapy electiveness, 201, 238, 244 for outpatient treatment of depression,174-175 recommended approach to, 201-202 Compensation effects on outcomes of treatment, 245, 248-252,273-274 295 European programs, 33, 64 neurosis, 249 See also Disability benefits Continuing Disability Investigations, 30,31 Conversion disorder, 169-170 Coping Scale Questionnaire, use in pain measurement, 225-226 Cordotomy, 205 Cornell Medical Index, assessment of chronic pain with, 180 Cultural/ethnic influences on disability, 33 on illness behavior, 158-160 D Dartmouth Pain Questionnaire, 215 Demonstration projects, recommendations for, 9-10, 255-257, 265, 270277 Depression (clinical) characteristics, 167 chronic pain and, 3, 133, 157,168, 172~173 in families of pain patients, 157, 168, 172 instruments for measuring, 167 neurobiological mechanisms of pain and, 171-172 prevalence in pain patients, 167 substance abuse associated with, 177 Depressive disorders psychopharmacological treatment, 175-177 psychotherapeutic treatment, 174175, 180 Depressive symptoms association between chronic pain and, 167, 168 caused by drug therapy, 173 Diagnosis of pain controversial, 197-198 difficulties in, 13-14, 195-200 expanded model, 19~195 history-taking, 191, 201 laboratory tests, 192 physical examination, 191-192,201 psychosocial factors in, 200-201 recomrr~ended improvements in, 200201 special techniques, 192 traditional medical model, 190-194 Dictionary of Occupational Titles, 46 Disability assessment, see Disability determina

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From page 296...

... , 30, 38, 40~1, 58, 69, 88-89, 95 cash payments, 38, 50, 88-89 coverage period, 60 eligibility, see Disability determinations; Eligibility for benefits expenditures for, 8~98 levels of, 95 negative effects of, controversy, 7881, 156, 245, 248-252 payments by SSDI/SSI, 37~8, 40-41, 50, 60, 89, 91-93, 95 private insurance, 60, 63, 89 rehabilitation and, 70-71, 78-81, 255-256, 274 after return to work, 51 simultaneously, SSDI and SSI, 38 termination of, 1, 30, 31, 56~7 types, 60 Veterans Administration, 58-61,8990 Workers' Compensation, 59-60,62, 89 See also Compensation Disability Benefits Reform Act of 1984 criteria for determining eligibility, 33-34 scope of, 31 standard for evaluating pain, 1, 21, 51~2, 76 Disability claims annual number filed, 42 application process, 42-46,52-53,60 disposition at all levels, 47-49 economic conditions and, 92,99 evaluation process, 5,42-46, 52, 5355, 59 growth of, 30, 69, 81, 91-93 incentives for, 95 most common bases of, 25 pain as a basis for, 55~7 tort settlements, 90 for vertebral disorders, 110 Disability definitions ambiguity in, 68 European, 33 medical condition linked to employability, 68 medical vs. functional concept, 69-70 private sector, 61, 63 restrictiveness of, 70 SSA, 4-5, 14-15, 22, 32-33, 38-42, 61,69-70,256,264,273-274 variation in, 93 Veterans A`lministration, 61 Workers' Compensation, 61 World Health Organization, 17 Disability determinations ability to work considered in, 45, 6970 age considerations in, 46 by ALJs, 5, 47,67,74-76,264 appeals of, 5-6, 46~0, 60, 67, 76-78 burden of proof, 57 case law inconsistencies in, 29,5557,67,77-78 criteria for, 14, 23, 29~0, 33-34, 57 differential impact of nature of impairment, 73 early, 10, 256,270-273 employment opportunities considered in, 2~30,81 evidence required for, 63-64,69,269 face-to-face, 5, 9, 47,64,264,272 federal district court, 7~78 functional approach to, 2,4, 5, 8-9, 45-46,69-70,220,223-224,254, 256,265,268-270,272-273 information gathering for, 8, 5~53, 103-109,265-267 institutional perspectives, 67

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From page 297...

... SSA, history of, 22-24 Disabled persons direct services for, 90-91 discrimination against, 34, 81 employment opportunities for, 28~0, 34, 81, 93 labor force participation, 80 medical care payments for, 90 motivation for recovery and rehabilitation, 10, 25, 78-81, 273 number and characteristics of, 94 work continuation by, 70, 95 Disc herniation education correlated with, 115 pain from, 197 surgery for, 204 work absence from, 112 Discrimination against disabled persons, 34, 81 Doctors, see Physicians Dopamine, role in pain modulation, 172, 176-177 Dorsal column stimulation, 205 Drug abuse among chronic pain patients, 156, 173, 177, 179 disability determinations and, 68 Drug therapy antidepressants, 175-176, 203 antipsychotics, 175 for back pain, 202-203 for chronic pain, recommended improvements in, 203-204 depressive symptoms caused by, 173 opioids, 135,172, 173, 203 in pain management programs, 239, 241 polypharmacy, 156, 173, 227, 241 for somatization disorder, 169 See also Psychopharmacology E Education and training back pain correlated with, 115 considerations in disability determinations, 46 disability correlated with, 94 of health care professionals to treat pain, 10-11, 266, 280-283 See also Patient education Electromyography for diagnosis of back pain, 192 Eligibility for benefits criteria for determining, 14, 23, 26, 29~0, 32~4, 69; see also Disability determinations Medicaid and Medicare, 50 periodic review to confirm, 50 SSDI/SSI, 37~8, 248 Veterans Administration, 58 Workers' Compensation, 61-62 Employment effects on outcomes of treatment, 245-248; see also Return to work; Unemployment; Work disability opportunities for disabled persons, 28-30, 81, 93 substantial gainful activity, 45, 253 End Stage Renal Disease Program, payments for, 90 Endogenous opioid system, 135, 176, 177 Epidemiology of chronic pain, 101-119, 266, 277278 of psychiatric disorders, 166-167 Epidural steroid injections for low back pain, 241 Experience of pain description of, 133, 146 individual variables in, 12, 15, 27, 133

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From page 298...

... 298 SEX threshold, 132,133, 159 tolerance, 3, 69, 133-134, 141 F Factitious disorder, 171 Families of pain patients depression and alcoholism in, 157, 168, 172 influences on illness behavior, 156158, 178-179, 238-240 involvement in treatment, 202, 233, 238-240 Federal courts, handling of chronic disabling pain by, 76-78 Federal Republic of Germany, disability definition, 33 Fibromyalgia/fibrositis, 197,199-200, 236, 241 Folk healers, 153 Functional impairment assessment of, 2, 4,5,8-9,220,254, 265, 268-270, 27~273 definition, 17 description, 27 imposed by pain, 54 G Glut~mic acid, role in pain processes, 131 H Handicap definition, 34 See also Disability Headaches illness behavior associated with, 134, 218 work days lost because of, 110 Health Belief Model, pain measurement with, 225 Health care services, alternative therapies, 153, 206 Heart attack, referred pain during, 129 HHS Co - mission on the Evaluation of Pain, definitions of acute pain, chronic pain, and impairment, 1718 recommended rehabilitation demonstration project, 274 Histamine, release in pain processes, 126 Holistic health care, 153, 206 Hopkins Symptom Checklist-90 (SCL90) , assessment of chronic pain with, 180, 252 Hyperactivity of sympathetic nervous system, 13~138 Hypnosis, 240 Hypnotic drugs, depressive symptoms from, 173 Hypochondriasis, 3, 170, 171,250 Hysteria, see Somatization disorder I Iatrogenesis, 156,202-205,223,282 mness/pain behavior in absence of diagnosable disease, 152-153 abnormal, 148, 170 avoidance of intimacy, 158 in back pain patients, 218 compensatory mechanisms, 152 conditioning, 157 coping responses, 151-154,156,225226,239,243,251 cultural/ethnic influences on, 3, 158160 definition, 13 expression/communication of pain, 133,146,151,155-156,159-160, 224-227 factors shaping, 147 family influences on, 15~158,178179,238-240 help seeking, 151-154 individual variation in, 147 judgments of, by health care providers, 217 malingering, 15~153 measurement of pain through, 217220 modeling, 157 observational data on, 217-219 operant learning, 157, 250 overuse syndromes, 152 pain tolerance factor in, 3, 133-134, 141 personality and, 15~156 processes of, 148-154 psychosocial factors in, 3,112,147, 155, 160 Seclusiveness, 152 reduced physical activity, 152 self-reports of, 219-220 somatization, 155-156,158,168,178

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From page 299...

... Flemming, consideration of job opportunities in disability determinations, 29 L fedora, analgesic erects of, 177 Labor force participation by disabled persons, 80 employment opportunities as a determinnnt of, 81 Legal decisions on disability determinations, inconsistencies in, 67, 77-78 on pain cases, inconsistency in, 31 See also Appeals; Case law on disability determinations Leukotrienes, release in pain processes, 126 Levine-Pilowsky Depression Questionnaire, 252 Listing of Impairments, SSA, 5, 8, 39, 45, 54, 69, 265, 267-268 Lithium, analgesic effects of, 177 M Malingering, 15~153, 171 Marcus v. Califano, pain as legitimate disability, 56 McGill Pain Questionnaire (MPQ3, 215-216, 251 Measurement of disability instruments for, 220-222 pain relation to functional status, 2, 4, 5, 8-9, 45-46, 69-70, 220, 223224, 254, 256, 265, 268-270, 272273 rehabilitation-focused tests, 222 sickness impact, 221-222 surveys, 93-94, 103 work performance assessment, 222223

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From page 300...

... Secretary, standard for evaluating pain, 56 Modeling/models acute pain, 124, 212 animal, applied to human pain studies, 124, 131, 137 biopsychosocial, for chronic pain, 27 chronic pain, 124, 212 expanded, of low back pain, 194-195 illness/pain behavior, 157 medical contrasted with nonmedical, 212-213 medical, of disability, 26 traditional medical, of low back pain, 190-194, 196 of unemployment-disability relationship, 91 Multidimensional Health Locus of Control Scale, pain measurement with, 224-225 Muscle atrophy from sustained pain, 137 Muscle contraction pain-associated, 138 stimulation of primal afferent nociceptors, 126 Muscle relaxants for back pain, 203 Myelography for diagnosis of back pain, 192, 204 Myelotomy, 205 Myofascial pain syndrome characteristics of, 286 diagnosis, 288-290 historical background, 286-287 natural history, 287-288 overlap between fibrositis and, 200 perpetuating factors, 138, 290 prevalence of, 240-241, 285-286 psychogenic pain disorder and, 170 treatment, 200, 241, 290-291 Myofascial trigger points in arthritis patients, 286 in back pain, 192, 197, 198-199 characteristics of, 288-290 development of, 198-199 referred pain from, 130, 192, 198199, 286-289 N Naltrexone, treatment of pain patients with, 178 National Institute of Mental Health Epidemiological Catchment Area project, 166 Nerve blocks to treat chronic pain, 234, 241, 250 conduction tests for diagnosis of back pain, 192 damage from back pain, 140 Netherlands, disability definition, 33

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From page 301...

... experimentally induced, 126, 134 cognitive and affective aspects of, 134, 201 common types, 109-110; see also Back pain consideration in disability determinations, 51~7, 61-63 of deep somatic and visceral structures, pathways of, 132 definitions, 18, 102, 104-109 description of, 133, 146 diagnosis, see Diagnosis of pain disproportionate to injuries, 136 economics of, 98 effects on central nervous system, 140 enhancement through physiological processes, 136-141. evaluation of, 53~5, 127-129; see also Diagnosis of pain evidence of, 53, 54 experience of, see Experience of pain expression and communication of, 133, 146, 151, 155-156, 159-160, 22~227 functional status and, 2, 4, 5, 8-9, 220, 254, 265, 268-270, 272-273 impaired sensation of, 131, 132 incidence, 110-111 indicators of, 151-152; see also mnesslpain behavior; Measurement of pain information gathering on, 5243; see also Surveys of pain/disability intensity, 127-128 joint, 110, 136, 218 key court cases, 55~7 from lesions of central nervous system, 139 management, see Pain management programs/pain clinics meaning attributed to, 149-151, 224225 measurement of, see Measurement of pain memory of, 226 muscle contraction associated with, 138 neurological mechanisms and structures, 13, 125, 171-172; see also Pain processes neuropathic, 139-140

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From page 302...

... 141 treatment, see Pain management programslpain clinics; Rehabilitation; Treatment of pain trigger points, see Myofascial trigger points VA consideration in disability assessments, 59,61 work disability due to, 103, 109-113, 222-223,246 Workers' Compensation consideration in disability determinations, 61-63 See also Acute pain; Back pain; Chronic pain Pain management programs/pain .

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From page 303...

... , pain measurement by, 141-142 Potassium release in pain processes, 126 Primary adherent nociceptors activation of, 4, 124-126, 137-139 axons of, 126-127, 131-132 chemical releases by, 131 damage to, 139-140 mechanisms of, 123, 131 monitoring pain intensity through, 127-128, 141 muscle contraction from, 126, 138 peripheral branching of, 130 regeneration of, 139 sensitization through repeated stimulation of, 136 Private disability insurance, 60-64, 89-90 Prostagland~ns, release in pain processes, 126 Psychiatric disorders in chronic pain patients, 166-167, 169; see also Depression (clinical) ; Depressive disorders Psychogenic pain disorder, 170, 171 Psychological factors in maintenance of pain, 140-141 Psychopharmacology for depressive disorders in pain patients, 175-177 Psychosocial factors affecting chronic pain, 116-117, 141, 196, 200-201 in illness behavior, 3, 112, 147, 155, 160 Psychotherapy for pain patients, 169, 174-175, 180, 240 Psychotropic drugs, analgesic effects of, 175-177 Purpose in Life Scale, pain measurement with, 224 R Race back pain correlated with, 113-114 relationship between disability and, 94 Recommendations, see Research recommendations Recovery, motivation for, 25, 78-81 Referred pain, 130, 192, 198-199, 286289 Reflex sympathetic dystrophy, 137-138 Rehabilitation of chronic pain patients, 16, 79, 97; see also Pain management programs/pain clinics costs, 235 disability benefits and, 70-71, 78-81, 255-256, 274 early, 10, 273-276 eligibility for (SSA)

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From page 304...

... amount of monthly payments, 50, 51, 95 appeals process, 5-6, 46-50, 60 application and evaluation process, 5, 42~46, 52~55, 60; see also Disability determinations benefits paid by, 37~8, 40-41, 50, 60, 89, 91-93, 95; see also Disability benefits conflicts and contradictions, 6-7, 6682, 263-264 contributions during disability, 23 definition of disability, 4 5, 14-15, 22, 32~3, 38-42, 61, 69-70, 256, 264, 273-274 disposition of claimants, 48-49 efficacy, 96-97 eligibility, 37-38, 248 funding reallocation to prevention, 97-98 growth in, 95-96 incentives for rehabilitation and return to work, 50~1 income support vs. rehabilitation, 7071 lengths and types of benefits, 60 problem of pain for, 21~5, 37-64, 6~82 purpose, 99 rehabilitation requirements and provisions, 61, 70 rules affecting return to work, 80-81 sequential evaluation process, 5-6, 43~7, 53-55, 69, 268-269 stay and offices involved with reviews, 67 state-level (DDS)

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From page 305...

... , 234,237 Treatment of pain in alcoholics and drug abusers, 177178 bed rest and restricted activity, 202203,223 chronic low back, 111-112,193-195, 202-205,241 cognitive-behavioral approach, 175, 201-202,238-239,243-244,250 collaborative approach, 202 compensation status as a factor in, 248-252 difficulties in, 13-14 through distraction and meaningful activity, 149 electrical stimulation of homologous brain regions, 134-135 employment as a factor in, 246-248 expanded model for, 194-195 frontal lobotomies, 134 multimodal approaches, 244-245, 254,255 negative erects of, 156,202-205,223, 282 operant conditioning, 178,238,243, 251 outcomes, see Outcomes of treatments physical modalities, 223-224,237238 psychopharmacological, 175-177 psychotherapeutic, 17~175, 240 recommended improvements in, 201205,265 relaxation therapy, 238,240,243 stress management, 240 surgery, 20~205 transcutaneous electrical stimulation (TENS) , 234, 237 vibration, 237 work simulation techniques, 223 See also Drug therapy Trial work period disability payments during, 10, 51, 257 disincentives to use, 80-81, 274 purpose, 252-253 U Unemployment, disability and, 27,8081, 91 V Vertebral disorders claims associated with, 110 classified as disabling by SSA, 42 physiotherapy for, 112 work absence from, 112 Veterans Administration cash disability transfers, 89-90 disability compensation programs, 58-61 Visual Analog Scale (VAS)

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From page 306...

... 306 INDEX West Haven-Yale Multidimensional Pain Inventory, 215-216 Work absenteeism, major causes of, 12 continuation by disabled persons, 70, 95 environment, factors related to back pain, 116 experience, considerations in disability determinations, 46 performance, assessment of disability through, 222~223 See also Return to work; Trial work period Work disability from arthritis, 115, 205 from back pain, 109-113, 222-223, 246 consideration in disability determinations, 69-70 frequency, from pain, 103 from joint pain, 110 relation of impairment to, 27 social predictors of, 80 Workers' Compensation cash disability transfers, 89-90 disability categories, 62 disability compensation programs, 59-63, 89 expenditures for rehabilitation, 97 World Health Organwation, definitions of disability, functional limitation, impairment, 17 X X rays for diagnosis of pain, 192, 201

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Index Pages 293-306

Index
Pages 293-306