RT Book, Section
A1 Audette, Joseph
A1 Schaufele, Michael
A2 Warfield, Carol A.
A2 Bajwa, Zahid H.
SR Print(0)
ID 3423042
T1 Chapter 84. Disability Assessment of Pain-Impaired Patients
T2 Principles & Practice of Pain Medicine, 2e
YR 2004
FD 2004
PB The McGraw-Hill Companies
PP New York, NY
SN 9780071443494
LK accessanesthesiology.mhmedical.com/content.aspx?aid=3423042
RD 2024/04/23
AB Approximately  one  third  of  all  Americans  have  a  chronically  painful  condition;  50%  to  60%  of  these  individuals  are  partially  or  totally  disabled.  Cost  estimates  in  the  United  States  run  as  high  as  $79  billion  a  year  in  direct  and  indirect  expenses,  with  40  million  physician  visits  annually  due  to  chronically  painful  conditions.1  Much  of  these  costs  are  related  to  the  disability  process  including  workers’  compensation,  litigation,  personal  indemnity,  lost  productivity,  and  Social  Security  Administration  (SSA)  payments.  There  has  been  a  73%  increase  in  workers’  compensation  costs  as  a  percentage  of  payroll  in  the  period  from  1980  to  1994,  and  in  the  same  period,  the  medical  costs  in  compensation  cases  rose  1.5  times  faster  than  did  general  health  care  costs  in  the  United  States.2  Although  from  1988  to  1996  the  length  of  disability  on  workers’  compensation  decreased  by  60.9%  and  the  average  cost  per  claim  decreased  by  41.4%,  this  likely  reflects  state  policy  changes  with  more  aggressive  case  management.3  Given  that  during  this  same  period  applications  for  SSI  and  SSDI  rose  by  greater  than  40%  in  1992,  one  can  assume  that  there  may  have  been  a  shift  from  workers’  compensation  to  federal  compensation.  Interestingly,  pain  was  a  factor  in  40%  to  60%  of  these  SSA  claims.4  The  reasons  for  this  dramatic  increase  are  multifactorial:  increased  social  and  vocational  demands,  and  change  in  work  ethics  may  have  contributed.  Health  care  professionals  themselves  may  be  a  significant  cause  of  this  change.  In  one  study,  using  the  Health  Care  Providers’  Pain  and  Impairment  Relationship  Scale  (HC-PAIRS),  community  health  care  providers  had  much  lower  expectations  regarding  the  functional  performance  of  patients  with  chronic  low  back  pain  than  health  care  professionals  who  treated  these  patients  with  a  functional  restoration  approach.5  Perhaps  we  demand  too  little  from  our  chronic  pain  patients,  therefore  contributing  to  increased  disability.