Without medical evidence, clinicians' judgment about chronic pain is often influenced by patient and situational factors

Supplemental Session: The Problem of Chronic Pain

Children's Health and Illness Recovery Program (CHIRP) ◽

10.1093/med-psych/9780190070472.003.0012 ◽

2020 ◽

pp. 109-112

Author(s):

Bryan D. Carter ◽

William G. Kronenberger ◽

Eric L. Scott

Keyword(s):

Chronic Pain ◽

Management Strategies ◽

The Body ◽

Situational Factors ◽

Protective Mechanism ◽

Complex Interactions ◽

Health And Illness ◽

Recovery Program ◽

The Brain

Chapter 11 provides supplemental material for teens whose chronic illness challenges involve major problems with chronic pain. While pain is a necessary protective mechanism of the body, chronic pain involves complex interactions between the nervous system, the brain, our emotions, and various situational factors that can actually make our experience of pain worse. The activities in this session are intended to help teens better understand these interactions and apply pain management strategies. Many of the coping strategies in the Children’s Health and Illness Recovery Program (CHIRP) have been shown to be effective in helping teens manage chronic pain more effectively so that they are able to more actively participate in the multiple areas so important to development.

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Amitriptyline treatment of chronic pain in patients with temporomandibular disorders

Journal of Oral Rehabilitation ◽

10.1046/j.1365-2842.2000.00572.x ◽

2000 ◽

Vol 27 (10) ◽

pp. 834-841 ◽

Cited By ~ 47

Author(s):

O. Plesh ◽

D. Curtis ◽

J. Levine ◽

W. D. Mccall Jr

Keyword(s):

Chronic Pain ◽

Temporomandibular Disorders

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Issues in California Workers' Compensation: Substantial Medical Evidence, Causation, and Apportionment

Guides Newsletter ◽

10.1001/amaguidesnewsletters.2020.sepoct02 ◽

2020 ◽

Vol 25 (5) ◽

pp. 12-15

Author(s):

Steven D. Feinberg

Keyword(s):

Compensation System ◽

Workers Compensation ◽

Medical Evidence

Abstract This article describes special aspects of addressing and defining substantial medical evidence, causation, and apportionment in the California Workers' Compensation system. Substantial medical evidence is framed in terms of reasonable medical probability, and the opinion must be based on fact and not be speculative. The issue of whether the injury occurred in the course of employment is left to the Trier of Fact (WCAB judge). The issue of arising out of employment is a medical issue left to the physician. Apportionment applies to both the industrial and nonindustrial cause of the disability.

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Spine Impairment Evaluation: Sixth Edition Approaches

Guides Newsletter ◽

10.1001/amaguidesnewsletters.2009.janfeb01 ◽

2009 ◽

Vol 14 (1) ◽

pp. 1-5

Author(s):

Craig Uejo ◽

Marjorie Eskay-Auerbach ◽

Christopher R. Brigham

Keyword(s):

Functional Status ◽

Spinal Injury ◽

Current Medical ◽

Clinical Testing ◽

Medical Evidence ◽

Sixth Edition ◽

Whole Person ◽

Rating Process ◽

Impairment Ratings ◽

Class Assignment

Abstract Evaluators who use the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, should understand the significant changes that have occurred (as well as the Clarifications and Corrections) in impairment ratings for disorders of the cervical spine, thoracic spine, lumbar spine, and pelvis. The new methodology is an expansion of the Diagnosis-related estimates (DRE) method used in the fifth edition, but the criteria for defining impairment are revised, and the impairment value within a class is refined by information related to functional status, physical examination findings, and the results of clinical testing. Because current medical evidence does not support range-of-motion (ROM) measurements of the spine as a reliable indicator of specific pathology or permanent functional status, ROM is no longer used as a basis for defining impairment. The DRE method should standardize and simplify the rating process, improve validity, and provide a more uniform methodology. Table 1 shows examples of spinal injury impairment rating (according to region of the spine and category, with comments about the diagnosis and the resulting class assignment); Table 2 shows examples of spine impairment by region of the spine, class, diagnosis, and associated whole person impairment ratings form the sixth and fifth editions of the AMA Guides.

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Clinical Update: Understanding Causation: An Example Using Carpal Tunnel Syndrome

Guides Newsletter ◽

10.1001/amaguidesnewsletters.2007.novdec02 ◽

2007 ◽

Vol 12 (6) ◽

pp. 5-8 ◽

Cited By ~ 3

Author(s):

J. Mark Melhorn

Keyword(s):

Risk Factors ◽

Carpal Tunnel Syndrome ◽

Carpal Tunnel ◽

Legal Responsibility ◽

Medical Evidence ◽

Anatomic Structure ◽

Legal Professionals ◽

Compensation Systems ◽

Tunnel Syndrome ◽

Four Levels

Abstract Medical evidence is drawn from observation, is multifactorial, and relies on the laws of probability rather than a single cause, but, in law, finding causation between a wrongful act and harm is essential to the attribution of legal responsibility. These different perspectives often result in dissatisfaction for litigants, uncertainty for judges, and friction between health care and legal professionals. Carpal tunnel syndrome (CTS) provides an example: Popular notions suggest that CTS results from occupational arm or hand use, but medical factors range from congenital or acquired anatomic structure, age, sex, and body mass index, and perhaps also involving hormonal disorders, diabetes, pregnancy, and others. The law separately considers two separate components of causation: cause in fact (a cause-and-effect relationship exists) and proximate or legal cause (two events are so closely related that liability can be attached to the first event). Workers’ compensation systems are a genuine, no-fault form of insurance, and evaluators should be aware of the relevant thresholds and legal definitions for the jurisdiction in which they provide an opinion. The AMA Guides to the Evaluation of Permanent Impairment contains a large number of specific references and outlines the methodology to evaluate CTS, including both occupational and nonoccupational risk factors and assigning one of four levels of evidence that supports the conclusion.

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