Pain and disability : clinical, behavioral, and public policy perspectives / Institute of Medicine, Committee on Pain, Disability, and Chronic Illness Behavior ; Marian Osterweis, Arthur Kleinman, and David Mechanic, editors.

Format:

Book

Contributor:

Institute of Medicine (U.S.). Committee on Pain, Disability, and Chronic Illness Behavior.

Osterweis, Marian.

Kleinman, Arthur.

Mechanic, David, 1936-

Language:

English

Subjects (All):

Chronic pain--Social aspects.

Chronic pain.

Chronic pain--Government policy.

Chronic pain--Economic aspects.

Disability evaluation.

Physical Description:

1 online resource (ix, 306 pages)

Edition:

1st ed.

Place of Publication:

Washington, D.C. : National Academy Press, 1987.

Language Note:

English

Summary:

Evaluating claims based on pain poses problems for the Social Security Administration (SSA) and other disability insurers. This volume covers the epidemiology and physiology of pain; psychosocial contributions to pain and illness behavior; promising ways of assessing and measuring chronic pain and dysfunction; and clinical aspects of prevention.

Contents:

Pain and Disability

Copyright

PREFACE AND ACKNOWLEDGMENTS

Contents

SUMMARY

CHRONIC PAIN

SOCIAL SECURITY ADMINISTRATION DISABILITY PROGRAMS

Problems in the System

CRITICAL GAPS IN KNOWLEDGE

RECOMMENDATIONS

1 Introduction

Overview of the Report

A Note about Definitions

References

PART I THE PROBLEM OF PAIN FOR THE SOCIAL SECURITY ADMINISTRATION

2 The Sociopolitical Background of the Pain Issue

THE LEGISLATIVE BACKGROUND OF THE PAIN PROBLEM IN DISABILITY INSURANCE

Early History of Social Security Disability

Physicians' Concerns About Medically Determined Disability

The Concept of Impairment

Disability and the Labor Market

The 1984 Amendments

DISABILITY, PAIN, AND DISTRIBUTIVE JUSTICE

3 Disability Determination and the Role Of Pain

OVERVIEW OF THE SOCIAL SECURITY DISABILITY SYSTEM

The Programs

Program Definitions

The Application and Evaluation Process

The Appeals Process

Program Benefits

Incentives for Rehabilitation and Return to Work

PAIN'S ROLE IN THE DETERMINATION OF DISABILITY

Pain in Social Security Law and Regulation

Pain and the Application Process

Pain and the Sequential Evaluation Process

Pain and the Courts

COMPARISON WITH OTHER DISABILITY COMPENSATION PROGRAMS

Veterans Administration

The Role of Pain

Workers' Compensation

Private Disability Insurance

Disability Compensation Programs in Western Europe

4 Conflicts And Contradictions In The Disability Program

CONGRESS AND THE SOCIAL SECURITY ADMINISTRATION

TENSIONS WITHIN THE PROGRAM

Medical Definitions Versus Functional Concept

Income Support Versus Rehabilitation

Physicians, Claimants, and Administrators

Administrative Law Judges Versus Program Administrators.

THE FEDERAL COURTS AND CHRONIC DISABLING PAIN

COMPENSATION AND INCENTIVES

Importance of Job Satisfaction

Program Rules as an Explanation of Labor Supply

Employment Opportunity as a Determinant of Labor Supply

CONCLUSIONS

PART II THE EXTENT AND COST OF THE PROBLEM

5 Economic Issues and the Cost of Disability

DISABILITY EXPENDITURES

Cash Transfers

Medical Care

Direct Services

TRENDS IN EXPENDITURES

Disabled Persons

A Note About Measurement

Number and Characteristics of the Disabled

Benefit Levels and Beneficiaries

Program Influences

Program Efficiency

PREVENTING DISABILITY BY REALLOCATING FUNDS

THE ECONOMICS OF PAIN: GAPS IN THE LITERATURE

6 The Epidemiology of Chronic Pain and Work Disability

METHODOLOGICAL ISSUES

Definitions and Measures of Chronic Pain

Study Samples

Methods of Data Collection

PAIN AND ITS CONSEQUENCES

What Kinds of Chronic Pain Do People Have?

Incidence and Prevalence of Relevant Outcomes

Back Pain and Medical Care

Descriptive Epidemiology of Chronic Pain and Disability

Trends in Time

Demographic Factors, Pain, and Work Disability

Physical Factors

Socioeconomic Status

Psychosocial Factors

Research Agenda

Epidemiological Studies

Methodological Research

PART III INFLUENCES ON PAIN AND PAIN BEHAVIOR

7 The Anatomy and Physiology of Pain

PAIN PROCESSES

Transduction

Transmission

Peripheral Nervous System

Pain Pathways In the Central Nervous System

Sensory Versus Affective Aspects of Pain

Modulation

PHYSIOLOGICAL PROCESSES THAT ENHANCE PAIN AND MAY LEAD TO CHRONICITY

Sensitization

Hyperactivity of the Sympathetic Nervous System: Reflex Sympathetic Dystrophy

Muscle Contraction.

Self-Sustaining Painful Processes: Livingston's ''Vicious Circle''

Neuropathic Pain

Acute Versus Chronic Pain

POTENTIAL METHODS OF PHYSIOLOGICAL MONITORING

8 Illness Behavior and the Experience of Pain

ILLNESS BEHAVIOR: AN INTEGRATING CONCEPT

THE PROCESS OF ILLNESS BEHAVIOR

Symptom Perception

Meaning Attribution

Expression and Communication

Help-Seeking Behavior and Other Coping Responses

THE INFLUENCE OF PERSONALITY, FAMILIAL, AND SOCIOCULTURAL FACTORS ON ILLNESS BEHAVIOR

Personality and Illness Behavior

Family Influences

Cultural Influences

9 Psychiatric Aspects of Chronic Pain

EPIDEMIOLOGY OF CERTAIN PSYCHIATRIC DISORDERS

CHRONIC PAIN, DEPRESSION, AND ANXIETY

Chronic Pain, Depression, and Somatoform Disorders

A Neurobiological View of Chronic Pain and Depression

Depression as a Consequence of Chronic Pain

Depressive Symptoms as a Consequence of Drug Therapy

TREATMENT OF DEPRESSIVE DISORDERS IN THE CHRONIC PAIN PATIENT

Psychotherapeutic Treatment

Psychopharmacological Treatment of Pain

ADDICTION AND ALCOHOLISM

PERSONALITY FACTORS AND CHRONIC PAIN

RESEARCH ON PSYCHIATRIC ASPECTS OF CHRONIC PAIN

PART IV ASSESSING AND TREATING PAIN AND DYSFUNCTION

10 Chronic Pain in Medical Practice

CLINICAL DECISION MAKING

The Diagnostic Process

Treatment of the Pain and the Disorder: The Medical Model

DIAGNOSING AND MANAGING THE PATIENT WITH PAIN: AN EXPANDED MODEL

WHY IS THE DIAGNOSIS OF CHRONIC PAIN SO ELUSIVE?

Unknown Disease Processes

Overlooked Diagnoses

Controversial Diagnoses

Myofascial Trigger Point Syndromes

Fibrositis or Fibromyalgia

Articular Dysfunction

IMPROVING DIAGNOSIS, TREATMENT, AND PREVENTION

Diagnosis

Treatment Of Chronic Pain

Bed Rest And Restricted Activity.

Drug Therapy

Surgical Treatment

RECOMMENDATIONS FOR CLINICAL RESEARCH

11 Measuring Pain And Dysfunction

BASIC CONCEPTS OF MEASUREMENT

MEASUREMENT TOOLS

Measurement Of Subjective Pain States

Self-Report: Data From Introspection

Self-Report Methods Using A Single Dimension

Self-Report Of Pain In Several Dimensions

Pain As Behavior: Observational Data

Pain Judgments By Health Care Providers

Measurement Of Pain Behavior

Mixed Methods: Self-Reports Of Pain Behaviors

RELATED MEASURES OF DISABILITY

Pain And Functional Status

Disability Assessment

Sickness Impact

Assessment of Work Performance

Severity of Pain and Dysfunction

FACTORS BIASING PAIN MEASUREMENT

Personal Meaning

Coping

Memory for Pain

Attributional Factors

Medication Toxicity

IMPLICATIONS FOR SSA DISABILITY ASSESSMENT

MEASUREMENT PANELISTS

12 Rehabilitation Approaches And Issues In Chronic Pain

THE REHABILITATION APPROACH

PAIN MANAGEMENT PROGRAMS: AN OVERVIEW

The Need for Standards

REHABILITATION TECHNIQUES FOR PATIENTS WITH CHRONIC PAIN

Physical Modalities

Behavior Modification

Patient Education

Psychosocial Rehabilitation

Stress Management

Medical Interventions for Pain Control

Attention to Myofascial Trigger Points

Use of Drugs

Nerve Blocks and Epidural Steroid Injections

Vocational Rehabilitation

OUTCOMES OF PAIN MANAGEMENT PROGRAMS

EMPLOYMENT AND COMPENSATION AS INCENTIVES OR DISINCENTIVES IN OUTCOMES OF PAIN MANAGEMENT PROGRAMS

Employment as A Factor in Treatment Outcome

Compensation Status as A Factor in Treatment Outcome

Studies Suggesting a Negative Effect of Compensation on Outcome

Studies Suggesting Little or No Negative Effect of Compensation

REHABILITATION ISSUES IMPORTANT TO THE SSA.

The Ssa and Vocational Rehabilitation

Measurement and Evaluation of Pain

The Question of Mandatory Rehabilitation

Research and Demonstration Projects

PART V CONCLUSIONS AND RECOMMENDATIONS

13 Conclusions and Recommendations

RECOMMENDATION 1 DATA COLLECTION AT THE SSA

RECOMMENDATION 2 NO NEW LISTINGS FOR PAIN OR ILLNESS BEHAVIOR

RECOMMENDATION 3 SIGNIFICANT PAIN' SHOULD TRIGGER AN ASSESSMENT

RECOMMENDATION 4 DEMONSTRATION PROJECTS

Demonstration: The Feasibility and Consequences of Early Assessment

Simple Assessment Tool

Early Face-to-Face Hearing

Integrated Functional Assessment

Demonstration Project: Does Early Rehabilitation Work?

Incentives and Disincentives for Rehabilitation

The HHS Pain Commission's Proposal

Demonstration Project for Early Rehabilitation

Evaluation of the Demonstrations

A Note About Research with Human Subjects

RECOMMENDATION 5 RESEARCH AGENDA

Epidemiological Initiatives

Clinical Research

Health Services Research

Improved Methodology and Multidisciplinary Research

RECOMMENDATION 6 EDUCATION TO IMPROVE THE CLINICAL CARE AND TREATMENT OF CHRONIC PAIN PATIENTS

APPENDIX

MYOFASCIAL PAIN SYNDROMES DUE TO TRIGGER POINTS

MYOFASCIAL PAIN SYNDROMES: HOW COMMON ARE THEY?

Why Are Myofascial Pain Syndromes So Common?

HISTORICAL BACKGROUND

NATURAL HISTORY

DIAGNOSIS

PERPETUATING FACTORS

TREATMENT

REFERENCES

INDEX.

Notes:

Bibliographic Level Mode of Issuance: Monograph

Includes bibliographies and index.

ISBN:

9786610221493

9781280221491

1280221496

9780309542678

0309542677

9780585149103

0585149100

OCLC:

427404677