Pain--it is the most common complaint presented to physicians. Yet pain is subjective--it cannot be measured directly and is difficult to validate. Evaluating claims based on pain poses major 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; clinical aspects of prevention, diagnosis, treatment, and rehabilitation; and how the SSA's benefit structure and administrative procedures may affect pain complaints.

Contents

• INSTITUTE OF MEDICINE
• PREFACE AND ACKNOWLEDGMENTS
• SUMMARY
• 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
    • Disability, Pain, And Distributive Justice
    • References
  • 3. Disability Determination and the Role Of Pain
    • Overview of the Social Security Disability System
    • Pain's Role in the Determination of Disability
    • Comparison with Other Disability Compensation Programs
    • References
  • 4. Conflicts And Contradictions In The Disability Program
    • Congress and the Social Security Administration
    • Tensions Within the Program
    • The Federal Courts and Chronic Disabling Pain
    • Compensation and Incentives
    • Conclusions
    • References
• PART II. THE EXTENT AND COST OF THE PROBLEM
  • 5. Economic Issues and the Cost of Disability
    • Disability Expenditures
    • Trends in Expenditures
    • Preventing Disability by Reallocating Funds
    • The Economics of Pain: Gaps in the Literature
    • Conclusions
    • References
  • 6. The Epidemiology of Chronic Pain and Work Disability
    • Methodological Issues
    • Pain and Its Consequences
    • References
• PART III. INFLUENCES ON PAIN AND PAIN BEHAVIOR
  • 7. The Anatomy and Physiology of Pain
    • Pain Processes
    • Physiological Processes That Enhance Pain and May Lead to Chronicity
    • Potential Methods of Physiological Monitoring
    • References
  • 8. Illness Behavior and the Experience of Pain
    • Illness Behavior: an Integrating Concept
    • The Process of Illness Behavior
    • The Influence of Personality, Familial, and Sociocultural Factors on Illness Behavior
    • Conclusions
    • References
  • 9. Psychiatric Aspects of Chronic Pain
    • Epidemiology of Certain Psychiatric Disorders
    • Chronic Pain, Depression, and Anxiety
    • Treatment of Depressive Disorders in the Chronic Pain Patient
    • Addiction and Alcoholism
    • Personality Factors and Chronic Pain
    • Research on Psychiatric Aspects of Chronic Pain
    • References
• PART IV. ASSESSING AND TREATING PAIN AND DYSFUNCTION
  • 10. Chronic Pain in Medical Practice
    • Clinical Decision Making
    • Diagnosing and Managing the Patient with Pain: An Expanded Model
    • Why is the Diagnosis of Chronic Pain So Elusive?
    • Improving Diagnosis, Treatment, and Prevention
    • Recommendations For Clinical Research
    • References
  • 11. Measuring Pain And Dysfunction
    • Basic Concepts Of Measurement
    • Measurement Tools
    • Related Measures Of Disability
    • Factors Biasing Pain Measurement
    • Summary
    • Implications for Ssa Disability Assessment
    • Measurement Panelists
    • References
  • 12. Rehabilitation Approaches And Issues In Chronic Pain
    • The Rehabilitation Approach
    • Pain Management Programs: an Overview
    • Rehabilitation Techniques for Patients with Chronic Pain
    • Outcomes of Pain Management Programs
    • Employment and Compensation as Incentives or Disincentives in Outcomes of Pain Management Programs
    • Rehabilitation Issues Important to the Ssa
    • References
• 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
    • Recommendation 5 Research Agenda
    • Recommendation 6 Education to Improve the Clinical Care and Treatment of Chronic Pain Patients
• APPENDIX MYOFASCIAL PAIN SYNDROMES DUE TO TRIGGER POINTS

This volume is the final report of a study conducted under Contract No. 600-85-0263 with the Social Security Administration, Department of Health and Human Services.

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.

This report has been reviewed by a group other than the authors according to procedures approved by a Report Review Committee consisting of members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.

The Institute of Medicine was chartered in 1970 by the National Academy of Sciences to enlist distinguished members of appropriate professions in the examination of policy matters pertaining to the health of the public. In this, the Institute acts under both the Academy's 1863 congressional charter responsibility to be an adviser to the federal government and its own initiative in identifying issues of medical care, research, and education.