Guidance on Impairment Ratings for Pain

Assessing Permanent Impairment for pain, injuries on or after July 1, 2014:

Using AMA Guides™ to the Evaluation of Permanent Impairment Sixth Edition:

1. Do not use Chapter 3 or PDQ, in most circumstances (exception: post-concussion headache). 
2. In nerve injuries, use sensory deficit as opposed to pain assessment(not “or pain”).
   • To be accurate, the QuickDASH (DISABILITIES OF THE ARM, SHOULDER AND HAND) questionnaire for Carpal Tunnel Syndrome, 10 of 11 questions must be answered.  Be careful that the patient does not interpreting questions #7 and #8 as limitations due to pain, ask about functions such as bathing, typing, groceries, and other daily activities or use more objective assessments such as stiffness and numbness (decreased sensation),Interpret question # 9 by using an assessment of sensory deficit or clinically evident disuse atrophy of the muscles or relevant changes to the skin color or warmth.Interpret question # 11 by asking for example: “How many nights/week did you have to change positions to go back to sleep?
3. For the DASH (DISABILITIES OF THE ARM, SHOULDER AND HAND) questionnaire for the upper extremity, 28 of 30 questions must be answered to be accurate. Be careful that the patient does not interpret questions #22 and #23 as limitations due to pain. 
   • Interpret questions # 24 and 25 by assessing clinically evident disuse changes.Interpret question # 29 by asking the same type of questions as listed under the QuickDASH # 11.
4. In most chapters: there are three grade modifiers:
   1. Functional History Grade Modifier (FHGM)
   2. Physical Examination Grade Modifier (PEGM)
   3. Clinical Studies Grade Modifier (CSGM)

In the Upper Extremity and Spine Chapters (15 and 17), if the diagnosis is non-specific chronic pain, such as wrist pain or neck pain, by definition there are no Physical Examination or Clinical Studies Modifiers that apply.  Do not change the Functional History Modifier.  Use only the default value (Class 0-1).

In the Lower Extremity Chapter (16) and most others, there is no change in your method of assessment of Physical Examination and Clinical Studies Modifiers.   Do not consider complaints of “pain” in using the Functional History Modifier.  Use physical findings such as limited motion, atrophy, or weakness in assessing their effect on functional abilities and limitations. For example (Table 16-6): because of the atrophy (measured in the thigh) and weakness, ask how many steps can be climbed, not because of pain but because of the weakness.  Then assess the Functional History Grade Modifier as a problem: mild, moderate, severe, or very severe.