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OCR for page 293
Inclex
A
Acetylcholine, role in pain modulation,
172
Acupuncture, 154
Acute pain
contrasted with chronic pain, 140-
141
definition, 18
models for, 124, 212
Administrative law judges (ALJs)
appeals of claim denials before, 5, 47,
67
conflicts between disability program
administrators and, 74-76, 263
number of, 67
reversal rate by, 75
Age
back pain correlated with, 113
characteristic of disabled persons, 94
considerations in disability determi-
nations, 46
relation between self-reported pain
and, 112
Aid to Families with Dependent Chil-
dren, cash disability transfers, 89
Alcoholism
among chronic pain patients, 177-
179
disability determinations and, 68
in families of pain patients, 157, 168
Alexithymia, 169
293
Algology/dolorolog~y, 233
Alternative care therapies
need for research on, 206
use by chronic pain patients, 153
American Medical Association Commit-
tee on the Medical Rating of Physi-
cal Impairment, 26
yaminobutyric acid, role in pain modu-
lation, 172
Analgesia
acupuncture, 154
stimulation-produced (SPA), 134-135,
172
Analgesics
for back pain, 203
opioid, 135,172,173, 203
Antidepressants, analgesic erects of,
175-176, 203
Antipsychotic drugs, analgesic effects
of, 175
Anxiety
relation to chronic pain, 131, 133-
134, 140-142, 166-168
role in maintenance of pain, 3, 140-
141
Anxiolytic drugs
electiveness in treating pain, 176
Appeals (SSA)
before ALJs, 5, 47, 67
federal district court, 76-78
process for denied claims, 5-6, 46~0,
60
OCR for page 294
294 D!~DEX
staff and offices involved with, 67
standard of review for, 50
Supreme Court, 50
of termination of benefits, 1, 30, 56-
57
Arthritis
classified as disabling by SSA, 41-42,
269
myofascial trigger points related to,
286
outcomes of treatment for, 205
rheumatoid, 42, 80, 114-116, 172
from sustained pain, 137
Articular dysfunction, 197, 200
Aspartic acid, role in pain processes,
131
Az~erbeuf v. Schweiker, pain as legiti-
mate disability, 56
B
Back pain
age, race, and sex correlations with,
113-114
alcoholism correlated with, 177
bed rest and restricted activity for,
202-203
behavior associated with, 218
causes of, 2, 13, 114 - 115, 196-200
clinical manifestations, 115
diagnosis of, 190-195, 204
drug therapy for, 20~203
incidence, 110-111, 113
marital status and recurrence of, 114
measurement of, 129, 179, 218-219,
222, 226
medical care for, 111-112
medical model for, 190-194, 196
nerve damage in, 140
outcomes of treatment, 194, 202-205
pain processes in, 126
physiotherapy for, 112
prevalence of, 104 - 108, 110-111, 113
progression to chrorucity, 109-110
psychosocial factors in, 116
sickness impact of, 221
socioeconomic status and, 115-116
surveys of, 10~108, 110-112
treatment modalities, 111-112, 193-
195, 202-205, 241
work disability from, 109-113, 222- Chronic pain
223, 246
workplace factors in, 116
Baerga v. Richardson, standard for
evaluating pain, 56
Barbiturates, treatment of pain with,
176
Behavior modification for treatment of
pain, 175, 201-202, 238-239, 243-
244, 250
Beneficiary Rehabilitation Program,
253
Benefits, see Disability benefits; Com-
pensation
Benzodiazepines, 173, 176, 203
Ber v. Celebrezze, standard for evaluat-
ing pain, 55~6
Biofeedback, 238, 240, 243
Bradykinin, release in pain processes,
126
Brief Pain Inventory, 216
Butyrophenones, 176
C
Case law on SSA disability determina-
tions involving pain
Auerbez~f v. Schweiker, pain as legiti-
mate disability, 56
Baerga v. Richardson, standard for
evaluating pain, 56
Ber v. Celebrezze, standard for evalu-
ating pain, 55~6
Werner v. Flemming, consideration of
job opportunities in disability de-
terminations, 29
Marcus v. Cal~fano, pain as legiti-
mate disability, 56
Miranda v. Secretary, standard for
evaluating pain, 56
Page v. Celebrate, standard for eval-
uating pain, 55, 56
Polasiz v. Heckler, standard for eval-
uating pain as a disability, 56~7
CAT scan, for diagnosis of back pain,
192, 204
Causalgia, 139
Central nervous system
erects of prolonged pain on, 140
lesions of, 139
monitoring metabolic activity in,
141-142
pain pathways in, 131-133, 141-142
Chiropractic care
effectiveness, 154, 206, 237
use by chronic pain patients, 153
age, race, and sex correlated with,
113-114
anxiety and, 131, 133-134, 140-141,
166-168
biopsychosocial model needed for, 27
contrasted with acute pain, 140-141
OCR for page 295
INDEX
costs associated with, 98
definitions, 18,102, 109
depressive disorders and, 3, 133, 157,
166-168, 172-173
diagnosis of, 195-196, 200-201
epidemiology of, 101-119, 266, 277-
278
experience of, 3, 12, 15, 27, 69, 132-
134, 141, 146, 159
from failure of pain suppression sys-
tem, 135
family influences on, 156-158, 168,
172, 178-179, 202
federal court handling of, 7~78
gaps in knowledge on, 7-8, 26~265
genetic predisposition to, 157
kinds of, 109-110
measures of, 10~103, 118-119; see
also Measurement of pain
models for, 124, 212
neurobiological mechanisms of de-
pression and, 171-172
personality factors and, 3, 178-180
physical factors associated with, 11=
115
prevalence, 113-114
progression to, 109-110
psychiatric aspects of, 3, 165-181
psychosocial factors associated with,
116-117, 141, 196, 200-201
research recommendations on, 8-10,
117-119, 139, 180-181, 206-207,
265-266, 281
socioeconomic status and, 115-116
somatization disorder and, 3, 168-169
syndrome, characterization of, 13; see
also Myofascial pain syndrome
treatment recommendations for, 201-
205, 265
trends over time, 112
Chronic pain patients
chiropractic care for, 153
rehabilitation of, 16, 79, 97; see also
Rehabilitation
substance abuse among, 3, 177-179
treatment of depressive disorders in,
174-177
Claims, see Disability claims
Cognitive therapy
electiveness, 201, 238, 244
for outpatient treatment of depres-
sion,174-175
recommended approach to, 201-202
Compensation
effects on outcomes of treatment, 245,
248-252,273-274
295
European programs, 33, 64
neurosis, 249
See also Disability benefits
Continuing Disability Investigations,
30,31
Conversion disorder, 169-170
Coping Scale Questionnaire, use in pain
measurement, 225-226
Cordotomy, 205
Cornell Medical Index, assessment of
chronic pain with, 180
Cultural/ethnic influences
on disability, 33
on illness behavior, 158-160
D
Dartmouth Pain Questionnaire, 215
Demonstration projects, recommenda-
tions for, 9-10, 255-257, 265, 270-
277
Depression (clinical)
characteristics, 167
chronic pain and, 3, 133, 157,168,
172~173
in families of pain patients, 157, 168,
172
instruments for measuring, 167
neurobiological mechanisms of pain
and, 171-172
prevalence in pain patients, 167
substance abuse associated with, 177
Depressive disorders
psychopharmacological treatment,
175-177
psychotherapeutic treatment, 174-
175, 180
Depressive symptoms
association between chronic pain and,
167, 168
caused by drug therapy, 173
Diagnosis of pain
controversial, 197-198
difficulties in, 13-14, 195-200
expanded model, 19~195
history-taking, 191, 201
laboratory tests, 192
physical examination, 191-192,201
psychosocial factors in, 200-201
recomrr~ended improvements in, 200-
201
special techniques, 192
traditional medical model, 190-194
Dictionary of Occupational Titles, 46
Disability
assessment, see Disability determina-
OCR for page 296
296 INDEX
tions; Measurement of disability
as a civil rights issue, 34
compensation programs in Western
Europe, 33, 64
cultural components, 33
data collection on, 8, 103-109, 26
267
early identification of, 10, 256, 270-
276
economics of, 87-99
label, damage to patient from, 73
leading causes, 12, 110
measurement of, see Measurement of
disability
medical model of, 26
mental, 31, 68
pain as basis for establishing, 55~7
prevalence, 94
prevention, funding for, 97-98
rates, 80, 92
severity of impairment, 45,54, 223-
224
SSA debate about, 22-24, 76
unemployment and, 27, 80-81,91-92
work continuation and, 70, 95
workers insured for, 40
Workers' Compensation categories of,
62
Disability benefits
appeals of terminations (SSA), 1, 30,
56~7
awards per year (SSA), 30, 38, 40~1,
58, 69, 88-89, 95
cash payments, 38, 50, 88-89
coverage period, 60
eligibility, see Disability determina-
tions; Eligibility for benefits
expenditures for, 8~98
levels of, 95
negative effects of, controversy, 78-
81, 156, 245, 248-252
payments by SSDI/SSI, 37~8, 40-41,
50, 60, 89, 91-93, 95
private insurance, 60, 63, 89
rehabilitation and, 70-71, 78-81,
255-256, 274
after return to work, 51
simultaneously, SSDI and SSI, 38
termination of, 1, 30, 31, 56~7
types, 60
Veterans Administration, 58-61,89-
90
Workers' Compensation, 59-60,62,
89
See also Compensation
Disability Benefits Reform Act of 1984
criteria for determining eligibility,
33-34
scope of, 31
standard for evaluating pain, 1, 21,
51~2, 76
Disability claims
annual number filed, 42
application process, 42-46,52-53,60
disposition at all levels, 47-49
economic conditions and, 92,99
evaluation process, 5,42-46, 52, 53-
55, 59
growth of, 30, 69, 81, 91-93
incentives for, 95
most common bases of, 25
pain as a basis for, 55~7
tort settlements, 90
for vertebral disorders, 110
Disability definitions
ambiguity in, 68
European, 33
medical condition linked to employ-
ability, 68
medical vs. functional concept, 69-70
private sector, 61, 63
restrictiveness of, 70
SSA, 4-5, 14-15, 22, 32-33, 38-42,
61,69-70,256,264,273-274
variation in, 93
Veterans A`lministration, 61
Workers' Compensation, 61
World Health Organization, 17
Disability determinations
ability to work considered in, 45, 69-
70
age considerations in, 46
by ALJs, 5, 47,67,74-76,264
appeals of, 5-6, 46~0, 60, 67, 76-78
burden of proof, 57
case law inconsistencies in, 29,55-
57,67,77-78
criteria for, 14, 23, 29~0, 33-34, 57
differential impact of nature of im-
pairment, 73
early, 10, 256,270-273
employment opportunities considered
in, 2~30,81
evidence required for, 63-64,69,269
face-to-face, 5, 9, 47,64,264,272
federal district court, 7~78
functional approach to, 2,4, 5, 8-9,
45-46,69-70,220,223-224,254,
256,265,268-270,272-273
information gathering for, 8, 5~53,
103-109,265-267
institutional perspectives, 67
OCR for page 297
INDEX 297
medical-based, 23-28, 31, 69-70
moral dimension, 67-68
nonmedical factors in, 26, 33, 45-46
pain's role in, 51-57, 59, 61-63
physician concerns about, 2028
physician roles in, 43, 45~6, 71-74
qualifications of evaluators, 43
recommended focus of, 161, 228, 256
SSA sequential evaluation process,
5-6, 43~7, 53~5, 69, 268-269
state-level (DDS), 5, 43, 52 53
subjectivity in, 66-69, 70, 75-76, 82,
264
vocational factors, 45
volume of, 6
Disability expenditures
administrative, 96-98
cash transfers, 88-89
direct services, 90-91
medical care, 89-90, 98
trends in, 91-97
Disability insurance
legislative background, 21~1
physician objections to, 24
private, 60-64, 89-90
programs, 89; see also Disability
benefits; Social Security disability
programs (SSDI/SSI)
SSA, history of, 22-24
Disabled persons
direct services for, 90-91
discrimination against, 34, 81
employment opportunities for, 28~0,
34, 81, 93
labor force participation, 80
medical care payments for, 90
motivation for recovery and rehabili-
tation, 10, 25, 78-81, 273
number and characteristics of, 94
work continuation by, 70, 95
Disc herniation
education correlated with, 115
pain from, 197
surgery for, 204
work absence from, 112
Discrimination against disabled per-
sons, 34, 81
Doctors, see Physicians
Dopamine, role in pain modulation,
172, 176-177
Dorsal column stimulation, 205
Drug abuse
among chronic pain patients, 156,
173, 177, 179
disability determinations and, 68
Drug therapy
antidepressants, 175-176, 203
antipsychotics, 175
for back pain, 202-203
for chronic pain, recommended im-
provements in, 203-204
depressive symptoms caused by, 173
opioids, 135,172, 173, 203
in pain management programs, 239,
241
polypharmacy, 156, 173, 227, 241
for somatization disorder, 169
See also Psychopharmacology
E
Education and training
back pain correlated with, 115
considerations in disability determi-
nations, 46
disability correlated with, 94
of health care professionals to treat
pain, 10-11, 266, 280-283
See also Patient education
Electromyography for diagnosis of back
pain, 192
Eligibility for benefits
criteria for determining, 14, 23, 26,
29~0, 32~4, 69; see also Disabil-
ity determinations
Medicaid and Medicare, 50
periodic review to confirm, 50
SSDI/SSI, 37~8, 248
Veterans Administration, 58
Workers' Compensation, 61-62
Employment
effects on outcomes of treatment,
245-248; see also Return to work;
Unemployment; Work disability
opportunities for disabled persons,
28-30, 81, 93
substantial gainful activity, 45, 253
End Stage Renal Disease Program, pay-
ments for, 90
Endogenous opioid system, 135, 176,
177
Epidemiology
of chronic pain, 101-119, 266, 277-
278
of psychiatric disorders, 166-167
Epidural steroid injections for low back
pain, 241
Experience of pain
description of, 133, 146
individual variables in, 12, 15, 27,
133
OCR for page 298
298 SEX
threshold, 132,133, 159
tolerance, 3, 69, 133-134, 141
F
Factitious disorder, 171
Families of pain patients
depression and alcoholism in, 157,
168, 172
influences on illness behavior, 156-
158, 178-179, 238-240
involvement in treatment, 202, 233,
238-240
Federal courts, handling of chronic dis-
abling pain by, 76-78
Federal Republic of Germany, disability
definition, 33
Fibromyalgia/fibrositis, 197,199-200,
236, 241
Folk healers, 153
Functional impairment
assessment of, 2, 4,5,8-9,220,254,
265, 268-270, 27~273
definition, 17
description, 27
imposed by pain, 54
G
Glut~mic acid, role in pain processes,
131
H
Handicap
definition, 34
See also Disability
Headaches
illness behavior associated with, 134,
218
work days lost because of, 110
Health Belief Model, pain measurement
with, 225
Health care services, alternative thera-
pies, 153, 206
Heart attack, referred pain during, 129
HHS Co - mission on the Evaluation of
Pain, definitions of acute pain,
chronic pain, and impairment, 17-
18
recommended rehabilitation demon-
stration project, 274
Histamine, release in pain processes,
126
Holistic health care, 153, 206
Hopkins Symptom Checklist-90 (SCL-
90), assessment of chronic pain
with, 180, 252
Hyperactivity of sympathetic nervous
system, 13~138
Hypnosis, 240
Hypnotic drugs, depressive symptoms
from, 173
Hypochondriasis, 3, 170, 171,250
Hysteria, see Somatization disorder
I
Iatrogenesis, 156,202-205,223,282
mness/pain behavior
in absence of diagnosable disease,
152-153
abnormal, 148, 170
avoidance of intimacy, 158
in back pain patients, 218
compensatory mechanisms, 152
conditioning, 157
coping responses, 151-154,156,225-
226,239,243,251
cultural/ethnic influences on, 3, 158-
160
definition, 13
expression/communication of pain,
133,146,151,155-156,159-160,
224-227
factors shaping, 147
family influences on, 15~158,178-
179,238-240
help seeking, 151-154
individual variation in, 147
judgments of, by health care provid-
ers, 217
malingering, 15~153
measurement of pain through, 217-
220
modeling, 157
observational data on, 217-219
operant learning, 157, 250
overuse syndromes, 152
pain tolerance factor in, 3, 133-134,
141
personality and, 15~156
processes of, 148-154
psychosocial factors in, 3,112,147,
155, 160
Seclusiveness, 152
reduced physical activity, 152
self-reports of, 219-220
somatization, 155-156,158,168,178
OCR for page 299
Index 299
symptom interpretation, 149-151,
224-225
symptom perception, 112, 148-149
Imipramine, 174
Impairments
assessment of, 2, 4, 5, 8-9, 220, 264,
265, 268-270, 272-273
concept of, 26-28
definition, 17, 39
differential nature of, 73
duration of, 42
indicators of, 42, 54; see also Disabil-
ity determinations
mental, 31, 39, 43
musculoskeletal, 41~2
relation to work, 27
severity, 45, 54, 223-224
SSA listing of, 5, 8, 39, 41~2, 45, 54,
69, 265, 267-268
verification of, 28
Veterans Administration ratings of,
58
See also Functional impairment
Instruments for measuring disability
Northwick Park Activities of Daily
Living Index, 220
Sickness Impact Profile (SIP), 221-
222
Instruments for measuring pain
Brief Pain Inventory, 216
Coping Scale Questionnaire, 225-226
Cornell Medical Index, 180
Dartmouth Pain Questionnaire, 215
Health Belief Model, 225
Hopkins Symptom Checklist-90, 180,
252
Levine-Pilowsky Depression Ques-
tionnaire, 252
McGill Pain Questionnaire (MPQ),
215-216, 251
Minnesota Multiphasic Personality
Inventory (MMPI), 179, 180, 221-
222, 250, 251
Multidimensional Health Locus of
Control Scale, 224-225
Numerical Rating Scale (NRS), 214
Pain Perception Profile, 216
Purpose in Life Scale, 224
recommendations for, 272-273
Visual Analog Scale (VAS), 21~216,
222, 273
Ways of Coping Checklist, 225
West Haven-Yale Multidimensional
Pain Inventory, 215-216
Insurance, see Disability insurance
Interpersonal therapy, 174
J
Job satisfaction
back pain and, 116
disability rates correlated with, 80
Jobs
exertional requirements, 46
See also Employment
Joint pain, work days lost because of,
110
K
Werner v. Flemming, consideration of
job opportunities in disability de-
terminations, 29
L
fedora, analgesic erects of, 177
Labor force participation
by disabled persons, 80
employment opportunities as a deter-
minnnt of, 81
Legal decisions
on disability determinations, incon-
sistencies in, 67, 77-78
on pain cases, inconsistency in, 31
See also Appeals; Case law on disabil-
ity determinations
Leukotrienes, release in pain processes,
126
Levine-Pilowsky Depression Question-
naire, 252
Listing of Impairments, SSA, 5, 8, 39,
45, 54, 69, 265, 267-268
Lithium, analgesic effects of, 177
M
Malingering, 15~153, 171
Marcus v. Califano, pain as legitimate
disability, 56
McGill Pain Questionnaire (MPQ3,
215-216, 251
Measurement of disability
instruments for, 220-222
pain relation to functional status, 2,
4, 5, 8-9, 45-46, 69-70, 220, 223-
224, 254, 256, 265, 268-270, 272-
273
rehabilitation-focused tests, 222
sickness impact, 221-222
surveys, 93-94, 103
work performance assessment, 222-
223
OCR for page 300
300 INDEX
Measurement of pain
back pain, 129, 179, 218-219, 222,
226
basic concepts, 212-213
through behavior, 217-220
biases in, 102, 110-111, 181, 224-227
determining chemical substance con-
centrations at tissue injury site,
141
difficulties in, 3 - , 129, 253-254
frequency, 104-108
indirect physiological, 142
positron emission tomography, 141-
142
with psychiatric assessment instru-
ments, 180-181
recording primary afferent nociceptor
activity, 4, 127-129, 141
research recommendations for, 118-
119, 180-181, 281
scaling, see Instruments for measur-
}ng pain
self-reports, 102-103, 111-112, 213—
216, 219-220
subjective states, 213-216
through sympathetic nervous system
activity, 142
thermography, 142
Medicaid, disability payments under,
50, 90
Medical care
for back pain, 111-112
for chronic pain, costs of, 98
disability program expenditures for,
89-90
See also Rehabilitation; Treatment of
pain
Medicare
coverage after return to work, 51
payments for SSDI beneficiaries, 89-
90
supplemental disability payments un-
der, 50
Mental health problems, disability de-
terminations and, 31, 68
Methotrimeprazine, 176
Minnesota Multiphasic Personality In-
ventory (MIMI), 179, 180, 221-
222, 250, 251
Miranda v. Secretary, standard for eval-
uating pain, 56
Modeling/models
acute pain, 124, 212
animal, applied to human pain stud-
ies, 124, 131, 137
biopsychosocial, for chronic pain, 27
chronic pain, 124, 212
expanded, of low back pain, 194-195
illness/pain behavior, 157
medical contrasted with nonmedical,
212-213
medical, of disability, 26
traditional medical, of low back pain,
190-194, 196
of unemployment-disability relation-
ship, 91
Multidimensional Health Locus of Con-
trol Scale, pain measurement with,
224-225
Muscle atrophy from sustained pain,
137
Muscle contraction
pain-associated, 138
stimulation of primal afferent noci-
ceptors, 126
Muscle relaxants for back pain, 203
Myelography for diagnosis of back pain,
192, 204
Myelotomy, 205
Myofascial pain syndrome
characteristics of, 286
diagnosis, 288-290
historical background, 286-287
natural history, 287-288
overlap between fibrositis and, 200
perpetuating factors, 138, 290
prevalence of, 240-241, 285-286
psychogenic pain disorder and, 170
treatment, 200, 241, 290-291
Myofascial trigger points
in arthritis patients, 286
in back pain, 192, 197, 198-199
characteristics of, 288-290
development of, 198-199
referred pain from, 130, 192, 198-
199, 286-289
N
Naltrexone, treatment of pain patients
with, 178
National Institute of Mental Health
Epidemiological Catchment Area
project, 166
Nerve
blocks to treat chronic pain, 234, 241,
250
conduction tests for diagnosis of back
pain, 192
damage from back pain, 140
Netherlands, disability definition, 33
OCR for page 301
SEX 301
Neuralgia, trigeminal and posthe~petic,
140
Neuroleptic drugs, analgesic effects of
175, 176
Nociceptors, see Primary afferent noci-
ceptors
Norepinephrine, role in depressive ill-
ness and pain modulation, 171-172
Northwick Park Activities of Daily Liv-
ing Index, 220
Nosophobia, 171
Nuclear magnetic resonance (NMR) im-
aging for diagnosis of back pain
192, 204
Numerical Rating Scale (NRS), pain
measurement with, 214
Nuprin Pain Report, 103-104, 109-111,
113-115
o
Occupational status, back pain and
115-116
Old Age, Survivors, and Disability
locust Fund, eligibility for benefits,
37
Opioid analgesics
depressive symptoms from, 172-173
long-term pain therapy with, 203
Osteoporosis, 42, 137
Outcomes of treatment
adequacy of study designs and meth-
odologies, 244
age and educational level as predic-
tors of, 251
of arthritis, 205
of back pain, 194, 202-205
behavioral therapy, 243-244, 250
chiropractic care, 154, 206, 237
cognitive therapy, 201, 238, 244
compensation effects on, 245, 248-
252, 273-274
employment effects on, 242, 244-248
multimodal approaches, 24~245
relaxation therapy, 238, 240, 243
p
Page v. Celebreze, standard for evalu-
ating pain, 55, 56
Pain
anatomy and physiology of, 123-142
assessment methods, see Instruments
for measuring pain; Measurement
of pain
causalgia, 139
central nervous system pathways,
131-133
chemicals producing, 126
chronic, see Chronic pain
clinically significant vs. experimen-
tally induced, 126, 134
cognitive and affective aspects of,
134, 201
common types, 109-110; see also
Back pain
consideration in disability determina-
tions, 51~7, 61-63
of deep somatic and visceral struc-
tures, pathways of, 132
definitions, 18, 102, 104-109
description of, 133, 146
diagnosis, see Diagnosis of pain
disproportionate to injuries, 136
economics of, 98
effects on central nervous system, 140
enhancement through physiological
processes, 136-141.
evaluation of, 53~5, 127-129; see
also Diagnosis of pain
evidence of, 53, 54
experience of, see Experience of pain
expression and communication of,
133, 146, 151, 155-156, 159-160,
22~227
functional status and, 2, 4, 5, 8-9,
220, 254, 265, 268-270, 272-273
impaired sensation of, 131, 132
incidence, 110-111
indicators of, 151-152; see also m-
nesslpain behavior; Measurement
of pain
information gathering on, 5243; see
also Surveys of pain/disability
intensity, 127-128
joint, 110, 136, 218
key court cases, 55~7
from lesions of central nervous sys-
tem, 139
management, see Pain management
programs/pain clinics
meaning attributed to, 149-151, 224-
225
measurement of, see Measurement of
pain
memory of, 226
muscle contraction associated with,
138
neurological mechanisms and struc-
tures, 13, 125, 171-172; see also
Pain processes
neuropathic, 139-140
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302 INDEX
perception, 123-125, 132
from peripheral nerve injury, 139
prevalence of, 104-108,110-111,
113-114
private sector consideration in dis-
ability determinations, 61,63-64
psychological factors in maintenance
of, 3, 140-141
receptors, see Primary afferent noci-
ceptor
referred, 129-131,136,192, 19~199,
286-289
religious and moral significance to,
151
response to, see Illness/pain behavior
role in disability determinations, 51-
57, 59, 61-63
self-sustaining, 136-140
sensitization, 136
sensory vs. affective aspects, 133-134;
see also Experience of pain
severity determination, 15, 151, 223-
224
sharp, well-localized, pathway for,
132
sociopolitical issues concerning, 21-
35
SSA standard for evaluating, 21, 51-
52, 55~7
threshold, 132,133, 159
tissue damage and, 14~147
tolerance variation, 3, 69, 133-134.
141
treatment, see Pain management pro-
gramslpain clinics; Rehabilitation;
Treatment of pain
trigger points, see Myofascial trigger
points
VA consideration in disability assess-
ments, 59,61
work disability due to, 103, 109-113,
222-223,246
Workers' Compensation consideration
in disability determinations, 61-63
See also Acute pain; Back pain;
Chronic pain
Pain management programs/pain
. .
c panics
accreditation of, 235
admission criteria, 234,242
behavior modification by, 238-239,
243
cognitive therapy, 238,244
drug therapy in, 239,241
follow-up procedures, 243
goals, 234,245
medical interventions, 240-241
multimodal treatments, 241 245
need for standards, 235-236
outcomes, 242-252
patient education by, 239,248,251
physical treatment modalities, 234,
236-238
psychosocial rehabilitation by, 239-
240
relaxation therapy, 238,240,243
stab qualifications, 235,236
stress management by, 240
studies needed on, 242-245
types of patients, 242
types of treatments, 234,236
variation among, 4,234-235
vocational rehabilitation by, 241-243
Pain Perception Profile, 216
Pain processes
convergence-facilitation hypothesis,
130
convergence-projection hypothesis,
130-131
Livingston's vicious circle, 138-140
in low back pain, 126
modulation, 124-125,129,134-135,
172,178
perception, 123-125,132; see also
Experience of pain
recording activity during, 127
self-sustaining, 13~140
sensory vs. affective, 133-134
transduction, 124-126,141
transmission, 124,126-133
Patient education in treatment ordain,
239,248,251
Peripheral nervous system, pain trans-
mission in, 12~133
Personality
factors in chronic pain, 3,178-180
illness behavior and, 154 - 166
Phenothiazines, 176
Physician-patient relationship
conflicts caused by disability certifi-
cation, 25,74,263-264
relevance to treatment of pain, 14
Physicians
concerns about medical determina-
tions of disability, 24-28
consultative, 7~73
objections to disability insurance, 24
role conflict (gatel~eeping), 71-74
roles in disability determinations, 43,
45-46, 71-74
SSA uses of, 71-74
treating, 71-73
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IDEA 303
Polaski v. Heckler, standard for evalu-
ating pain as a disability, 56~7
Positron emission tomography (PET),
pain measurement by, 141-142
Potassium release in pain processes,
126
Primary adherent nociceptors
activation of, 4, 124-126, 137-139
axons of, 126-127, 131-132
chemical releases by, 131
damage to, 139-140
mechanisms of, 123, 131
monitoring pain intensity through,
127-128, 141
muscle contraction from, 126, 138
peripheral branching of, 130
regeneration of, 139
sensitization through repeated stimu-
lation of, 136
Private disability insurance, 60-64,
89-90
Prostagland~ns, release in pain process-
es, 126
Psychiatric disorders in chronic pain
patients, 166-167, 169; see also De-
pression (clinical); Depressive dis-
orders
Psychogenic pain disorder, 170, 171
Psychological factors in maintenance of
pain, 140-141
Psychopharmacology for depressive dis-
orders in pain patients, 175-177
Psychosocial factors
affecting chronic pain, 116-117, 141,
196, 200-201
in illness behavior, 3, 112, 147, 155,
160
Psychotherapy for pain patients, 169,
174-175, 180, 240
Psychotropic drugs, analgesic effects of,
175-177
Purpose in Life Scale, pain measure-
ment with, 224
R
Race
back pain correlated with, 113-114
relationship between disability and,
94
Recommendations, see Research recom-
mendations
Recovery, motivation for, 25, 78-81
Referred pain, 130, 192, 198-199, 286-
289
Reflex sympathetic dystrophy, 137-138
Rehabilitation
of chronic pain patients, 16, 79, 97;
see also Pain management pro-
grams/pain clinics
costs, 235
disability benefits and, 70-71, 78-81,
255-256, 274
early, 10, 273-276
eligibility for (SSA), 71, 255-256
European encouragement of, 64
exercise program, 237
expenditures for, 90-91, 97-98
financial disincentives to, 25, 79
incentives for, 50-51, 71, 273-274
income support vs., 70-71
issues important to SSA, 252-257
mandatory, 254-255
motivation for, 10, 25, 78-81, 273
private insurance requirements, 61,
63
psychosocial, 239-240
recommended research on, 274-277
VA program, 59, 61
vocational, 90-91, 224, 241-243, 252-
253, 257, 274
weaning pain patients from drugs,
173
Workers' Compensation participation
requirements, 61-62
Rehabilitation Act of 1973, section 504,
definition of handicapped, 34
Religious healers, 153
Research recommendations
case control studies, 118
chronic pain, 8-10, 117-119, 139,
180-181, 205-207, 265-266, 281
clinical studies, 10, 205-207, 245,
278-280
on compensation effects on outcomes,
248-249, 278-279
epidemiological studies of chronic
pain, 10, 117-118, 266, 277 - 278,
280
health services utilization, 206, 279
on pain measurement, 118-119, 180-
181, 281
on psychiatric aspects of chronic pain,
180-181
on rehabilitation, 274-277
Residual functional capacity, determi-
nation of (SSA), 5, 8-9, 4606, 220,
254, 265, 268-270, 27~273
Return to work
disability benefits (SSA) after, 61
factors affecting, 8~81
as a measure of outcome, 248
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304 D!lDEX
outcomes of therapies stressing, 242,
244, 246
SSA incentives for, 50
Rhizotomy, 205
S
Schedule for Affective Disorders and
Schizophrenia, 167
Sciatica, surgery for, 204
Self-care movement, 153
Self-reports
in measurement of pain, 102-103,
111-112, 213-216
of illness/pain behavior, 219-220
See also Surveys of pain/disability
Self-support program of SSI, 51
Sensitization, 136
Serotonin
role in depressive illness and pain
modulation, 171-172
role in pain processes, 126, 171-172
Sex, back pain correlated with, 113
Shoulder pain, behavior associated
with, 218
Sickness Impact Profile (SIP), 221-222
Social Security Act
1966 amendments, 253
1980 amendments, 30
1984 amendments, see Disability
Benefits Refor~n Act of 1984
Listing of Impairments, 5, 8, 39, 41-
42, 45, 54, 69, 265, 267-268
regulations implementing, 39
Social Security Administration (SSA)
Appeals Council of Office of Hearings
and Appeals, 6, 47, 67
conflicts between Congress and, 68-
69
data collection by, 8, 265-267
history of disability insurance, 22-24
nonacquiescence policy, 77-78
policy implementation role, 68
rehabilitation issues important to,
25~257
Social Security disability programs
(SSDI/SSI)
amount of monthly payments, 50, 51,
95
appeals process, 5-6, 46-50, 60
application and evaluation process, 5,
42~46, 52~55, 60; see also Disabil-
ity determinations
benefits paid by, 37~8, 40-41, 50,
60, 89, 91-93, 95; see also Disabil-
ity benefits
conflicts and contradictions, 6-7, 66-
82, 263-264
contributions during disability, 23
definition of disability, 4 5, 14-15,
22, 32~3, 38-42, 61, 69-70, 256,
264, 273-274
disposition of claimants, 48-49
efficacy, 96-97
eligibility, 37-38, 248
funding reallocation to prevention,
97-98
growth in, 95-96
incentives for rehabilitation and re-
turn to work, 50~1
income support vs. rehabilitation, 70-
71
lengths and types of benefits, 60
problem of pain for, 21~5, 37-64,
6~82
purpose, 99
rehabilitation requirements and pro-
visions, 61, 70
rules affecting return to work, 80-81
sequential evaluation process, 5-6,
43~7, 53-55, 69, 268-269
stay and offices involved with re-
views, 67
state-level (DDS), 5, 43, 52-53
tensions within, 69-76
trends over time, 40-41
workload size, 96
Socioeconomic status, chronic pain and,
115-116
Sociopolitical issues on pain, 21~5
Somatization
disorders, 3, 169
tendency to, 155-156, 158
Somatoform disorders
features of, 168-171
prevalence, 166
Somatosensory cortex, pain perception
in, 123
Somatostatin, role in pain processes,
131
Spinal cord, pain transmission pathway
in, 131
Spinal disorders listed by SSA as dis-
abling, 41-42
Spinal morphine, focal installation of,
205
Spinal stenosis, surgery for, 204
Spinothalamic tract cells, properties of,
132
Stress
management, 240
role in maintenance of pain, 3, 140-
OCR for page 305
VEX 305
141, 155
Substance abuse, see Alcoholism; Drug
abuse
Substance P. role in pain processes,
131, 138, 172
Substantial gainful activity, 45, 253
Suffering
association with pain, 150
in absence of diagnosable disease, 153
Surgery, unnecessary, 156
Surveys of pain/disability
data collection methods, 8, 52~3,
103-109, 265-267
Nuprin Pain Report, 103-104, 109-
111, 113-115
and related psychiatric disorders,
16~167
See also Self-reports
Sympathetic nerves, referred pain
caused by, 130
Sympathetic nervous system
hyperactivity of, 136-138
measurement of pain through, 142
Symptoms
depressive, 167,168, 173
interpretation of, 149-151, 224-225
perception of, 112,148-149
T
Thal~Tnus, pain perception in, 123,132
Thermography
for diagnosis of back pain, 192
pain measurement through, 142
register of myofascial trigger points
on, 289
Training, see Education and training
Transcutaneous electrical stimulation
(TENS), 234,237
Treatment of pain
in alcoholics and drug abusers, 177-
178
bed rest and restricted activity, 202-
203,223
chronic low back, 111-112,193-195,
202-205,241
cognitive-behavioral approach, 175,
201-202,238-239,243-244,250
collaborative approach, 202
compensation status as a factor in,
248-252
difficulties in, 13-14
through distraction and meaningful
activity, 149
electrical stimulation of homologous
brain regions, 134-135
employment as a factor in, 246-248
expanded model for, 194-195
frontal lobotomies, 134
multimodal approaches, 244-245,
254,255
negative erects of, 156,202-205,223,
282
operant conditioning, 178,238,243,
251
outcomes, see Outcomes of treatments
physical modalities, 223-224,237-
238
psychopharmacological, 175-177
psychotherapeutic, 17~175, 240
recommended improvements in, 201-
205,265
relaxation therapy, 238,240,243
stress management, 240
surgery, 20~205
transcutaneous electrical stimulation
(TENS), 234, 237
vibration, 237
work simulation techniques, 223
See also Drug therapy
Trial work period
disability payments during, 10, 51,
257
disincentives to use, 80-81, 274
purpose, 252-253
U
Unemployment, disability and, 27,80-
81, 91
V
Vertebral disorders
claims associated with, 110
classified as disabling by SSA, 42
physiotherapy for, 112
work absence from, 112
Veterans Administration
cash disability transfers, 89-90
disability compensation programs,
58-61
Visual Analog Scale (VAS), pain inten-
sity measurement with, 21 0 216,
222,273
W
Ways of Coping Checklist, use in pain
measurement, 225
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306 INDEX
West Haven-Yale Multidimensional
Pain Inventory, 215-216
Work
absenteeism, major causes of, 12
continuation by disabled persons, 70,
95
environment, factors related to back
pain, 116
experience, considerations in disabil-
ity determinations, 46
performance, assessment of disability
through, 222~223
See also Return to work; Trial work
period
Work disability
from arthritis, 115, 205
from back pain, 109-113, 222-223,
246
consideration in disability determina-
tions, 69-70
frequency, from pain, 103
from joint pain, 110
relation of impairment to, 27
social predictors of, 80
Workers' Compensation
cash disability transfers, 89-90
disability categories, 62
disability compensation programs,
59-63, 89
expenditures for rehabilitation, 97
World Health Organwation, definitions
of disability, functional limitation,
impairment, 17
X
X rays for diagnosis of pain, 192, 201
Representative terms from entire chapter:
pain patients
