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 -- References -- 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 -- The Role of Pain -- Private Disability Insurance -- The Role of Pain -- Disability Compensation Programs in Western Europe -- References -- 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 -- References -- 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 -- CONCLUSIONS -- References -- 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 -- References -- 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 -- References -- 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 -- CONCLUSIONS -- References -- 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 -- References -- 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 -- References -- 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 -- 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 -- 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 -- 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 -- 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.