How To Objectively Quantify Pain For Impairment Ratings

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According to the AMA Guides, “Pain is an essential determinant of the incapacitation of many individuals who undergo impairment evaluation. When pain persists, it has the capacity to dominate a person’s existence, contributing to significant impairment, reduction in the quality of life, functional limitations, and disability.”

An impairment rating quantifies the injury and scales the impairment’s severity. This rating acts as one of the most important pieces of information for determining case settlement outcomes in auto insurance claims. It carries immense weight in the determination of case settlement values and the amount of financial compensation an injured party is entitled to receive.

The AMA Guides operate under the premise that injuries cause deficits in functioning and can be quantitatively assessed during an impairment evaluation and consider pain intensity, emotional distress related to pain, and ADL deficits secondary to pain. The Guides give the greatest weight to interference with ADL’s.

Traditionally, pain assessment has relied on subjective means such as patient-reported findings (o-10 Analog Score) or pain questionnaires. According to the Guides, “A basic challenge for a system of rating pain-related impairment is to incorporate the subjectivity associated with pain into an impairment rating system whose fundamental premise is that impairment assessment should be based on objective findings.” For pain to be considered in an impairment rating, it must be quantified in the evaluation. If pain-related impairment is ratable, the examiner may award a pain-related increase of an impairment rating score. 

Algometry testing: An objective assessment of pain

Algometry testing is an objective, quantifiable method for assessing pain. Because of its reliability and reproducibility, algometry can be used for medico-legal documentation of pain intensity. Algometry testing measures pressure applied to specific locations on the patient. Pressure Threshold Testing is the minimum pressure required to cause the patient pain. Measurements are performed over areas of muscle tenderness at specific trigger points.

Normative data exists for males and females in the areas which trigger points are frequently found. Clinical cutoff values have also been established in determining a clinically abnormal response to pain/pressure stimulus. Bilateral deficits from the opposite side are also considered positive Algometry test findings.

Duties Under Duress/Loss Of Enjoyment Of Life

Duties Under Duress (DUD) and Loss Of Enjoyment of Life (LOE) are two of the largest value drivers auto insurance companies take into account which can significantly contribute to increased case settlement values. DUD relates to pain experienced while performing an activity despite pain they experience, while LOE relates to a person unable to continue performing an activity due to an injury. This can include work, household/ domestic activities, hobbies, and recreational activities. Two things are needed for auto insurances to assign a value for DUD/LOE: 

  1. Experiencing pain while performing an activity.
  2. Documentation of the activity and pain in medical records.

In addition to quantifying pain through Algometry testing, documenting pain-related behaviors during the physical examination can also assist in validating injury severity. Examples include documenting patient-reported complaints of pain during ROM testing and observations of pain-related behaviors such as wincing/grimacing during testing and correlating these to DUD/LOE to further validate injury severity.

Objectively assessing pain through Algometry testing further facilitates meeting the value drivers used by auto insurance companies in determining case settlement outcomes, and ensures your patients and clients receive the fair case settlement value they deserve.

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