Principles & Practice of Pain Medicine > Part VII. Pain, Administration and the Law > B. Legal and Ethical Issues > Chapter 84. Disability Assessment of Pain-Impaired Patients Joseph Audette and Michael Schaufele

Functional Assessment Methods in Pain Patients

"Disability assessment should be viewed as an attempt to determine the behavior or performance of an individual in a specific context.¹⁶ Loss of a specific function such as the inability to bend to pick up a 15-lb box at work may coexist with the ability to bend and pick up a 30-lb, 3-year-old child. This functional dissonance can exist without conscious malingering because of the powerful differences between the absolute inability to perform a task versus the inability to perform a certain task comfortably in a specific environmental context. This makes the differentiation between those who cannot work from those who do not want to work quite difficult. Pain is subjective and is influenced by environmental factors. Impairments and disabilities may fluctuate depending on the situation in which a chronic pain patient finds himself.Since pain is a multidimensional experience and is private and subjective in nature, it may be the most difficult measurement to perform in health assessment. Its results often do not follow the basic requirements of psychometric measurement, that is, reliability and validity. Pain measurement can capture two dimensions of the pain experience; namely, the sensory aspects of the pain and the person's emotional reaction to the pain. Although most clinical applications use fairly simple intensity scales, newer measurement methods are starting to evolve. Based on sensory decision theory, these methods attempt to distinguish the stimulus strength from the subjective response. It has been demonstrated, for..."