What Back Patients Need to Understand about Pain, Function and Disability

The terms pain, function and disability describe different aspects of the pain experience, and each has different implications, depending on context. A treating physician addresses a person’s subjective pain rating; physical and occupational therapists focus on how pain impacts ability to perform activities of daily living (function); while third party payers and the legal system are concerned with disability as it relates to the workplace.

What is Pain?

Pain is both a physical and emotional experience, and it is different for each patient. This is why physicians who treat pain base their clinical evaluations on both physical signs and symptoms and the patient interview, paying close attention to any similar experiences in the patient’s history, the individual’s emotional reaction to pain, social support, etc. According to orthopedic surgeon, Gordon Waddell (2004), the initial trigger for back pain is always physical; however, emotions and context play critical roles in how pain is experienced.

What is Function?

Function refers to a person’s ability to complete activities of daily living, such as bathing, dressing, toileting, basic house chores, shopping, and work responsibilities if the person is employed. Although some of this can be determined through patient interviews, some clinicians use a functional capacity evaluation to determine changes in the patient’s abilities and limitations as a result of back pain. This may include cardiovascular fitness, lifting ability and fitness for work (Waddell, 2004). Some rehabilitation experts also recommend a psychological evaluation as part of the process (Bruns & Disorbio, 2015) since a person’s emotional state has a significant impact on their motivation to improve. Contextual factors such as uncooperative co-workers can make patients hesitant to reintegrate back into the workplace. On the flip side, over-solicitous friends and family who encourage passivity can also cause the patient to lose his or her motivation for independence.

What is Disability?

Disability is often used in the medicolegal context of worker’s compensation claims. In this case, disability is typically an administrative determination (Feinberg & Brigham, 2015), based upon a physician’s evaluation. The American Medical Association defines disability as “an umbrella term for activity limitations and/or participation restrictions in an individual with a health condition, disorder or disease,” (AMA, 2007). Disability results from impairment that leads to loss of function. Laws regarding disability vary from state to state, but legal proceedings often involve an independent “disability evaluator” (Feinberg & Brigham, 2015). The physician who performs the evaluation has no physician/patient relationship. The purpose of the evaluation is to provide an expert, objective evaluation of the patient’s condition for use in litigation. It is also important to note that the information in the evaluation is, unlike most medical records, not confidential (Feinberg & Brigham, 2015).

Why Does This Matter?

If a back patient believes that his or her injury is work-related, it is important to understand the difference between clinical and legal evaluations. A clinical evaluation is used to determine the most effective treatment. A legal evaluation determines an employer’s liability, based on the likelihood that the workplace did in fact contribute to a disabling back injury that will result in significant if not permanent inability to return to work. Patients who are pursuing disability claims should familiarize themselves with state and federal laws. The best place to start is with the Social Security Administration. Check out this website for more information.

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