Chronic Pain, AMA Guidelines & The LAT

Approximately 1 in 4 Canadians lives with a chronic pain condition.

When a chronic pain condition is the result of an accident, certain guidelines must be used to define the condition. With time, those guidelines can change, and that has an impact on the individuals affected, personal injury law, and, of course, compensation.

Recently, the License Appeal Tribunal (LAT) made a decision that involved chronic pain guidelines that may have an effect on future personal injury cases. Today, we’re talking about that decision and what it means for individuals seeking chronic pain status.

AMA Guidelines on Chronic Pain

Defining injuries and their extent typically relies on the criteria set by the American Medical Association (AMA). In terms of chronic pain, doctors and courts often rely on the AMA Guides to the Evaluation of Permanent Impairment.

The most recent criteria for diagnosing chronic pain appear in the 6th Edition of the AMA Guides. The criteria are as follows:

  • Use of prescription drugs beyond the recommended duration and/or abuse of or dependence on prescription drugs or other substances
  • Excessive dependence on health care providers, spouse, or family
  • Secondary physical deconditioning due to disuse and or fear-avoidance of physical activity due to pain
  • Withdrawal from social milieu, including work, recreation, or other social contracts
  • Failure to restore pre-injury function after a period of disability, such that the physical capacity is insufficient to pursue work, family or recreational needs
  • Development of psychosocial sequelae after the initial incident, including anxiety, fear-avoidance, depression, or nonorganic illness behaviors

The guidelines state that three of these six criteria must be met in order for a health care professional to diagnose chronic pain.

A New Authoritative Source for Chronic Pain Definitions?

The definition outlined above is the latest provided by the AMA. Previously, health care professionals relied on the 4th edition of the AMA Guides to the Evaluation of Permanent Impairment, published in 1993. Although one may assume that the latest definition supersedes the previous definition, that has not always been the case.

However, in a recent decision, the LAT adopted the latest definition, noting that it may be an “authoritative source” moving forward. The decision in this case is not binding to future cases, but it is of interest to future chronic pain cases.

Nguyen v Allstate

The definition of chronic pain is especially important in MIG cases. This is because the chronic nature of some minor injuries, as defined by the Statutory Accidents Benefits Schedule (SABS), means that recovery isn’t possible under the MIG limits.

Such was the case in Nguyen v Allstate. Nguyen had received a presumptive diagnosis of chronic pain syndrome from his orthopedic surgeon. His surgeon had found that he satisfied two of the criteria for chronic pain: duration and dysfunction.

The criterion used to come to this diagnosis was that of the 4th edition of the AMA Guides. As such, the Respondent argued that the diagnosis of chronic pain was not accurate because the guidelines for diagnosing chronic pain had been updated in the 6th edition.

The LAT Decision

The LAT held that the presumptive diagnosis of Nguyen’s orthopedic surgeon was “not convincing”.  Because the LAT was not provided a copy of the 4th or 6th editions of AMA Guides, they were unable to assume that satisfying two of the diagnostic criteria was sufficient for a presumptive diagnosis.

As such, the LAT stated that the orthopedic surgeon didn’t properly apply the “factors to be taken into consideration” and that the concept of presumptive diagnosis means that there is likely more criteria required to confirm the diagnosis. Furthermore, the LAT held Nguyen’s injuries to the upper and lower spine as well as his diagnosis were clearly within the criteria for minor injuries. They added that the use of the word chronic did not change that fact.

Perhaps most importantly, the LAT stated that “The 6th Edition published in 2008 better reflects the development of defining and understanding chronic pain syndrome than the 4th Edition published 15 years earlier”. It’s this reliance on the latest AMA Guides that could potentially impact the future of chronic pain cases.

Are You Suffering from Chronic Pain as the Result of an Accident?

Chronic pain has a devastating effect on the lives of victims. Adding to the devastation is the difficulty of securing a diagnosis for this condition. But that diagnosis is an important part of getting the compensation your deserve when you’re injured in a motor vehicle accident or as the result of someone else’s negligence.

If you or someone you love is suffering from chronic pain as the result of an accident, you need someone who understands personal injury law through and through, including the most recent changes that can affect your case. Contact us at Sharma Law to find out how we can help.

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