Persistent pain and the injured worker: Integrating biomedical, psychosocial, and behavioral factors in assessment.

Health care providers are often asked to determine the level of impairment, degree of disability, and rehabilitation potential for injured workers. Compalints of persistent pain and especially compalaints that are: (1) not substantiated or that are disproportionate to physical pathology identified by physical examination and laboratory diagnostic procedures, or (2) that prove to be differentially responsive to identical treatments that are technically appropriate cause a great deal of frustration for health care providers and third-party payers. Much of the confusion in this area relates to the minimal association between (1) the extent of impairment and degree of disability, and (2) between the magnitude of physical pathology and severity of the pain report. In this paper, we discuss factors that contribute tothe frustration and confusion and propose a comprehensive biobehavioral model that integrates biomedical, psychosocial, and behavioral variables. We also present an assessment model, the Multiaxial Assessment of Pain (MAP) patients, and describe operationalizations of the primary components of this model.