AMA Guides 6th Edition - Tennessee

[Pages:47]AMA Guides 6th Edition

IAIME and TN Bureau of WC James B. Talmage MD

AMA Guides, 6th Edition, Chapter 15 & 16 Complex Regional Pain Syndrome

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Questions ?

James B. Talmage MD, Occupational Health Center,

315 N. Washington Ave, Suite 165 Cookeville, TN 38501

Phone 931-526-1604 (Fax 526-7378) olddrt@ olddrt@occhealth.md

"When All Else Fails,

READ the INSTRUCTIONS."

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Complex Regional Pain Syndrome

? "The hallmark of this condition is a characteristic burning pain that is present without stimulation or movement, that occurs beyond the territory of a single peripheral nerve, and that is disproportionate to any suspected inciting event." ? p 450-451and p 538

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Complex Regional Pain Syndrome

? Pages 450-454 and 538-542

? Type I (RSD)

? NO nerve injury, and

? Type II (Causalgia)

? Definite nerve injury @ onset

? Highly controversial

? All associated physical and radiologic findings can be due to disuse.

? Differential Diagnosis: includes disuse atrophy,

unrecognized general medical problems,

somatoform disorder, factitious disorder, and

malingering

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Malingering and Factitious

Disorder Do Occur

? Mailis-Gagnon reported that 4 of 15 women who met the 1994 IASP criteria for CRPS had evidence of active self-inflicted signs which abated with casting, strict observation, etc.

? [Mailis-Gagnon A, Nicholson K, Blumberger D, Zurowski M. Characteristics and Period Prevalence of Self-induced Disorder in Patients Referred to a Pain Clinic with the Diagnosis of Complex Regional Pain Syndrome. Clinical Journal of Pain 2008; 24 (2): 176-185]

Malingering and Factitious Disorder Do Occur

? Other small case series of patients with factitious disorder or malingering have been published.

? [Taskaynatan MA, Balaban B, Karlidere T, Ozgul A, Tan AK, Kalyon TA: Factitious disorders encountered in patients with the diagnosis of reflex sympathetic dystrophy. Clin Rheumatol 2005;24(5):521-526.]

This Means ...

? A forensic psychiatric evaluation should be performed

? NOT by a masters level psychologist who routinely "rubber stamps" patients as "appropriately depressed" and "OK for invasive pain procedures"

? NOT by a PhD or MD who routinely says "Axis II DEFERRED"

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