Chronic Pain and the Disability Epidemic

Aronoff, Gerald M.

doi:10.1097/00002508-199112000-00013

Cited by 49 publications

(31 citation statements)

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“…Suicide among children and teenages has risen dramatically, the divorce rate soars, and there is an increased incidence of the category `depression' in the hospital admission or discharge summaries of individuals with `physical' pain (Aronoff, 1991). Society appears extremely unhealthy.…”

Section: Introductionmentioning

confidence: 99%

“…The health care professional and the patient become increasingly uncertain as to the most appropriate course of treatment and both develop a sense of impotence and helplessness. As each becomes frustrated and disappointed in the other, their interaction becomes more strained and less direct (Aronoff, 1991).…”

Section: Introductionmentioning

confidence: 99%

“…Between 1971 and1981, the number of people with disabling back problems increased 168% whereas the population increased by 12.5% (Gatchel et al, 1994). Aronoff (1989Aronoff ( , 1991 has termed this a `disability epidemic' and believes it has become a major public health problem in the US and other countries where entitlement programs are believed to be appropriate alternatives to gainful employment.…”

Section: Introductionmentioning

confidence: 99%

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Preventing disability from chronic pain: a review and reappraisal

Aronoff

Feldman²

2000

International Review of Psychiatry

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Chronic pain and disability are closely related. Evidence supporting the role of the central nervous system (cortical and limbic system), as opposed to peripheral, nociceptive processes, in the development and maintenance of chronic pain is reviewed. This includes the phenomenon of central sensitization, relevant limbic-cortical processes, and psychiatric diagnoses often co-morbid with chronic pain. Psychological and socioeconomic `red flags' for a poor return to work prognosis are delineated. The critical importance of cognitive beliefs and, therefore, physician statements to patients concerning their medical condition, resulting restrictions, and limitations is emphasized. The relationship between motivation, performance, and patients' beliefs about what they can do (self-efficacy) and what will happen when they return to work is discussed. The need for a comprehensive interdisciplinary approach oriented towards functional restoration to enable patients with chronic pain to reach maximum medical improvement (MMI) is reviewed. It is argued that psychiatry, with a bio-psychosocial perspective is uniquely qualified to evaluate and treat chronic pain.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Preventing disability from chronic pain: a review and reappraisal

Aronoff

Feldman²

2000

International Review of Psychiatry

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“…Although formal evaluations of effort in testing and symptom validity ought to constitute essential components of all assessments, they are at times erroneously considered narrowly to be a proxy for malingering detection in disability evaluations. Historically, the concept of "secondary gain" has become one of the core yet most commonly misinterpreted constructs in the forensic model of disability (Aronoff 1991;Kennedy 1946;Mendelson 1994;Schultz et al 2000). The misinterpretation of "secondary gain" has been detrimental to the development of other motivational constructs involving gains and losses associated with disability that have a potential to more comprehensively and accurately explain the relationship between impairment and disability (Dersh et al 2005;Fishbain et al 1994;Kwan et al 2001;Leeman et al 2000).…”

Section: Beyond Malingering Detection: the Economy Of Gains And Lossementioning

confidence: 99%

Determining Disability: New Advances in Conceptualization and Research

Schultz

2009

Psychol. Inj. and Law

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This special issue of Psychological Injury and Law on disability presents state-of-the-art conceptualization and empirical research that will help psychologists and attorneys in the area of disability determination. This paper constitutes an introduction to and contextualization of the articles in the issue. It focuses on key advances in the field of disability research that are anticipated to move forward the practice of psychological injury and law. These new advances include the following: (1) a theoretical shift toward an integrative and dynamic biopsychosocial framework of health and disability, (2) development of complex multidimensional constructs of motivation, including primary, secondary, and tertiary gains and losses involved in disability claims, (3) increased emphasis on the perception of fairness and justice in disability claims from both psychological and legal perspectives, (4) increased understanding of the functional impact of psychological impairment, (5) inclusion of age-related factors in predicting disability, and (6) the interdisciplinary growth of this field. Although disability prediction and determination constitute the key objectives of clinical and forensic assessments in psychological injury, they are still poorly understood (Schultz and Stewart 2008;Schultz 2008). There are no evidence-based practice guidelines in this field and limited access to graduate and postgraduate training as well. Historically, research in this discipline has been fragmented and guided by disparate conceptual frameworks and methodologies. Forensic psychologists providing disability testimony have been thus vulnerable in court.The purpose of this special issue of the journal Psychological Injury and Law on the topic of disability is to introduce readers to a cross-section of the newest advances in the conceptualization of and research in occupational disability. The papers selected for this special issue are highly representative of the multifold theoretical and empirical developments that are bound to challenge, inform, and advance the field of psychological injury and law for years to come.Theoretical and empirical advancements in the field of disability determination have been long overdue (Schultz 2008;Schultz and Stewart 2008). These developments have not yet been in keeping with the so-called "disability epidemic," i.e., growing statistics of temporary and permanent disability claims, particularly those involving complex and comorbid mental health disabilities (Gnam 2005), pain, and postconcussional sequelae.The development of improved conceptual and evidentiary underpinnings for disability determination in psychological injury and law will assist forensic psychologists in applying the best practice standards and guidelines, as well as help treatment providers in dealing with disability issues. Furthermore, these advances will serve to inform litigation practices on both the defense and plaintiff side in the area of psychological disability and, from a long-term perspective, facilitate legisla...

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“…In parallel, simulation has expanded enormously. Aronoff [23] estimated that one third of people attending the Boston Pain Clinic had "learned how to be pain patients" and another third complaining of pain did not deserve health care.…”

Section: Iatrogenesismentioning

confidence: 99%

Epidemic occupational pseudo-illness: The plague of acronyms

Bell¹

2000

Current Review of Pain

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Genuine disorder caused by repetitive movement has unmistakable features vitally different from occupational pseudo-illness, which comes and goes in new guises and massive epidemics wherever the label legitimizes gain from compensation. The assumption of an existing label such as the carpal tunnel syndrome gives the false idea of greater potential for deception. The solution to the menace lies in logical reasoning, which recognizes falsity before it begins to dominate the minds of the community.

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Chronic Pain and the Disability Epidemic

Cited by 49 publications

References 0 publications

Preventing disability from chronic pain: a review and reappraisal

Preventing disability from chronic pain: a review and reappraisal

Determining Disability: New Advances in Conceptualization and Research

Epidemic occupational pseudo-illness: The plague of acronyms

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