Articles from prior issues of The Advocate

July/August, 1999

Chronic Pain and Disability Determination: A Psychological Perspective
Presented By Robert Hodes, Ph.D.
by Judy Nesbitt, Illinois DDS

DR. HODES BEGAN HIS PRESENTATION with the statement that he was not going to tell us how to fill out an RFC. He stated that approximately 10% of SSDI/SSI claims include a primary allegation of severe chronic pain but without “adequate” physical findings. Pain is a symptom and no basis of finding for a disability unless there are medical signs and laboratory findings.

Process Unification training taught us that no symptom can be the basis for a finding of disability unless there are medical signs and findings demonstrating the existence of a medically determinable physical or mental impairment that could reasonably be expected to produce the symptoms.

To determine an individual’s ability to do basic work activities, the adjudicator must make a finding about the credibility of the individual’s statements about the symptoms and its functional effects.

The allegation of severe chronic pain is difficult for the disability program to handle because it is no based on concrete findings. Out evaluation system is not set up to handle pain symptoms very well since symptoms are objective. It is hard to observe and evaluate pain symptoms. Our disability program is dualistic in purpose where we separate the physical and mental problems. However, Dr. Hodes stated that this is not how it exists in the real world or even in our neurological system.

What mental impairments commonly accompany or produce chronic pain symptoms? How can one assess the credibility of these complaints? His response to these questions includes the mental impairments of somatoform disorder, major depression, anxiety disorder and personality disorder. He continues that pain disorder associated with just a general medical condition is not a psychiatric problem.

Unexplained medical symptoms are much more common in claimants with a history of major depression or anxiety than in any other medically ill patients. Dr. Hodes states that everyone who applies for disability has a secondary gain such as some tangible benefit. Furthermore, people who develop a life style of pain disorders do so because they want a secondary gain. Psychological factors such as ineffective coping skills, self-defeating beliefs and chronic anger are all psychological factors for the chronic pain patient but are difficult to pick out in an examination (mental status).

Dr. Hodes went on to describe the various mental impairments in their relation to chronic pain symptoms. He states that claimants with somatization disorders usually have a very large case file. In fact, this type of disorder can be weighted on a scale - take the case file out and put it on an actual scale and see how much the file weighs. Many adjudicators are fairly comfortable to check to see if people who have chronic pain disorders also have major depression. However, they are less comfortable to associate chronic pain with anxiety. Post traumatic stress disorder often results in pain disorders after an injury or accident.

Dr. Hodes concludes that very few good perspective studies of claimant’s with chronic pain syndromes exist. There appear to be typical patterns for chronic pain syndromes. Finally, the adjudicator must consider the many factors of suspected malingering or exaggeration when evaluating the disability of chronic pain disorders.