The first question I ask when evaluating a Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) claim for chronic pain is “are you seeing a specialist? I am surprised that many potential clients that have been experiencing chronic pain for an extended period have never seen a specialist. Although I respect family care physicians, and believe that they play an important role in pain treatment, it is rare for an individual to be approved for Social Security disability benefits when they are solely under the care of a family physician.
When reviewing disability, the Social Security Administration requires medical proof of your disability. This means that the Social Security Administration will look for objective results that support your limitations. It is important that your treatment records contain details reflecting your symptoms, your response to treatment, results of diagnostic testing, and a plan of treatment.
The Medical Society of Delaware (“MSD”) is a society of physicians with the core purpose to “guide, serve and support Delaware physicians, promoting the practice and professional medicine to enhance the health of our communities”. In May 2006, MSD developed treatment guidelines for chronic pain. Although MSD abandoned the development of new guidelines in February 2009, the previously developed guidelines remain available for review.
According to MSD, the guidelines were created to assist primary care physicians in treatment of patients with chronic pain in recognition that chronic pain causes physical and emotional suffering of patients. It is specifically recommended by MSD that consultation with specialists be incorporated into the patient’s treatment plan. Physicians are directed to consider not only the pain diagnosis, but also emotional and functional impact pain has on their patients.
The following areas are notable in the guidelines:
- The diagnosis of a painful condition should include an extensive differential diagnosis that rules out treatable and reversible etiologies while rationally managing symptoms of severe pain.
- An initial assessment of chronic pain should include a detailed history (including vocational issues related to pain), full physical exam, consideration of diagnostic studies, differential diagnosis, and a plan of care. The plan of care should be developed with consideration of patient’s history, examination, and goals.
- When implementing a treatment plan, physicians are instructed to ask about pain regularly, accept patient reports of pain, intervene early, and provide information that helps empower patients to make appropriate decisions.
- Timetables should be developed and the rationale of treatment should be discussed with patients. Documenting the treatment by measuring the progress of pain is essential.
- Objective examination results that reveal abnormalities should raise red flags that lead to specialist referral.
- After diagnostic assessment of pain, conventional treatment (including physical therapy, exercise, chiropractic evaluation and short acting pain medications) should be followed by specialist referral if no improvement in symptoms after more than 6 weeks of treatment.
- Family physicians should determine if psychiatric symptoms exist and consider referral for psychiatric or psychological assessment.
- After an initial treatment plan is created, physicians should monitor and record changes in medical history, perform a focused exam to correlate subjective complaints, observe functional limitations, order and review diagnostic testing, and revise the treatment plan based on the patient’s response to treatment.
The guidelines suggested by MSD explain why specialist care is important when you suffer from long-term chronic pain. If your family physician has not referred you for specialist care, it is important that you discuss and question that decision. If your pain fails to respond to the treatment that you are receiving, suggest additional care to better evaluate your symptoms and discuss the guidelines with your physician.
I am not suggesting that a family physician should not be involved in chronic pain treatment, only that your physician should realize when additional care is needed. The plan for pain management care should be reviewed with your family physician, and your family physician should manage and coordinate your care with other physicians. The purpose of these guidelines is to help you obtain relief of your pain. If your physician follows these guidelines, your condition will be better documented, you will receive heightened care for your condition, and it will ultimately be more likely that you will qualify for Social Security disability benefits if your condition fails to improve.
This article was written by Steven Butler. Steven is a partner at Linarducci & Butler, PA and his practice is limited to Social Security Disability/SSI claims. Steven offers free initial consultations for Social Security Disability/SSI claims to residents of Delaware, Maryland, New Jersey and Pennsylvania. To schedule a consultation with Steven, please use the Linarducci & Butler Contact Form or call 302-613-0707 to schedule an appointment.
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