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You may wish to visit this site, from which the following are excerpts.
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Pain
Managed Care and Pain
Acute and Chronic Pain in Sickle-Cell Disease
Quality Improvement Guidelines for the Treatment of Acute Pain and Cancer
Pain
Pain Forum

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Contact the Editor:
Jan Frandsen, MSN CRNP
webeditor@...

Contact APS:
American Pain Society
4700 W. Lake Ave.
Glenview, IL 60025
847-375-4715
fax: 877-734-8758 [Toll Free]
info@...

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MAY/JUNE 1999 . VOLUME 9, NUMBER 3

Pain and Public Policy

Michael A. Ashburn, MD, and Corey D. Fox, PhD, Department Editors

Chronic Pain and the Americans with Disabilities Act

Most pain practitioners regularly encounter cases in which the resolution of
patients disability is important to ensure clinical success and pain program
credibility. Such cases generally involve workers compensation claims and,
to a lesser degree, beneficiaries or claimants of the Social Security
Disability Insurance Program (SSDI) or private long-term disability (LTD)
programs. However, pain practitioners generally have only minimal contact
with issues and cases surrounding the Americans with Disabilities Act (ADA)
(1990). The ADA is an important program that illustrates many of the
challenges of successfully addressing disability management issues for
people with chronic pain.

Background
The movement to establish rights for people with disabilities has a long
history, which will not be reviewed here. Federal legislation aimed at
reducing discrimination against people with disabilities dates back to at
least 1968, when bills similar to the ADA began to be introduced. The ADA
was signed into law in 1990, and most of the employment provisions became
effective in 1992.
The ADA employs the same definition of disability employed in Section 504 of
the Rehabilitation Act of 1973. A person with a disability is considered
someone who

has a physical or mental impairment that substantially limits that person in
some major life activity;

has a record of such a physical or mental impairment; or

is regarded as having such a physical or mental impairment.

Practitioners are concerned primarily with the provisions of Title I of the
ADA, which prohibit employers with 15 or more employees from discriminating
against people with disabilities for purposes of hiring, promotion,
discharge, benefits, or any other aspect of employment. These provisions
apply to all current or prospective employees who are qualified, which means
that employees with disabilities must be able to perform the essential
functions of a job, whether or not employers provide reasonable
accommodations for them. Furthermore, employers should experience no undue
hardship or threats by hiring or retaining such employees or by providing
reasonable accommodations for them.



Effect of the law
There is considerable controversy among disability advocates and employers
about the effect of the ADA on the employment of disabled people. About
two-thirds of Americans with disabilities were unemployed in 1994, a rate
that is nearly identical to the rate in 1986, but the proportion of
unemployed people with disabilities who say they want to work has risen from
approximately 66% to 79% (LaPlante, 1997). This trend cannot reasonably be
attributed to the ADA, but the beneficial effects of the statute certainly
have not been realized.
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The principal employer violations cited in EEOC complaints, in order of
frequency, have included

Unwarranted discharge

Failure to provide reasonable accommodations

Harassment

Hiring violations

Discipline

Layoffs

More than 80% of the complaints have alleged either unwarranted discharge or
failure to provide reasonable accommodations. The ADA was intended to
prevent these types of discrimination against people with disabilities.
However, the statutes impact on employment practices has not been
systematically evaluated, and complaints based on soft diagnoses, such as
back conditions and mental health problems, continue to be variable.
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Most physicians are not in the best position to determine whether a patient
is a qualified individual with a disability because he or she is found to be
able to perform the essential functions of a job. This type of evaluation
requires considerable familiarity with the physical, cognitive, and
behavioral parameters of a particular job. With given impairments documented
by medical evaluation, such assessments are best performed by occupational
and vocational experts in consultation with the employer.

A prescription for reasonable accommodations usually cannot be performed on
a medical basis. For most chronic pain patients, the relationship between
pain, impairment, and functional capacities cannot be evaluated objectively,
because the roles of effort, incentives, and various psychological factors
cannot be adequately taken into consideration. When medical restrictions
(e.g., rest periods, lifting restrictions, work tasks) are promulgated,
defensive attitudes on the employers part are often reinforced, and the
certification of disability may itself exacerbate the suffering and
dysfunction of the claimant (Loeser & Sullivan, 1995). It is usually more
productive for the practitioner to generate medical reports delineating
objective medical impairments (or the lack thereof) and to ensure referral
to the appropriate disability management specialists.

Generally, practitioners are not able to facilitate patients return to work
through disability evaluations and accommodation recommendations. Employers
are most likely to accommodate their valued employees (with or without ADA
protections) whether or not they suffer from pain problems, and the
physicians role in this process is usually maximized by facilitating
communication rather than delineating parameters for work.
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