Pain disorders are generally classified in one of four classes, ranging from mild to severe. The following checklist can be reviewed to determine impairment classifications as a result of pain disorders.
Class 1 — mild
- The pain severity, resulting from a combination of both intensity and frequency, is considered mild.
- The individual’s pain is only be mildly aggravated by performing activities of daily living, and the individual is generally able to perform them with few, if any, modifications.
- The individual demonstrates either little or no emotional distress when responding to pain.
- The individual does not receive treatment for pain on a regular basis.
- Any pain-related limitation during the physical examination will be mild and appropriate with few pain behaviors or over-expressions, such as moaning, limping, guarded reaction, grimacing and the like during examination.
Class 2 — moderate
- The pain severity, based on both intensity and frequency, is considered moderate.
- The individual has moderate difficulty managing activities of daily living and must make important significant modifications to perform them.
- The individual demonstrates mild to moderate distress in response and relation to pain.
- The individual requires ongoing medical treatment and monitoring, and takes medication much of the time.
- The individual demonstrates pain-related limitations on physical examination and a number of pain behaviors appear during the examination.
Class 3 — moderately severe
- Pain is present most of the time and may reach intensity levels ranging from 9 to 10 on a scale of 1 to 10.
- The individual can perform activities of daily living, but only with substantial modifications, and is unable to perform many routine activities.
- The individual demonstrate moderate to severe distress in response and relation to the pain.
- The individual receives medication to control pain on a maintenance basis.
- On physical examination, the individual demonstrates severe pain-related limitation, and it may be difficult to perform an examination with results also being difficult to interpret.
- Pain behaviors are consistently observed during the examination and appear to be consistent and congruent with organic dysfunction.
Class 4 — severe
- Pain is virtually continuous with intensity reaching the 9 to 10 level consistently and at its worst.
- The individual needs assistance from others for many activities of daily living (including dressing, preparation of food, bathing and the like) and also has to spend a great deal of time accomplishing them.
- The individual demonstrates severe distress in response and relation to the pain, and often indicates that the pain is unbearable or out of control.
- The individual receive the maximum pharmacologic support and medicinal treatment for pain on an ongoing basis.
- Physical examination is virtually impossible to perform because the individual is intolerant of any of the typical examination maneuvers, e.g., unable to ambulate to allow palpation and the like.
- The pain behaviors observed appear to be congruent with organic dysfunction.
Sample pain questionnaire
Many physicians use a pain questionnaire, which allows for self-reporting of severity. One such example follows: