How Much Weight Should Be Given To Pain in Impairment Ratings?
Whether or not to include PRI in the Guides can be frames as a qualitative yes or no question. However, it is more fruitful to from the issue in quantitative terms by asking the following question: How much weight should be given to pain in impairment ratings? Opponents of PRI, in effect, argue that pain (and other subjective factors) should be given zero weight, so that impairment ratings reflect only objective factors. Many proponents of including PRI in the Guides argue not only that pain should considered in impairments ratings but also that a PRI system should permit patients with severe pain to receive impairment awards with high WPI percentages. An impairment rating system could make a “cautious foray into the difficult waters” of PRI assessment by permitting awards to be made for PRI, but capping these awards at a modest level. This describes the strategy used in the Guides’ Fifth Edition, in which PRI capped at 3% WPI. In the absence of persuasive empirical research on the extent to which pain affects the ability of people with medical conditions to function or the measurement problems that arise when PRI is assessed, any dcision about caps for PRI will be perceived as arbitrary.