A Review of Evidence-Based Biopsychosocial Laws Governing the Treatment of Pain and Injury
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The impact of scientific findings on medical, psychological, and legal concepts has led to the adoption of laws and regulations that do not easily fit into the established legal categories of medical law or mental health law. Instead, this convergence of forces has resulted in laws and regulations mandating biopsychosocial treatment guidelines, where both medical and psychological cares are integrated within the framework of a single paradigm. Laws and regulations of this type have been adopted by a number of US states and Canadian provinces, and could be considered to represent a new category, for which we offer the term “biopsychosocial law.” Biopsychosocial laws currently pertain to medical treatment guidelines for workers’ compensation, a medical treatment system noted for high costs, high levels of litigation, and psychological involvement. There are a number of examples of biopsychosocial laws, but the most noteworthy are based on guidelines developed by the Colorado Division of Workers’ Compensation, the American College of Occupational and Environmental Medicine, the Work Loss Data Institute, and The Reed Group. These guidelines differ significantly with regard to features, conditions covered, and strength of evidence basis. However, all of these guideline systems were developed with the intent of providing good care while controlling costs, are evidence based, integrate the practice of medicine and psychology, and are legally mandated in certain jurisdictions. Taken together, these guidelines represent a growing convergence of scientific evidence, professional society positions, payor policies, and legal regulations. These forces are propelling a broad societal shift away from Cartesian assumptions that the body and mind are separate, and toward a biopsychosocial paradigm for the treatment of injury and illness.
KeywordsBiopsychosocial Law Chronic pain Disability Workers’ compensation Psychological testing Guidelines Evidence-based methods
The authors would like to express their deep appreciation to Marty McReynolds and Barbara Fahmy of the Colorado Division of Worker Compensation, whose help made this article possible.
Dr. Bruns served on the Colorado task forces that developed the psychiatric impairment, chronic pain, and chronic regional pain syndrome medical treatment guidelines, and the advisory panels for low back pain, cervical spine injury, and traumatic brain injury medical treatment guidelines. He also led the development of the Colorado Division of Work Compensation review of psychological tests, which has since been adopted by the Official Disability Guidelines (ODG) and the California Medical Utilization Schedule (MTUS). Dr. Bruns also served on the panel that wrote the ACOEM Chronic Pain Guidelines and as a reviewer for the American Medical Association’s Guides to the Evaluation of the Permanent Disability, 6th edition.
Dr. Mueller is the Medical Director of the Colorado Division of Workers Compensation and has led development of all of the Colorado Medical Treatment Guidelines. She served as a co-chair for the ACOEM chronic pain guidelines and on the panel for the low back ACOEM guidelines. She was one of the six section editors for the AMA Guides to Permanent Impairment, 6th edition, and is a frequent lecturer for the American Board of Independent Medical Examiners. Dr. Mueller was a co-author for the recent Workers Compensation Research Institute (WCRI) monograph reviewing patterns of treatment for low back pain in 14 different states and is currently authoring revisions to the Medical Disability Advisor’s (MDA) rehabilitation summaries.
Dr. Warren served on the panel that wrote the ACOEM Chronic Pain Guidelines and is also serving on the ACOEM Mental Health Guidelines. Her book, The Management of Workplace Mental Health Issues and Appropriate Disability Prevention Strategies, was published by the Work Loss Data Institute, which also published the Official Disability Guidelines (ODG). Dr. Warren also served on the Reed Group’s Medical Disability Advisory (MDA) board, and as a reviewer for the American Medical Association’s Guides to the Evaluation of the Permanent Disability, 6th edition.
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