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THE PAIN, ENJOYMENT AND GENERAL ACTIVITY SCALE (PEG) AND WORKERS’ COMPENSATION: WHAT YOU NEED TO KNOW

Posted on February 15, 2021 by Edward Singer

The California Workers’ Compensation System employs various scales and tests to assist with Injured Workers’ evaluation and treatment. One of these tests is the Pain, Enjoyment and General Activity Scale (PEG.)

This article will discuss the PEG Scale and how it can be used within the workers’ compensation system.

Why Are Scales Used in General?

Scales can be used for many reasons. Scales are generally self-reporting. Thus, all that is needed to administer one is a pen, a clipboard, and the questionnaire. Thus, they are a cheap, quick and easy way to extract information from Injured Workers. Scales can show that an injured Worker is credible. They can show that an Injured Worker is malingering or exaggerating. Scales can show a cry for help.

One way a scale can be used Is by comparing them to prior scales. When compared, it can show a patient’s assessment of medical improvement or lack thereof.

Scales are employed by medical examiners, treaters and utilization review evaluators to assess the Injured Workers’ disability status, permanent disability, and whether forms of treatment are indicated and should be approved.

In an article discussing PEG, it was noted that “[t]he competing demands of primary care, in which visits are short and pain is only one of several problems warranting attention, make efficiency of assessment a paramount concern. A balance must be found between feasibility and key characteristics such as reliability, validity, and responsiveness.” Krebs EE, Lorenz KA, Bair MJ, et al. Development and initial validation of the PEG, a three-item scale assessing pain intensity and interference. J Gen Intern Med. 2009;24(6):733-738. doi:10.1007/s11606-009-0981-1

What Is PEG Scale’s Complete Name? How Does It Relate to Workers’ Compensation?

The PEG Scale’s full name is the Pain, Enjoyment of Life and General Activity Scale.

California Workers’ Compensation Law employs the AMA Guides to assess permanent impairment. In the assessment of permanent impairment, Pain is a factor that is considered. Also, Activities of Daily Living is also a factor.

In sum, the scale overlaps some of these issues.

What Does the PEG Scale Consist Of?

The PEG Scale consists of three questions that are rated from 0 to 10.

What is the Pain Scale’s First Question?

The first question is “what number best describes your pain on average in the past week?”

How is the First Scale Question Answered?

The question is answered in a 0 to 10 scale. 0 being “no pain” to 10 being “pain as bad as you can imagine.”

What is the Second Question of the Pain Scale?

The second question is “what number best describes how, during the past week, pain has interfered with your enjoyment of life?”

How is the Second Question Answered?

The question is answered in a 0 to 10 scale. 0 being “does not interfere” to 10 being “completely interferes.”

What is the Third Question on the Pain Scale?

The third question is “what number best describes how, during the past week, pain has interfered with your general activity?”

How is the Third Question Answered?

The question is answered in a 0 to 10 scale. 0 being “does not interfere” to 10, “completely interferes.”

How is the PEG Scale Scored?

The scale is scored by adding up all three numbers and dividing by 3.

What Is the PEG Scale Specifically Used For?

“This scale can be administered in person at a clinic or hospital, answered via phone interview or personally completed at home. It is a flexible scale that can be used for many scenarios. For example, the PEG scale is often used to determine if a medication is effective; using it for this purpose helps determine an individual’s level of functioning while taking medication(s). Individuals who show a stable level of functioning, with no other factors that suggest a dosage adjustment, a medication taper or a medication change is needed, would then continue on their medication regime.” Painscale.com

Is There Any Advice to An Injured Worker?

Yes. These scales will be used possibly for two purposes: first, to evaluate your credibility, and second, to evaluate your improvement with respect to prescription medications and treatment.

Thus, it is best to make your best efforts to accurately answer them.

What If I Need Advice?

If you would like a free consultation regarding workers’ compensation, please contact the Law Offices of Edward J. Singer, a Professional Law Corporation. We have been helping people in Central and Southern California deal with their workers’ compensation cases for 27 years. Contact us today for more information.

THE QUEBEC BACK PAIN DISABILITY SCALE AND WORKERS’ COMPENSATION: WHAT YOU NEED TO KNOW

Posted on December 24, 2020 by Edward Singer

For both workers’ compensation treatment and evaluation, Injured Workers are frequently asked to fill out surveys concerning their medical conditions. The Quebec Back Pain Disability Scale (QBPDS) is one of those surveys.

This article will discuss how and why such scales are used within the workers’ compensation system, what is the Quebec Back Pain disability Scale, what questions are asked within the scale, how the scale is scored? and what it can mean to a workers’ compensation claim.

What is the QBPDS?

This questionnaire is one that addresses back pain. It inquires as to the daily activities that impacted by Back Pain.

Why are Surveys and Scales Used?

Surveys and Scales which ask the Injured Worker to self-report on their conditions are helpful to both treating doctors and evaluators. First, they are a cheap quick method of getting some insight into the Injured Worker’s complaints. Second, they can give the doctor or evaluator a sense of how serious the worker perceives their injury. Third, they can give some insight as to whether someone is exaggerating with respect to the complaints. Fourth, if the same scale is administered over time, it can reveal some insight as to the course of the injured Worker’s condition. Repeated testing may show whether the Injured Worker sees their pain improving, staying the same, or getting worse.

What are the QBPDS Questions Asked?

There are twenty questions asked within the inventory. The questions are about getting out of bed, sleeping through the night, turning over in bed, riding in a car, standing up for 20-30 minutes, sitting in a chair for several hours, climbing one slight of stairs, walking a few blocks, walking several kilometers, reaching up to high shelves, throwing a ball, running one block, taking food out of the refrigerator, making your bed, putting socks or pantyhose on, bending over to clean the bathtub, moving a chair, pulling or pushing heavy doors, carrying two bags or groceries, and lifting and carrying a heavy suit case.

Note: The questions are interesting in that they include activities that an individual may rarely or never participate in. For example, there are some people who do not throw balls or handle suit cases.

How Are the Responses Scored?

There are five responses that can be made. They are not difficult at all, minimally difficult, somewhat difficult, fairly difficult, very difficult, and unable to do. They are scored from 0-5.

Note: The responses address ability to perform activities as opposed to the individual’s pain experience.

What Do the Scores Mean?

A higher score represents a greater level of perceived functional disability. A lower score represents a lower level of perceived functional disability.

Is The QBPDS Helpful for Treating Evaluators and Physicians With Respect to Permanent Disability Assignment?

In California Workers’ Compensation Law, Activities of Daily Living are a basis for making impairment assessments. Impairment assessments render a Whole Person Impairment which then translates into a Permanent Disability Percentage. The QBPDS can be helpful to an evaluator on their assessment. The Activities of Daily Living based upon the AMA Guides 5^th Edition are Self-care: urinating, defecating, brushing teeth, personal hygiene combing hair, bathing, dressing oneself, and eating, Communication: writing, typing, seeing, hearing, and speaking, Physical activity: standing, sitting, reclining, walking, and climbing stairs, Sensory Function: hearing, seeing, tactile feeling, tasting, smelling, Nonspecialized Hand Activities: grasping, lifting, tactile discrimination, Travel: riding, driving, flying, Sexual Function: orgasm, ejaculation, lubrication, erection, and Sleep: restful and nocturnal sleep pattern.

The QBPDS does not explore self-care and sexual function. Therefore, it is not fully comprehensive to render an ADL assessment.

As an Injured Worker, What Should I Do When I Fill Out These Scales?

When fill out these scales, try to be accurate as possible. Sometimes, I personally roll my eyes when I see scales in which every answer is the highest.

What if I Need Advice?

Wong-Baker Pain Scale & Workers’ Compensation

Posted on October 4, 2020 by Edward Singer

Frequently Injured Workers, when attending workers’ compensation evaluations and treatment are asked to fill out a lot of questions and forms. One of these forms that they may have to fill out is the Wong-Baker FACES® Pain Rating Scale.

These Scales can impact an Injured Worker’s industrial claim.

This article will discuss the Wong-Baker FACES® Pain Rating Scale, how It is used in a Workers’ Compensation claim, and how it can impact an Injured Worker’s claim.

What is the Wong-Baker FACES® Pain Rating Scale?

The Wong-Baker Pain Rating Scale is a tool which is used to allow for patients to provide a self- assessment of their pain. It was created by Donna Wong and Connie Baker in 1983 to help children communicate about their pain. .

Part of the goal is to improve the assessment by using the scale for the purposes of assisting in pain management. The Wong-Baker Faces Foundation indicate that the Scale is self-assessment tool [that] must be understood by the patient, so [that[ they are able to choose the face that best illustrates the physical pain they are experiencing. The Foundation note that the Scale is “not a tool to be used by a third person, parents, healthcare professionals, or caregivers, to assess the patient’s pain. There are other tools for those purposes”.

What Does the Scale Look Like? How It is Scored?

The picture above is a version of the scale. This picture was taken off of the Wikipedia article. The Scale is copyrighted. The Scale is proprietary. Therefore, if you are interested in the material you should contact the Foundation.

The instructions for its usage is to “explain to the person that each face represent a person who has no pain(hurt), or some, or a lot of pain.” “Face 0 doesn’t hurt at all. Face 2 hurts just a little bit. Face 4 hurts a little bit more. Face 6 hurts even more. Face 8 hurts a whole lot. Face 10 hurts as much as you can imagine, although you don’t have to be crying to have his worst pain.”

The person is asked to choose the face that best depicts the pain they are experiencing. Supra.

Besides the Scale, the Patient may be asked to “to mark their areas of pain on a drawing of a human figure then rate each area using the faces scale.”.

What Was This Scale Designed for? What is Your Opinion Concerning It?

Originally, it was designed for children to help them communicate their pain.

In California, there are a number of Injured Workers who do not speak English. There are some Injured Workers who are illiterate. Some are illiterate even in their language of origin. This type of Pain Scale can assist these individuals express themselves with respect to their pain. It is noted by the Foundation that for children there was “considerable difficulty using any scale with unfamiliar words or scales based on numbering or ranking concepts. The use of the Numeric Rating Scale [were] growing in popularity at this time, but young children had trouble using the numbers.” Thus, this type of scale is of some value with certain Injured Workers.

With respect to other workers, the Scale is more problematic. In the world of workers’ compensation, there is a focus on activities of daily living and how an injury impacts them. This particular scale, while it may be effective with respect to ascertaining pain information for other reasons, does not provide information used for disability assessment in the workers’ compensation system.

With respect to Adults, pain is viewed must differently than with children. Adults react to pain as an irritation, a distraction, frustration, and may generate anger and upset. Adults do not necessarily cry because of their pain. Most adults, however, can understand how the scale signifies a range from no pain to extreme pain. In sum, its inquiry is superficial. Again, this is not an indictment of the Scale, it is simply the problem that occurs when it is employed for something it was not intended for.

How Can The Wong-Baker Scale Be Used For In Workers’ Compensation?

In my opinion, the Scale may have some credibility value. Also, it may document the trajectory of an Injured Worker’s condition. If this Scale is used on multiple occasions, one can look to see how consistent the reporting it. Also, it can possibly bring light to possible exaggeration. Scores at level 10 may give rise to suspicion of exaggeration.

Any Advice Concerning the Scale?

It is very important for Injured Workers to try to be accurate with respect to the score. While providing a “10” may be a “cry for help,” I would suggest that the Injured Worker actually “cry for help” and tell the evaluator or treater that they are experiencing some level of frustration with respect to their treatment and their relief from the pain. This will prevent an allegation of exaggeration.

What If I Need Advice?

If you would like a free consultation concerning any workers’ compensation case, please contact the Law Offices of Edward J. Singer, a Professional Law Corporation. They have been helping people in Central and Southern California deal with their worker’s compensation cases for 28 years. Contact us today for more information.