PR 02005.029 Montana

A. PR 01-117 Use of Chronic Pain Evaluation Form

DATE: March 9, 2001


The Office of Disability did not create and does not sanction the use of the chronic pain evaluation form in question. The form is copyrighted material created by a contractor for the Pain Assessment Instruments Development project; however, the results of the study did not meet SSA's needs so SSA did not publish any chronic pain assessment forms. These forms must be obtained through the publisher, and should not be used under the assumption that SSA or the Office of Disability created them or condones their use.


You have requested our opinion regarding a request from a Dr. S~, one of your consultative examination providers, regarding his use in his medical practice of a form he appears to believe SSA designed to evaluate chronic pain. Specifically, you stated in your opinion request:

Somehow [Dr. S~] came across the following SSA Publication: "Chronic Pain Evaluation by Karen R~, a Valid Standardized Assessment Instrument." There really isn't a Form number. What is on this publication is a SSA Contact [sic] number: 600900229. Apparently this publication is a compilation of forms which can be used to assess one's experience of pain. He is wondering if he can copy these assessment forms for his own use and the use of other doctors in his practice.

Based on information we have received from SSA's Office of Disability (OD), we have concluded Dr. S~ is mistaken in believing that SSA created the forms he wishes to use. Rather, the forms appear in a copyrighted publication and may not be copied. Following is a summary of the information we have discovered from our research.

Because we did not have copies of the forms Dr. S~ wishes to use, we did an Internet search based on the information provided. We discovered that Karen S. R~, M.D., is the author of a book entitled Chronic Pain Evaluation: A Valid, Standardized Assessment Instrument, which was published by Butterworth-Heinemann in 2000. We obtained a copy of this book at the Denver Public Library and found that it is an outgrowth of the SSA-sponsored (Contract #600-90-0229) Pain Assessment Instruments Development project, which was completed in 1994. Dr. R~ was the Principal Investigator. However, Barry E~ (Executive Program Policy Officer at OD) and Victoria D~ (an analyst in OD's Division of Medical and Vocational Policy who served as SSA's manager on the project) have advised that the results of the study did not meet SSA's needs and SSA therefore did not publish any chronic pain assessment forms.

Rather, it appears that Dr. R~ created the forms and published them in the book cited above. Notably, the forms in the book are imprinted with type that states: "Copyrighted--Do Not Duplicate." The book also contains a full-page announcement that physicians may order a pack of 25 sets of pain assessment instruments for $25.00. We are attaching a sample of one page of a form and the ordering information.

In sum, SSA cannot authorize Dr. S~ to make copies of and use the forms because they are covered by copyright. Instead, he must order the forms from the publisher. Furthermore, in conducting consultative examinations for SSA, Dr. S~ should not use these forms under the assumption that SSA has sanctioned their use.

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PR 02005.029 - Montana - 04/26/2002
Batch run: 11/29/2012