Mindestanforderungen an das ärztliche Gutachten zur erwerbsbezogenen Leistungsfähigkeit von Kranken mit chronisch-unspezifischen Schmerzen.

Assessing working capacity in patients with chronic nonspecific pain disorders applying for disability pensions is a core tasks of practical social medicine. Traditionally the evaluation focused on the nosological classification and clinical description of the pain disorder with rather vague concepts of its consequences in terms of disabilities and handicaps. The author proposes to reverse the sequence. Following the International Classification of Impairments, Disabilities and Handicaps (WHO 1980) work incapacity can be seen as an "occupational handicap". Its qualities, severity and credibility depend on the existence of objectifyable disabilities (especially behaviour, locomotor, body disposition, dexterity and situational disabilities). These may be attributed to clinical impairments and an underlying disease process. Among impairments pain has to be assessed multidimensionally. As in clinical medicine a nosological diagnosis is a useful but neither necessary nor sufficient prerequisite for a sociomedical evaluation of pain patients.