Op-pain160030 799..802

This commentary is in response to Drs. Feinberg and Brigham’s request for reader feedback of their 2014 revision of their 2006 “Guide to the Guides . . . ” [1]. They teach that its use improves rating accuracy. We concur. Their 2014 revision generates impairment rating protocols in injured workers that are based on the AMA Guides to the Evaluation of Permanent Impairment, 5 Edition (GUIDES) [2]. In response to their request for feedback, we wish to bring attention to published rating inaccuracies in the GUIDES and the unreliability of measuring chronic pain based only on self-report [3–6]. We have two goals. One is to introduce a neurosciencebased metric and related protocol that eliminates all identified GUIDES defects when rating chronic pain whole-person impairment. A second is to stimulate evaluation of this neuroscience-based assessment protocol as a potential gold-standard diagnostic benchmark in chronic pain medicine that currently does not exist. The search for a reliable chronic pain metric is the “holy grail” in all of pain medicine that challenges pain medicine practitioners, patients, drug developers, and the medical-legal community at large [6].