An unpleasant sensory or emotional experience
Associated with actual or potential tissue damage
Chronic Pain Defined
Pain that extends beyond the expected period of tissue healing
May be defined as pain that lasts 3–6 months
Usually accompanied by psychosocial factors
Chronic Pain vs. Secondary Gain
Secondary gain is a significant psychosocial factor
Chronic pain more common when secondary gain may be present
Clinical outcome studies exclude Workers' Comp and patients in litigation
Such patients sometimes have poor outcomes
Other Factors Implicated in Chronic Pain
More common in those who have experienced physical, emotional and sexual abuse
More common in cases of early abandonment during childhood
More common with a personal or family history of substance abuse
Often used to obtain pain medication
Important Information You and Your Consultant Should Use in Evaluating Chronic Pain Claims
The difference between the injured party’s history and the timeline as presented by relevant medical records.
The physical examination
The diagnostic studies
Use of Medical Records
Without an objective review of the unchanging medical records related to the case, there’s no concrete, objective interpretation of the events as they occurred years before.
Human testimony can vary over time.
Court cases are usually years after an injury.
Medical records don’t change.
1. First Medical Record Review
Do early records reflect an injury to that "chronic pain" body part?
Remember, symptoms are complaints and signs are objective findings
2. Second Medical Record Review
Did the claimant seek immediate medical care?
Did the examining physician order diagnostic tests?
Were there referrals to specialty physicians?
3. Third Medical Record Review
Did a physician recommend the claimant not work?
Does the claimant tell all of their treating physicians about their severe disabling condition?
Does the claimant have timely follow-up doctor visits for their "severe" injury?
Does it Boil Down to Behavior? Not Just The Patient’s Behavior.
The physician's behavior reflects their concern for the severity of the injury
The claimant's behavior is reflected in their medical care:
Timeliness of their first visit
Frequency of follow-up visits
Consistency of their complaints to all of their medical providers
Which Complaints are Related to the Accident?
Those that are documented shortly after the accident
New onset of symptoms weeks or months later are usually not related
Typically get better with time rather than worse — may reflect new conditions or psychosocial issues
Independent Medical Evaluations (IMEs)
Must be thorough, impartial, objective, and well-documented
All complaints the claimant attributes to the accident need to be addressed
The physician conducting the IME can be accused of causing injury and improper behavior
Video and sound recording can detract from the clinical aspects of the IME encounter and turn it into a performance
Radiologists are trained to comment on all findings regardless of their clinical significance
Even normal, uninjured spines can show abnormalities. Experts are expected to know the differences between clinically significant findings and normal physiological variance.
changes positively correlated to the aging process