Know the Basics
Chronic pain symptoms are by and large, subjective, and as such, cannot generally be corroborated by objective findings on physical examination or imaging such as CT scan or MRI. There has been ongoing controversy in the medical community, in particular with regard to the legitimacy of fibromyalgia, largely due to the subjective experience of the complainants’ pain. Nonetheless, despite the ongoing controversy surrounding fibromyalgia, chronic fatigue and chronic pain sufferers are increasingly getting their proverbial “day in court” and are obtaining successful results from the judiciary.
As a personal injury practitioner handling chronic pain claims, it is important to understand the essential characteristics of chronic pain and fibromyalgia, and to appreciate that sufferers frequently present with psychological features. In addition, it is important to understand that inherent personality traits may also contribute to enhanced perception of pain and illness behaviour.
I have read the excellent paper prepared for this conference by Dr. Angela Mailis-Gagnon, Director of the Comprehensive Pain Program at the Toronto Western Hospital, which provides a useful synopsis of the basic concepts involved in understanding chronic pain. I urge you to read this paper and to keep it handy as a guidebook for understanding the litigants who present before our courts claiming to be chronic pain sufferers. In particular, I draw your attention to the section of Dr. Mailis-Gagnon’s report dealing with the DSM IV (Diagnostic and Statistical Manual of Mental Disorders, 4th edition) Classification of Chronic Pain Disorders. In my experience, the experts who tend to be accepted in court have extensive familiarity with the DSM IV and the 3 types of Pain Disorders recognized by the 2004 edition:
- Chronic Pain Disorder associated with a Medical Condition;
- Chronic Pain Disorder associated with a Medical Condition and Psychological Factors;
- Chronic Pain Disorder associated with Psychological Factors.
Dr. Mailis-Gagnon explains in her paper that the latter two types of Pain Disorders (Syndromes) feature psychological factors which are “considered important in the generation, maintenance and exacerbation of the pain.” In the third Pain Disorder listed above, Chronic Pain Disorder associated with Psychological Factors, the underlying disability is actually based on psychological factors.
As such, if you are acting on behalf of a Plaintiff with chronic pain, getting to know your client is essential to establishing a road map for your case.
For the full article, click to download: Five Essentials for Litigating Chronic Pain