Chronic Pain – Is it all the in head?

November is Complex Regional Pain Syndrome (CPRS) Awareness Month. Unlike most other serious diseases, CPRS is a mystery to many simply due to the fact that is not easily identified, is often misunderstood and misdiagnosed, and is also not very well publicised. In fact, it is an extremely painful condition where sufferers experience persistent, severe debilitating pain which can have an enormous impact on their lives and those around them. This disease can strike at any age and affects both men and women, although it is much more common in women.

It is claimed that doctors are not sure what actually causes some individuals to develop CRPS while others with similar trauma do not. In more than 90 percent of cases, the condition is triggered by a clear history of trauma or injury. The most common triggers are fractures, sprains/strains, soft tissue injury (such as burns, cuts, or bruises), limb immobilisation (such as being in a cast), or surgical or medical procedures (such as needlestick). Research has in fact demonstrated that CPRS is a physical disorder contrary to some old fashioned theories, which have attributed it as a psychological disorder. In light of this and as part of CRPS awareness month, Melanie Burden, Partner and Head of Multi Track Personal Injury at Simpson Millar takes time to dispel a misconception that some chronic pain conditions such as CPRS are purely psychological.

In Melanie’s years of practice as a personal injury solicitor, she has experienced the tactics employed by Defendants to discredit Claimants suffering with debilitating chronic pain conditions. Amongst other issues, there have been suggestions that Claimants are malingering, in other words exaggerating their claim for financial gain or that they are suffering from a form of a psychological disorder such as a somatoform disorder or hysteria. In fact, one client was told by his own treating physiotherapist that there was nothing wrong with him and it was all in his head.

There are many pain conditions where you can see objective signs of pain but many symptoms of pain conditions are subjective, so only the sufferer themselves knows just how they are feeling as you cannot experience the pain of another person.

In the past, matters were not helped by the fact that Chronic pain conditions, including CRPS were included in the Chapter on Psychiatric and Psychological Damage in the Judicial College (formerly the JSB) Guidelines.

The assignment of Chronic Pain as a Chapter in its own right for valuation of damages in the JC Guidelines 11th Edition 2012 reflected a sea change in the classification of Chronic Pain conditions including CRPS which are now recognised as series injuries in their own right in the publication by the Judicial College.  CRPS (Complex Regional Pain Syndrome) has thankfully also been afforded its own subcategory within the chapter on Chronic pain, which helpfully gives guidance to the judiciary, Claimant and Defendant Solicitors alike.

The Chronic Pain Chapter in the latest 13th edition of the JC Guidelines provides the following helpful factors to take into account when considering the value for an award of damages for a Chronic Pain Condition including:

  1. the degree of pain experienced;
  2. the overall impact of the symptoms (which may include fatigue, associated impairments of cognitive function, muscle weakness, headaches etc. and taking account of any fluctuation in symptoms) on mobility, ability to function in daily life and the need for care/assistance;
  3. the effect of the condition on the injured person’s ability to work;
  4. the need to take medication to control symptoms of pain and the effect of such medication on the person’s ability to function in normal daily life;
  5. the extent to which treatment has been undertaken and its effect (or its predicted effect in respect of future treatment);
  6. whether the condition is limited to one anatomical site or is widespread;
  7. the presence of any separately identifiable psychiatric disorder and its impact on the perception of pain;
  8. the age of the claimant;
  9. prognosis.

The guidance does identify the potential link with an identifiable psychiatric disorder and its impact on the perception of pain as a factor to be taken into account, but it is very clear that this is just one of multiple factors to consider and take into account when dealing with a claim for Chronic pain. This is a welcome step for many injured people who struggle to come to terms with some of the defences raised by some Defendants that there pain is purely a psychological condition.

It is well recognised, however, that many people suffering from Chronic Pain conditions, particularly CRPS can experience psychological symptoms and recognised psychiatric disorders. This can be because living with a long term pain condition can be very distressing and can cause depression and anxiety. Accessing psychological treatment and support can be extremely beneficial to people caught in a cycle of chronic pain. Clients have described the real benefits of cognitive behavioural therapy treatment to help them come to terms with their injury, their pain and to teach them coping strategies to help manage the pain. Experts recognise that a dedicated multi-disciplinary pain management programme can have enormous benefits in rehabilitating a client with a chronic pain condition.

A collaborative approach, working together with Defendants to access clients a combined package of quality multi-disciplinary treatment is the preferred approach as it is proven that the earlier a sufferer of chronic pain can access a pain management programme, the better the outcome is likely to be.

Ironically, contrary to the old fashioned school of thought that chronic pain is in the head, research and studies have shown that most suffers of chronic pain have demonstrable changes in the grey matter of the brain proving that chronic pain really can be a physical disorder.[1][2]

Melanie Burden, Partner and Head of Multi Track Personal Injury at Simpson Millar

[1] Chronic Pain May Change the Structure of the Brain  – A May , Pain 137 ( 2008)   7 – 15

[2] How Neuroimaging Studies Have Challenged Us to Rethink: Is  Chronic Pain A Disease?  I Tracey and M C Bushnell , The Journal of Pain , Vol 10 ( No 11 2009) pp 1113-11120

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