What is Pain?

September 10, 2018

While no one likes going through it, pain  is a necessary feeling in our lives. It protects us from injury and death. Pain teaches us not to touch a hot stove or step on a bed of nails. But it can also take control of our lives in a negative way.

Pain is an important factor in workers' compensation and personal injury cases. It is the driving force behind much of the medical treatment workers undergo. Yet, it is a nebulous concept. Pain is not objective nor easy to explain; only you feel your pain.

Physicians and medical staff historically consider pain as subjective, meaning that only the person feeling it can understand it, feel it or fully experience it. The traditional pain scale rating allows patients to quantify their pain sensations by using a measure from one to ten, with one as zero pain and ten indicating a pain that is intolerable and which sends you to the hospital emergency room.

Depending upon the patient's other symptoms and the results of the various testing which orthopedic surgeons and neurosurgeons perform, the validity of the patient's 1-10 scale result may be questioned. This means that a physician or medical provider's opinion about their patient's pain becomes very important. Thus, choosing a physician you can trust is invaluable. Our law firm provides guidance to our clients in the selection of their physicians. In workers' compensation cases, a claimant is only allowed one choice of physician in each area of specialty, so this is an important decision.

Can pain be measured by objective standards? Historically, no. However, new research utilizing MRI (magnetic resonance imaging) and conducted in Oxford, England has promising results. The 7-Tesla MRI is a new MRI

version, four times as powerful than the average hospital MRI machine. Researchers using this new technology examine scans of brains using functional MRI (fMRI) which allow the scientists to study the neural activity of the brain in response to applied pain stimuli such as pokes, prods, burns, and electric shocks. Scientists are looking to find ways to capture the pain experience in quantifiable, objective ways which would allow a standardization of medical treatment.

A more objective measure of pain could also help physicians determine which pain medications are more useful. In this age of addiction and our country’s current  opioid crisis, this could be a lifesaver for patients with true chronic pain. A standardized empirical method metric for pain would allow a more scientific, objective measure to guide medical providers in not only proving their patient's pain, but it could possibly justify the use of the opioids and other pain medications.

This is important since Louisiana, among many other states, passed a statute restricting the first time prescription of opioids for acute pain to no more than a seven (7) day supply. Louisiana medical providers must document specific reasons to go beyond the seven (7) day supply. Finally, all physicians prescribing opioids must participate in the prescription monitoring program. In light of the significant opioid epidemic, this is a reasonable measure to curb and prevent overuse by patients and prescribing by physicians.

In summation, treating "pain" in the legal context is not an easy thing to do. Insurers are unwilling to fund overuse of pain medication which the claimant/plaintiff may legitimately need. There is a constant battle, a push and pull, between payors (insurers mostly) and the injured workers and plaintiffs to find a happy balance between the flat out denial of pain medication and fear of overuse. We work to help our injured clients to obtain the best possible medical care while recovering from their work accident and/or personal injury.