Chronic Pain & Fibromyalgia
What is chronic pain?
Clients who are able to return to work and their former recreational activities within a few weeks of being injured rarely develop chronic pain. Chronic pain has many different definitions, but generally refers to any ongoing pain that persists more than 6 months in the absence of objective signs of injury. While most soft tissue injuries resolve within a matter of weeks, some do not. Occasionally our clients develop long lasting symptoms that cannot be explained by looking at X-rays or other diagnostic tests. Nonetheless, chronic pain can be debilitating and cause our clients to become totally disabled in the worst cases.
Once about two years have passed since a person is injured, the prognosis for further improvement is usually poor. At that stage symptoms can be expected to persist indefinitely if not permanently.
There is generally thought to be a psychological contribution to ongoing chronic pain. This is not to say that chronic pain is “in the client’s head” or that the client is “crazy”. However, common sense would suggest that anyone who is in constant pain for an extended time is likely to become at least a little depressed as a result of dealing with their pain and not being able to resume their former lifestyle.
Chronic pain sufferers often fail to get enough sleep. This can lead to even worse pain, which leads to less sleep and a vicious cycle is started. As a result, doctors often prescribe medication to improve sleep.
What is Fibromyalgia?
Fibromyalgia (FM) is a form of chronic pain. Doctors have divided the body into four quadrants (upper and lower, right and left) and pinpointed 18 “trigger points”. If at least 11 of the trigger points are painful to the application of pressure, and if those points are spread over all four quadrants, a diagnosis of FM is considered. The diagnosis may be elusive because trigger points may be positive on one examination and not the next. Further, what one doctor considers positive another doctor may consider negative. Fatigue and sleep disorders are usually considered features of FM.
The diagnosis of FM itself means little medically and even less legally. There are no treatment regimes unique to FM. Most doctors tend to recommend exercise and various types of medication, including very low doses of anti-depressants to help with sleep. Since the diagnosis of FM does not imply a specific treatment plan, define the degree of disability, or imply any given prognosis, we prefer to concentrate on the fact that a client with FM suffers chronic pain. This way we avoid getting into the debate of whether the label of fm is appropriate or not.
Implications for Legal Claims
The challenge facing any client advancing a legal claim for compensation for chronic pain, including fibromyalgia, is that there is no obvious sign of injury. Pain cannot be measured. Worse, clients will often be accused by defendants of either exaggerating their problems or benefiting from “secondary gain”, which is usually code for saying that the client’s symptoms are ongoing because they expect to receive a financial award for their condition. They are urged just to get on with their former life.
Such attitudes are unfair and overlook that chronic pain usually means the loss of financial security (as a result of being unable to work), the loss of friends and other social connections, and the loss of their ability to pursue one’s desired activities. If fm sufferers could “get on with” their lives, they surely would.
There is some encouraging news for sufferers of chronic pain. Medical literature contains more and more articles which support the authenticity of chronic pain and the idea that the pain is primarily due to physical rather than psychological causes. In particular, many forms of persistent pain in the neck are now being attributed to damage to the facet joints and researchers have had good results administering blocks to these joints to help alleviate the pain. Encouraging new treatments are being developed including acupuncture, facet blocks, and other approaches that did not exist even a few years ago.