Inflammatory Pain. What can I say on this one? It is activated or initiated by and through an overactive immune response which results in inflammation rather than a direct physical injury. More often than not it involves swelling, stiffness and throbbing. You will see this type of pain in such things as rheumatoid arthritis.
Nociplastic Pain. This is pain having its foundation in and through the central nervous system where pain pathways are affected and can become overly sensitive. This can occur without clear evidence or signs of tissue damage or nerve injury. You will often see this in such conditions as fibromyalgia.
Q. We don’ t want you to get“ big-headed“ here, but to put it mildly, doctors and patients focus on you and dwell on you and talk about you and think about you and even dream about you all the time! You are of course present for these communications. What can you tell us about the problem of a doctor simply asking a patient to“ describe” YOU and then the doctor relying heavily upon that explanation in order to make a diagnosis or to treat or to arrive at a prognosis?
Pain: Even for the most highly trained and skilled physician asking a patient to“ describe your pain“ and then thinking you will get a reliable response upon which to make a diagnosis is similar to having a basket full of feathers and throwing them into the air and trying to predict the exact spot where each feather will land. I am telling you firsthand: nobody can accurately describe me! Can’ t be done with just a verbal explanation. Remember, each individual comes from a world of unique and different experiences and the life that he / she has lived, includes beliefs, philosophies, socio-economic world of being raised as a child, education, relationships, struggles in adversity in life and so much more. Twins can have the same exact injury to the same exact spot on the body and yet each will describe me in a completely different way. In the medical office setting, there is even a greater problem— namely, that usually the patient has a raised level of anxiety, merely by being in a doctor’ s office and almost always the doctor and his / her staff give the feeling that everything must be rushed and urgent and sped up! Clearly, you can understand why the mere verbal description is an inferior way of determining the extent of me. This is, in part, why doctors and nurses and other medical personnel struggle with reliably recording information derived directly from a patient and then trying to translate that into a report with which is supposed to be scientific and objective! By the way, I hope you are taking notes!
Q. Pain, we see and hear a lot about pain scales. From your perspective are pain scales a meaningful way of explaining you and your existence and your intensity to judges and juries?
Pain: Pain scales are indeed helpful and useful. The first problem though is that most lawyers don’ t even think about pain scales until shortly before trial. These lawyers basically misunderstand and misuse and abuse everything about pain scales! Pain scales need to be introduced into the case as early as possible— even at the very beginning of the medical care and treatment. The best advocates set up“ in person“ meetings at an early stage of the case with the key treater or treaters in order to discuss how the pain scales can be made part of the medical records. Lawyers should be speaking with the treaters to discuss how the treater can use pain scales during visits and examinations and interviews with the patient / client. The pain scales need to become a part of the medical record. The pain scales need to be embedded into pleadings, including the complaint and in responses to interrogatories and in motions and briefs. Pain scales should play a significant role in mediation. Pain scales should be used in trial— not only in opening statement, but with various witnesses.
There is, however, another problem: some pain scales are meaningful and can be used as great teachers to help others understand the nature and extent of pain while other pain scales are basically worthless or useless. Let me give you an example: in one instance recently, I was causing intense and horrific and intolerable pain in a 61-year-old woman who had tripped and fallen in a hotel and not only was enduring neck pain and back pain— but she suffered a broken wrist as well as a fractured elbow. On one particular visit to her treating orthopedic surgeon, she explained this to her doctor. Yet when his nurse presented her with one of the so-called“ pain scales“… which was nothing but a bunch of either frowns or smiley faces— she quickly chose one that would be interpreted as only having minimal pain, even though that was contrary in a huge way to what she was telling her doctor. Many of these pain scales are woefully