Chronic Pain

1. Definition

Pain is defined as a sensory and emotional experience that feels unpleasant and that is associated with actual, potential or apparent tissue damage. Pain has physical, psychological and social dimensions. Pain can be caused by an event (e.g. injury) or as part of a painful chronic condition.

Acute pain plays a physiological role – it is a vital protective mechanism. In contrast, chronic pain serves no physiological role.

The impact of chronic pain can range from minor restrictions on one’s state of being to complete loss of function.

Chronic pain can develop as a result of a traumatic injury. It can also appear in some cases of minor injury.

2. Types

1. Pain Syndromes
   Chronic pain syndrome is when pain persists after an injury has healed. It consists of both physical and psychological changes with symptoms of persistent pain and subjective feelings of pain that exceed objective findings and that is associated with dysfunctional pain behaviors (such as self-limitation in activities of daily living). Chronic pain syndrome arises because the injury causes elevated levels of biochemicals that send pain signals to the central nervous system; pain signals pass up the spinal cord to the brain whose receptors become permanently influenced and affected; as a consequence the brain, which normally sends signals inhibiting pain signals, now does not, leading to greater pain awareness.
   Complex regional pain syndrome (or CRPS, and aka reflex sympathetic dystrophy) is where the pain is out of proportion to the initial injury. There are many symptoms of CRPS which include continuous burning or throbbing in the affected area, swelling of the painful area, joint stiffness, and decreased ability to move the affected body part. CRPS usually affects an arm or a leg. The causes of CRPS are not completely understood but are speculated to be related to an injury to or abnormality of the peripheral or central nervous systems. If it is seen at all, it is after an injury, a surgery, a stroke or a heart attack.
   Fibromyalgia is basically widespread musculoskeletal pain which can also be accompanied by symptoms of fatigue, anxiety or depression, sleep disorders, memory and concentration impairments, headaches and digestive problems. The way it works is that excessive muscle activity causes continuous contracture of resting muscle fiber, and impaired energy supply in turn causes release of biochemicals which activate nearby pain receptors. Precisely why people develop fibromyalgia is not known, but it can occur after an injury, a surgery or an infection or be due to significant stress or because of genetics.
   Facet joint syndrome is back and neck pain caused by damage to the facet joints. The facet joints are vertebrae in the spine that allow the back and neck to bend backward and forward. Either because of trauma or disc degeneration, the facet joint can break down and become inflamed and lead to pain signals in nearby nerve endings. This condition therefore affects the lower back, buttocks and/or upper thighs.
   Myofascial pain syndrome (or MPS) is where pressure on sensitive joints in your muscles – called trigger points – cause pain in the muscle and referred pain (i.e. pain in seemingly unrelated parts of your body). Symptoms may include deep aching pain in the muscles, pain that persists or worsens, a tender knot in a muscle and/or difficulty sleeping due to the pain. The condition can occur in only one side of the body or on both.
   Compartment syndrome is where blood flow through arteries is impaired by the swelling of muscle in a closed space or compartment. It can be either acute – which is caused by a fracture, penetrating injury or crush injury and is considered a medical emergency – or chronic – which is most often due to vigorous exercise or overuse of a particular muscle group.
2. Pain Disorders
   In comparison with pain syndromes, where the cause of the pain is physical, in pain disorders, the cause of the pain is psychological. Somatoform pain disorder is where chronic physical pain cannot be explained by physical causes. Conversion disorder (once known as hysteria) is where neurological symptoms such as paralysis or numbness cannot be explained by neurological causes.
3. Potential Sequelae
   Although one should always consult with their healthcare professional(s) to learn the effects of one’s particular pain condition, some long-term effects of pain include: psychological sequelae (e.g. anger or irritability), impaired sleep and decreased physical fitness.
4. Potential Long-Term Functional Limitations
   Pain may negatively affect one’s ability for self-care or one’s caregiving of dependents, relationship management and/or ability to do work or leisure activities.
5. Potential Long-Term Treatment Needs
   Depending on the degree of impairment, a patient with a pain condition may, in terms of future care, need help including but not limited to: medication, assistive devices, physiotherapy, pain management, counseling, sleep restoration, an exercise program and/or therapy.
6. Legal Ramifications
   Chronic pain can occur where there is an automobile accident, slip and fall or bike or boating accident, or any traumatic injury.

Compared to injuries such as fractures for which there is objective evidence such as X-Ray scans, chronic pain is mostly based on subjective evidence. This means that a different approach must be utilized if the injury in question is chronic pain. Azimi Law can help you assemble the evidence required for proof. A detailed record including dates of how the pain is affecting you day-to-day; medical records of healthcare professionals treating you for your chronic pain; and testimony of witnesses and/or experts, are methods of proving chronic pain.

In some cases, people who are suffering from long-term pain take time off from work and claim long-term disability benefits.

As well, to pass the threshold test to have standing to sue for general damages and healthcare expenses, the Insurance Act states one must have sustained a permanent serious disfigurement or a permanent serious impairment of an important physical, mental or psychological function. In some cases, chronic pain may satisfy the latter criteria. For instance, in Adams v. Taylor (https://canlii.ca/t/g2gb0), the court concluded, based on evidence from the plaintiff’s two psychiatrists, orthopedic surgeon and family doctor, that the plaintiff, who was in a car accident and thereafter was diagnosed with chronic pain (including symptoms of pain in her neck, shoulders, upper and lower back, arms, buttocks and legs; difficulty sleeping and disturbed sleep; and fatigue), had met the threshold to claim general damages. This was because the impairment was deemed permanent; it impaired an important function in her life (such as her ability to work); and the impairment was considered serious.

If you are suffering from chronic pain as a result of an injury or accident, Azimi Law can help you obtain the compensation you deserve.

References

Mayo Clinic, “Complex Regional Pain Syndrome”, “Fibromyalgia” and “Myofascial Pain Syndrome”: https://www.mayoclinic.org/.

Lisa Zaretsky and Bonnie Koreen, “Pain”, Sprains, Strains and Automobiles: A Medically Illustrated Guide to Commonly Litigated Injuries. Toronto, Ontario: Carswell, January 1, 2011.

Statutory Accident Benefits Schedule (or “SABS”), made under the Insurance Act, R.S.O. 1990, c.I.8, s 3(1).