Barrie Personal Injury Lawyers Discuss: Demystifying Chronic Pain
Despite there being no authoritative definition of ‘chronic pain’, the term has been accepted by both the courts and the medical community to include a variety of conditions. Littlejohn Barristers delves into the legal ambiguities of chronic pain.
According to the Supreme Court of Canada (“SCC”) decision, Nova Scotia (Workers Compensation Board) v. Martin, chronic pain is generally considered to be:
“… pain that persists beyond the normal healing time for the underlying injury or is disproportionate to such injury, and whose existence is not supported by objective findings at the site of the injury under current medical techniques.”
Nova Scotia (Workers Compensation Board) v. Martin, 2003 SCC 54 (CanLII) at para 1.
There is, however, scepticism stemming from the fact that the condition cannot usually be supported by objectively, detectible evidence. As a result, alienation and perpetual disadvantage exists for victims of chronic pain. Despite medical and legal advancements, these perceptions continue to this day; potentially resulting in barriers for legitimately disabled persons from receiving fair compensation and accessing disability benefits.
Classifications of Chronic Pain: Definitions and Taxonomy
Pain is defined by the International Association for the Study of Pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.” This definition correctly accounts for the existence of pain beyond the direct physical manifestation of tissue damage, and therefore considers two types of pain: (1) acute and (2) chronic.
According to the American Psychiatric Association (“APA”), acute pain is the chosen medical term if the pain lasts for less then six months, following the underlying cause for the pain (i.e. cut/bruise, broken bone, surgery, childbirth etc.). Acute pain is a common physical response to many injuries and often subsides as the medical condition subsists. These acute injuries result in complete healing about 85% of the time. However, if the pain continues beyond the six-month period, then the condition transforms into chronic pain, which is defined by the American Medical Association (“AMA”) as “pain that persists beyond the expected healing time of the medical disorder thought to have initiated the pain.” 
Chronic pain syndrome can exist through multiple disorders, including Central Sensitization and Somatic Symptom Disorder, but notwithstanding the term, they carry a common characteristic in that the pain is continuous and disabling. A debate exists amongst the medical community that centres upon whether chronic pain is a psychological or physical disorder. Difficulties with classification and the reality that chronic pain is overtly multifaceted, has led some organizations to create more holistic categories; an outcome which is helpful for conceptualizing and treating chronic pain. For instance, the AMA characterizes chronic pain syndrome through a biopsychological approach in order to view the condition as a whole. The result is that chronic pain is viewed as a “complex and dynamic interaction among biological, psychological, and social factors that perpetuates, and may even worsen, the clinical presentation.” This new reality clashes with the outdated biomedical approach, which presumes that all pain has a specific physical cause. Therefore, the biopsychological approach appreciates that while physical stimuli (i.e. injury) may be present, chronic pain can exist independent of it.
On the other hand, Fibromyalgia is considered to have a more physical rather than psychological cause. Fibromyalgia is a medical condition characterized by chronic widespread pain and a heightened response to physical pressure, as the central nervous system misperceives sensatory signals. That said, the cause is unknown so while the APA does not currently classify fibromyalgia as a mental disorder, it still may be.
Implications: ‘Vicious Cycle’
Chronic pain disorders ultimately affect the subject individual’s well-being and quality of life in an adverse fashion. They largely act as barriers to prosperous employment and social well-being and can cause familial issues, over-reliance on health-care providers, and further mental illness. In addition, a chronic pain disorder can result in a ‘vicious cycle’, arising from a reinforcing chain of events that exist in a negative feedback loop with detrimental results.
For instance, if an individual develops a pain disorder, they may lose their employment as a result. Due to the vicious circle and the social element of the disorder (as seen through the biopsychological approach), the pain would worsen. The cycle continues and the implications become more adverse unless the cycle is broken.
Implications: Post-Martin Legal Action
The negative consequences are variable, but vast. Thankfully, legal action is available to minimize these effects, whether or not a discernible source of the chronic pain exists. After the SCC affirmed chronic pain as a disability under section 15 of the Charter in Martin, it became unconstitutional to read out chronic pain victims from legislative benefits or intentionally cause them to specifically incur disadvantages in a statutory scheme. Since Martin, the tort case law has also trended toward larger amounts for chronic pain awards.
The personal injury lawyers at Littlejohn Barristers have significant experience representing clients suffering from chronic pain. If you have been in an accident or have been denied disability benefits and suffer from chronic pain, contact our Barrie office at 705-725-7355 to see if we can help.
1.Note that while six months is a largely arbitrary number, it is meant to encompass the expected time of healing required of most situations with tissue damage (with the exception of injuries to the nervous system).