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Doctors’ understanding of the science of pain slowly sharpens

One common challenge in the quest for short- or long-term disability benefits is getting the insurance company to take the disabling nature of pain seriously. There is friction between insurers asserting that claimants have not objectively proven that they are disabled by pain and claimants who struggle to “prove” the pain that contributes to their disabilities. 

Pain is a subjective experience unique to each patient and there is no simple lab test or scan to objectively confirm its existence or intensity.

Nature of pain 

Research is uncovering more and more about the science behind the experience of pain, according to an article in The New Yorker. As this piece describes it, pain presents an “intractable problem: it is a physiological process, just like breathing or digestion, and yet it is inherently, stubbornly subjective …” 

The New Yorker reports that in the past 20 years, some researchers — especially scientist Irene Tracey of Oxford University — have gotten closer to finding methods for quantifying pain. 

Tracey describes how “sensory perceptions” like taste and hearing cause brain activity in specific places, whereas brain activity in response to pain is more complex, showing up in multiple areas. She has studied high-level MRIs for years that show complex brain activity around pain. 

Brain activity with pain 

She observes that brain activity associated with pain varies among patients depending on: 

  • The anticipation of pain
  • Concentrating on a distraction from pain, like counting
  • Depression and anxiety
  • Religious faith
  • Acute versus chronic pain 

Despite the involvement of many brain areas, Tracey has been able to identify one location in the brain which is “consistently active” during pain: the dorsal posterior insula. 

In 2013, Colorado neuroscientist Tor Wager created an algorithm that identifies the existence of pain and its intensity in brain scans. Could this be the beginning of a more objective test to help disability claimants “prove” pain? The New Yorker author concludes the formula is not yet reliable enough for widespread use. 

One bio-legal expert cited in the article believes that in about a decade, the enhanced MRI brain scans may be more routinely used in legal proceedings when pain is at issue. Other experts disagree, opining that brain-scan evidence from advanced MRIs is not yet reliable enough to constitute admissible legal evidence of pain, or to be a basis upon which to discredit a subjective pain complaint. 

What about chronic pain? 

Tracey says that chronic pain acts like a disease of its own, “rather than a symptom,” and that chronic-pain mechanisms are quite mysterious. She has identified two parts of the brain stem associated with chronic pain, but notes that other factors affecting its frequency and intensity may include past “acute bodily distress,” genetics, “gender, age, stress, poverty, and depression.” 

What about presenting pain in your disability claim? 

A lawyer can assist a claimant in filling out forms and submitting evidence to support the existence of disabling pain. General tips include: 

  • When filling out forms or talking to medical providers, use precise language to describe the nature of pain like sharp, numbing, dull, crushing, shooting and other descriptive words.
  • Describe in detail how pain restricts activities and abilities.
  • Thoroughly document all impairments known to cause pain with objective medical evidence because it is harder to discredit pain complaints that are likely associated with medical problems that have been objectively proven.
  • Submit statements from family members and friends who have observed how pain impacts the claimant. For example, does the claimant cry, moan, exclaim or wince with certain kinds of movement or exertion? Is there limping? 

We will continue to provide important information in this space about medical advancements in the understanding of pain, which can be so important to our clients seeking disability benefits.