Chronic Pain

Casualty BI - Chronic Pain

help

GO!

Click the headings above to jump to that section,or press on the right hand edge of the screen to start the session.

• Meaning of chronic pain and chronic pain indicators

Learning Objectives

We are going to cover:

It's important to note that pain is subjective and defined by the person experiencing it. The medical community now understands that chronic pain involves the mind's role in processing and interpreting pain signals. A fundamental point to recognise is that the absence of an obvious explanation for the pain does not mean the pain isn't real or that the case can be dismissed. Claimants can still succeed and, in some cases, recover substantial damages. However, chronic pain indicators can sometimes suggest that a claimant might be exaggerating. Not all reported pain and loss of amenity are due to genuine pain conditions. While keeping these risk indicators in mind, claims handlers must also recognise that genuine chronic pain conditions exist. If not identified early, these conditions can deteriorate over time and significantly increase the claim's cost.

Not all chronic pain is unexpected. Orthopedic experts may agree that a significant injury can lead to long-term chronic pain. This part of the module focuses on cases where the physical injury should have resolved, but complaints of pain persist over the long term.

Chronic pain is pain that persists longer than the temporal course of natural healing, associated with a particular type of injury or disease process.

Chronic Pain

Before we delve into chronic pain indicators and handling related claims, let's first understand the meaning and definition of chronic pain:

Personal Factors

Medical Histories

Medical Indicators

Chronic Pain Indicators

Identifying the signs of chronic pain early is crucial to prevent the condition from worsening and to avoid increased claims costs. The indicators have been separated into three categories:

• Disproportionate response to the accident at the scene (e.g. being taken to the hospital following a minor accident, hysteria at the scene)
• Failure to return to work after a minor injury
• Unsuccessful applications for benefits
• Excessive internet research by the claimant or their family
• Ongoing physiotherapy beyond initial recommendations
• Referral to a Pain Clinic or Pain Management Team
• Use of crutches, walking aids, or wheelchairs without fractures
• Requests for MRI/CT scans when x-rays show no fractures

Reported Pain Indicators:

• Pain reported in excess of what would be expected from the original injury
• Ongoing pain reported beyond six months with no physical cause
• Pain persisting after the removal of a cast following a fracture

Fractures exhibiting: - Skin color changes- Temperature differences- High pain levels from minimal contact, such as water- Excessive swelling or sweating- Changes in hair growth

Medical Indicators

Medical Indicators are often apparent from medical reports, rehabilitation reports or information provided by Claimants or their solicitors. Click on the icons below for further details.

By keeping these indicators in mind, claims handlers can better identify genuine chronic pain conditions early, ensuring appropriate management and preventing unnecessary escalation of claims costs.

• Preference for alternative remedies such as acupuncture, chiropractic care, or homeopathy
• Specific choice or change of claimant solicitor (certain firms specialise in chronic pain claims and may acquire such claims from other firms)
• Mention of conditions like Chronic Fatigue Syndrome (CFS), Fibromyalgia, or Chronic Pain Syndrome (CPS)

Behavioral and Medical History Indicators:

• Pain reported as out of proportion to the injury or sudden deterioration
• Recurrent visits to the GP or hospital
• History of injuries to similar areas
• Somatic complaints with no known cause for past pain
• History of conditions like Irritable Bowel Syndrome (IBS), gynecological problems, overreactions to pain, pain groups, or residential pain management

Medical Indicators Continued

By closely reviewing rehabilitation and medico-legal reports, claims handlers can spot issues that might affect the claim. This detailed approach helps manage claims better and ensures all important factors are considered.

Psychological and Emotional Indicators:

• Depression, anxiety, or stress
• History of physical, sexual, or mental abuse
• Marital or relationship issues, or family breakdown
• Agoraphobia or Munchausen’s syndrome
• Bullying

Medical and Behavioral History:

• Unexplained pain
• Gynaecological issues
• Multiple past complaints, often with unknown causes, including jaw pain
• History of stomach complaints and Irritable Bowel Syndrome (IBS)
• Alcohol, drug, or prescription medicine abuse
• Frequent visits to the GP for minor complaints

Medical histories are best gathered from medical records, but these are not always available early in a claim. However, important details can often be found in rehabilitation and medico-legal reports. It’s important to read the entire rehabilitation report, not just the treatment updates. Similarly, you should read the full medico-legal reports, not just the opinions and prognoses. Click on the icons below to see the key indicators to look for.

Medical Histories

Broken or dysfunctional home life, upbringing, or overprotective parents

History of abuse

Relationship issues at work

Psychological issues in close family members

Male over 45 years old

Female over 35 years old

Public sector worker (e.g., police, teacher, armed services), care worker, or in full time education

Personal Factors

Personal factors can indicate a susceptibility or predisposition to chronic pain. While some factors may be irrelevant on their own, a pattern can emerge when multiple indicators are present, especially across all three categories. This can help handlers identify cases of chronic pain or claims that may develop into chronic pain cases if not settled early. Click the icons below to see the key indicators:

Gather additional information at this stage. Refer back to the Claims Notification Form (CNF) for details on treatment and employment. Verify if the Claimant, who was working at the time of the CNF, is still employed and performing the same duties and hours. Chronic Pain claims should be flagged and discussed with your TAH SAH

Upon receipt of a Stage 2 pack, claims handlers should scrutinise the medical report for any missed indicators of chronic pain that the claimant’s solicitor might have overlooked. If an offer is served and indicators are spotted, consult with the RehabTeam, a colleague, or TAH for confirmation before proceeding to settle the claim.

Practical Handling of Chronic Pain Claims

It is important to always look out for chronic pain indicators and act swiftly if you identify any. Indicators of such conditions can sometimes be apparent early on, such as over-reaction to low-velocity impacts or extreme cases where the fire brigade has to cut roofs off minimally damaged cars to extract drivers without obvious physical injuries. Often, however, chronic pain starts as a typical soft tissue injury, and the first signs may not be evident until the initial medical report or if recovery does not progress as expected.

Note that pain management treatment alone can often be estimated between £6,000 and £10,000. Claimants may request funding for this before updating medical evidence. Psychiatrists and Pain Management Consultants often suggest that pain management programmes are less effective while claims are ongoing. Therefore, it is advisable to include the cost of pain management programmes in global, generous settlement offers, and such cases should definitely be discussed with your TAH/SAH. If you receive an interim payment request or additional medical evidence, assess whether the solicitor has identified any chronic pain indicators. Regardless, review the information, seek referrals if necessary, and consider making a generous offer to settle.

Practical Handling of Chronic Pain Claims continued...

Let's see what you remember!

Let's see what you remember!

Let's see what you remember!

If you would like to provide any feedback, please click here.

You have now reached the end of this session.

Casualty BI - Chronic Pain

Navigation help

Hover your mouse over each button for help.