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Measuring Pain

Fairfax Injury Lawyer Brien Roche Addresses Measuring Pain

Brien Roche

Measuring pain is difficult to say the least.  Pain and suffering claims comprise a large percent of personal injury actions.  A large part of the plaintiff’s loss is the pain and suffering. The question is how does one go about measuring it?

Measuring Pain-Functional MRI

In an Arizona case a truck driver was sprayed with tar. This caused first and second degree burns to his arm and face.  He was treated for the pain with several doses of morphine. Although the burns healed he continued to feel pain in his right arm which prevented him from working.   The defense asserted that the truck driver was faking.  

Functional MRI

The truck driver’s chronic pain manager suggested a fMRI brain scan as a way of measuring pain. Functional Magnetic Resonance Imaging (fMRI) has been used to measure activity in the brain. What it does is detect blood flow to particular areas of the brain. The blood flow is portrayed by the scanner’s magnets that track the blood oxygen levels.

Joy Hirsch was contacted by the plaintiff’s attorney about performing an fMRI. At the time she was a professor in the Department of Neuroscience, Radiology and Psychology at Columbia University. One of her specialties was mapping the brain for neurosurgeons. Neurosurgeons use this service in order to avoid damaging essential functions during surgery. Plaintiff’s counsel in that case felt that maybe she could map the level of pain in the truck driver’s right arm. In fact she was able to do so through an fMRI.

The Institute of Medicine projects that as many as 100 million Americans suffer from chronic pain. It costs society $635,000,000,000.00 per year in terms of healthcare expenses and lost work productivity. Call, or contact us for a free consult.

Measuring Pain-Beyond the Traditional

The traditional way of measuring pain is on a scale of 1 to 10.  That scale is purely subjective.  One person’s 5 may be another person’s 10.

What Hirsch did was to take images during tests. The truck driver squeezed a rubber ball using each hand. She then took images. When the trucker squeezed the rubber ball the pain in his injured hand rose to a level of what he described as 9.5.  He felt no pain in his left arm when he squeezed the ball. Hirsch was able to detect increased blood flow activity when the driver squeezed the ball with his right hand.  That increased blood flow activity was seen in the pain circuit of the brain. 

Her readings on the scans were consistent with the truck driver’s rating of pain. In other words squeezing the ball with his injured hand caused pain which was seen on the brain scan.  Squeezing the ball with the non-injured hand did not show activity on the brain scan.

Some people maintain that a person can cheat the scan by imagining pain. Hirsch maintains that cheating is not possible. She says recreating sensation in the mind is all but impossible.

Functional MRI Availability

Another researcher by the name of Vania Apkarian at Northwestern University has also used the fMRI to document pain.

A Ridgefield, Connecticut-based company known as Millennium Magnetic Technologies advertises, among other diagnostic services, brain scanning to validate the presence of pain.  Dr. Steven Levy, the company’s CEO, maintains that the scans can be used to quantify the amount of pain.  The procedures used cost $4,850.00 and include three (3) scans.  The scans are taken before, during and after the staff induce pain in the patients’ troubled areas.

Other Tools

Also thermography has been used to measure pain.  Thermography however has a high rate of false positives. There have been mixed results in terms of these results being admitted into evidence.

Another pain measurement device is a laser thermometer which shows the differential in temperature between the injured body part and the nearby non-injured body part. Call, or contact us for a free consult.

Measuring Pain-Pain Management

Pain management is big business in medicine.  It is reported in some journals that as many as 100 million Americans suffer from chronic pain.
Every person heals in a different fashion.  Likewise, every person feels pain in a different fashion.  The source of the pain, whether it be some physical injury or otherwise, disrupts blood flow. The nerves transmit signals in different ways for each person. 

Chronic Pain

The traditional notion is that chronic (long term) pain is a symptom or result that is caused by some specific condition.  That is, a punch in the face causes pain not only in the facial area but may cause pain in the neck and down the spine. 

Some doctors are now thinking that pain may not just be the result of physical trauma.  Pain may also, in some instances, be the result of how your brain deals with pain signals.  In other words the brain and the neurons that carry the pain signals may become programmed with a type of neurological memory. When the original cause of the pain has gone away the pain may still remain. 

Other doctors think there may be some genetic origin to chronic pain.  That is, some people may have a predisposition to chronic pain. This may be based upon their gene makeup.  That may require specific targeting to that gene as the source of the chronic pain.

Measuring Pain-Treating Chronic Pain

The  treatment for chronic pain has been to treat it as being caused by inflammation. Therefore the treatment has been such things as aspirin, aspirin substitutes or physical therapy.

Several other modes of treatment that are in use are such things as acupuncture, massage therapy and medical hypnosis. These are attempts to reprogram the brain as to how to deal with pain.  

Chronic pain treatment can be complex. Chronic pain affects more people than cancer, diabetes, heart attack and stroke combined. Chronic pain sufferers often are misdiagnosed, misunderstood and miserable.

The good news is that chronic pain treatment can work. It requires the right blend of approaches. The traditional model of medication and rest is not enough. Rather than relieving the pain drugs may make it worse. What is required is the right blend of physical therapy, weaning off addictive medicine and counseling.

It is not unusual for people to feel acute pain after an injury or illness. If the pain last more than 12 weeks it is considered chronic. With the prolonged use of pain medication the nervous system becomes distorted. Pain receptors become more sensitive. Internal pain blockers become less effective. This can make the lightest touch seem painful. Chronic pain is associated with depression. This can then lead to fatigue and anxiety. It can also produce changes in mood, appetite and sleep.

Patients with depression may experience increased pain. Both depression and chronic pain share some of the same neurotransmitters and nerve pathways. As the pain gets worse the body’s ability to respond may weaken. The key is to get the depression under control. Drugs can provide some relief. They can be an important part of chronic pain treatment.

Measuring Pain-The Right Medicines

The extended use of strong addictive drugs such as opioids, Percocet or Valium may make the pain worse. These block the transmission of pain from the site to the brain. Over time the nerves send stronger pain signals. In other words the nerves turn up the volume in order to get the attention of the brain. Hence higher doses are required to block the louder signals. The pain receptors and processors get so confused that stimuli of any sort are seen as pain. The drugs no longer work.

What is needed is a holistic approach. This should include getting off the ineffective drugs and applying useful ones. In addition physical therapy and exercise must be used to teach the damaged nerves the difference between normal and harmful sensations. The patient must be committed to problem solving and avoiding isolation. He must work at improving communication and embracing physical therapy. He must work with a counselor to reframe the illness. Support groups can be a big help in this regard. Call, or contact us for a free consult.

Measuring Pain-Back Pain

One in four adults experience back pain in the course of a year.  This is a common reason for doctors’ visits.  Most people recover from back pain without any treatment.

The treatment mode tends to be over-the-counter medicine, rest and exercise  for nonspecific back pain.  Nonspecific back pain is not linked to a particular injury or disease.

Getting an MRI or X-ray may be needed for back pain related to a specific event. Likewise if the back pain has persisted for six weeks or longer.  In doing an X-ray or MRI the doctor is looking for a herniated disc or bone spur.  

Back Pain Is Common

However 25% of the population is going to show some pathology on an MRI or X-ray test of the back. This is true even though they may not be having any symptoms. Most orthopedic surgeons will tell you that for chronic back pain, physical therapy should be attempted. This is designed to strengthen the muscle support. In addition ceasing certain activities that may be causing the problem may be needed.

If the pain persists an injection of steroids or nerve block directly into the back may provide temporary relief.  That temporary relief will then hopefully give your back enough time to heal naturally. Also the physical therapy may hasten the healing process.

Dealing With Back Pain

Some general tips in terms of dealing with back pain are:

  • Acetaminophen or ibuprofen may help.
  • Sufficient rest
  • Stretching the affected body parts
  • Staying within your zone of no pain means do not push the body part into painful positions. This means trying to strengthen the nearby uninjured body parts so that they can better help with motion while the injured part heals. This should be the goal of physical therapy.
  • Keep moving. Although rest is needed becoming a slug in most cases is not going to hasten the healing process.

Call, or contact us for a free consult.

Measuring Pain-Acupuncture

Acupuncture involves the placement of needles into areas of the body. They are then manipulated by hand or with some electrical stimulation. The idea is either restoring health to that body area or limiting pain that may be emanating from that area. Acupuncture may be especially helpful in dealing with long term issues. These may include chronic symptoms of nausea or abdominal pain.

In addition it may be effective in preventing nausea after surgery with children and also lessening the pain of surgery. Indeed, one doctor in New York has found it to be effective in terms of dealing with attention-deficit hyperactivity disorder and also with asthma. 

In general, it has been found that acupuncture tends to produce only short term relief per session. In order to have some long term relief the sessions need to be long term.

The FDA monitors acupuncture procedures by requiring that the needles be sterile. In addition they can be used only one time by qualified personnel.

Measuring Pain-Facial Disfigurement

Facial disfigurement claims are often under evaluated because they are looked at only from the point of view of the disfigurement. They must also be looked at from the point of view of the impact upon earning capacity.  The subtle bias against a person who has a facial disfigurement is huge. Unattractive people are viewed more negatively than attractive people. Also people are generally biased in favor of those who are good-looking.

Opportunities in the workplace are sometimes denied to people who are disfigured. Unattractive people are frequently considered less productive and less intelligent. A personal injury attorney handling this type of injury claim needs to be aware of this.

Loss of Income Due To Disfigurement

There are social science findings that can be used to establish that a client is reasonably certain to suffer permanent reduction in earning capacity because of a significant facial disfigurement.  The role of the expert is to tell the jury general truths about their specialized experience. That is the basis for the admissibility of social science testimony from a psychologist. He may describe the effect of bias on a facially disfigured person.  The vocational expert then uses these social science studies to prove that disfigurement has harmed or will harm the plaintiff’s potential earning capacity

Call, or contact us for a free consult. For more information on pain and suffering see the other pages on this site.See also the pages on Wikipedia on pain and suffering.

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Contact Us For A Free Consultation

Measuring Pain

Fairfax Injury Lawyer Brien Roche Addresses Measuring Pain

Brien Roche

Measuring pain is difficult to say the least.  Pain and suffering claims comprise a large percent of personal injury actions.  A large part of the plaintiff’s loss is the pain and suffering. The question is how does one go about measuring it?

Measuring Pain-Functional MRI

In an Arizona case a truck driver was sprayed with tar. This caused first and second degree burns to his arm and face.  He was treated for the pain with several doses of morphine. Although the burns healed he continued to feel pain in his right arm which prevented him from working.   The defense asserted that the truck driver was faking.  

Functional MRI

The truck driver’s chronic pain manager suggested a fMRI brain scan as a way of measuring pain. Functional Magnetic Resonance Imaging (fMRI) has been used to measure activity in the brain. What it does is detect blood flow to particular areas of the brain. The blood flow is portrayed by the scanner’s magnets that track the blood oxygen levels.

Joy Hirsch was contacted by the plaintiff’s attorney about performing an fMRI. At the time she was a professor in the Department of Neuroscience, Radiology and Psychology at Columbia University. One of her specialties was mapping the brain for neurosurgeons. Neurosurgeons use this service in order to avoid damaging essential functions during surgery. Plaintiff’s counsel in that case felt that maybe she could map the level of pain in the truck driver’s right arm. In fact she was able to do so through an fMRI.

The Institute of Medicine projects that as many as 100 million Americans suffer from chronic pain. It costs society $635,000,000,000.00 per year in terms of healthcare expenses and lost work productivity. Call, or contact us for a free consult.

Measuring Pain-Beyond the Traditional

The traditional way of measuring pain is on a scale of 1 to 10.  That scale is purely subjective.  One person’s 5 may be another person’s 10.

What Hirsch did was to take images during tests. The truck driver squeezed a rubber ball using each hand. She then took images. When the trucker squeezed the rubber ball the pain in his injured hand rose to a level of what he described as 9.5.  He felt no pain in his left arm when he squeezed the ball. Hirsch was able to detect increased blood flow activity when the driver squeezed the ball with his right hand.  That increased blood flow activity was seen in the pain circuit of the brain. 

Her readings on the scans were consistent with the truck driver’s rating of pain. In other words squeezing the ball with his injured hand caused pain which was seen on the brain scan.  Squeezing the ball with the non-injured hand did not show activity on the brain scan.

Some people maintain that a person can cheat the scan by imagining pain. Hirsch maintains that cheating is not possible. She says recreating sensation in the mind is all but impossible.

Functional MRI Availability

Another researcher by the name of Vania Apkarian at Northwestern University has also used the fMRI to document pain.

A Ridgefield, Connecticut-based company known as Millennium Magnetic Technologies advertises, among other diagnostic services, brain scanning to validate the presence of pain.  Dr. Steven Levy, the company’s CEO, maintains that the scans can be used to quantify the amount of pain.  The procedures used cost $4,850.00 and include three (3) scans.  The scans are taken before, during and after the staff induce pain in the patients’ troubled areas.

Other Tools

Also thermography has been used to measure pain.  Thermography however has a high rate of false positives. There have been mixed results in terms of these results being admitted into evidence.

Another pain measurement device is a laser thermometer which shows the differential in temperature between the injured body part and the nearby non-injured body part. Call, or contact us for a free consult.

Measuring Pain-Pain Management

Pain management is big business in medicine.  It is reported in some journals that as many as 100 million Americans suffer from chronic pain.
Every person heals in a different fashion.  Likewise, every person feels pain in a different fashion.  The source of the pain, whether it be some physical injury or otherwise, disrupts blood flow. The nerves transmit signals in different ways for each person. 

Chronic Pain

The traditional notion is that chronic (long term) pain is a symptom or result that is caused by some specific condition.  That is, a punch in the face causes pain not only in the facial area but may cause pain in the neck and down the spine. 

Some doctors are now thinking that pain may not just be the result of physical trauma.  Pain may also, in some instances, be the result of how your brain deals with pain signals.  In other words the brain and the neurons that carry the pain signals may become programmed with a type of neurological memory. When the original cause of the pain has gone away the pain may still remain. 

Other doctors think there may be some genetic origin to chronic pain.  That is, some people may have a predisposition to chronic pain. This may be based upon their gene makeup.  That may require specific targeting to that gene as the source of the chronic pain.

Measuring Pain-Treating Chronic Pain

The  treatment for chronic pain has been to treat it as being caused by inflammation. Therefore the treatment has been such things as aspirin, aspirin substitutes or physical therapy.

Several other modes of treatment that are in use are such things as acupuncture, massage therapy and medical hypnosis. These are attempts to reprogram the brain as to how to deal with pain.  

Chronic pain treatment can be complex. Chronic pain affects more people than cancer, diabetes, heart attack and stroke combined. Chronic pain sufferers often are misdiagnosed, misunderstood and miserable.

The good news is that chronic pain treatment can work. It requires the right blend of approaches. The traditional model of medication and rest is not enough. Rather than relieving the pain drugs may make it worse. What is required is the right blend of physical therapy, weaning off addictive medicine and counseling.

It is not unusual for people to feel acute pain after an injury or illness. If the pain last more than 12 weeks it is considered chronic. With the prolonged use of pain medication the nervous system becomes distorted. Pain receptors become more sensitive. Internal pain blockers become less effective. This can make the lightest touch seem painful. Chronic pain is associated with depression. This can then lead to fatigue and anxiety. It can also produce changes in mood, appetite and sleep.

Patients with depression may experience increased pain. Both depression and chronic pain share some of the same neurotransmitters and nerve pathways. As the pain gets worse the body’s ability to respond may weaken. The key is to get the depression under control. Drugs can provide some relief. They can be an important part of chronic pain treatment.

Measuring Pain-The Right Medicines

The extended use of strong addictive drugs such as opioids, Percocet or Valium may make the pain worse. These block the transmission of pain from the site to the brain. Over time the nerves send stronger pain signals. In other words the nerves turn up the volume in order to get the attention of the brain. Hence higher doses are required to block the louder signals. The pain receptors and processors get so confused that stimuli of any sort are seen as pain. The drugs no longer work.

What is needed is a holistic approach. This should include getting off the ineffective drugs and applying useful ones. In addition physical therapy and exercise must be used to teach the damaged nerves the difference between normal and harmful sensations. The patient must be committed to problem solving and avoiding isolation. He must work at improving communication and embracing physical therapy. He must work with a counselor to reframe the illness. Support groups can be a big help in this regard. Call, or contact us for a free consult.

Measuring Pain-Back Pain

One in four adults experience back pain in the course of a year.  This is a common reason for doctors’ visits.  Most people recover from back pain without any treatment.

The treatment mode tends to be over-the-counter medicine, rest and exercise  for nonspecific back pain.  Nonspecific back pain is not linked to a particular injury or disease.

Getting an MRI or X-ray may be needed for back pain related to a specific event. Likewise if the back pain has persisted for six weeks or longer.  In doing an X-ray or MRI the doctor is looking for a herniated disc or bone spur.  

Back Pain Is Common

However 25% of the population is going to show some pathology on an MRI or X-ray test of the back. This is true even though they may not be having any symptoms. Most orthopedic surgeons will tell you that for chronic back pain, physical therapy should be attempted. This is designed to strengthen the muscle support. In addition ceasing certain activities that may be causing the problem may be needed.

If the pain persists an injection of steroids or nerve block directly into the back may provide temporary relief.  That temporary relief will then hopefully give your back enough time to heal naturally. Also the physical therapy may hasten the healing process.

Dealing With Back Pain

Some general tips in terms of dealing with back pain are:

  • Acetaminophen or ibuprofen may help.
  • Sufficient rest
  • Stretching the affected body parts
  • Staying within your zone of no pain means do not push the body part into painful positions. This means trying to strengthen the nearby uninjured body parts so that they can better help with motion while the injured part heals. This should be the goal of physical therapy.
  • Keep moving. Although rest is needed becoming a slug in most cases is not going to hasten the healing process.

Call, or contact us for a free consult.

Measuring Pain-Acupuncture

Acupuncture involves the placement of needles into areas of the body. They are then manipulated by hand or with some electrical stimulation. The idea is either restoring health to that body area or limiting pain that may be emanating from that area. Acupuncture may be especially helpful in dealing with long term issues. These may include chronic symptoms of nausea or abdominal pain.

In addition it may be effective in preventing nausea after surgery with children and also lessening the pain of surgery. Indeed, one doctor in New York has found it to be effective in terms of dealing with attention-deficit hyperactivity disorder and also with asthma. 

In general, it has been found that acupuncture tends to produce only short term relief per session. In order to have some long term relief the sessions need to be long term.

The FDA monitors acupuncture procedures by requiring that the needles be sterile. In addition they can be used only one time by qualified personnel.

Measuring Pain-Facial Disfigurement

Facial disfigurement claims are often under evaluated because they are looked at only from the point of view of the disfigurement. They must also be looked at from the point of view of the impact upon earning capacity.  The subtle bias against a person who has a facial disfigurement is huge. Unattractive people are viewed more negatively than attractive people. Also people are generally biased in favor of those who are good-looking.

Opportunities in the workplace are sometimes denied to people who are disfigured. Unattractive people are frequently considered less productive and less intelligent. A personal injury attorney handling this type of injury claim needs to be aware of this.

Loss of Income Due To Disfigurement

There are social science findings that can be used to establish that a client is reasonably certain to suffer permanent reduction in earning capacity because of a significant facial disfigurement.  The role of the expert is to tell the jury general truths about their specialized experience. That is the basis for the admissibility of social science testimony from a psychologist. He may describe the effect of bias on a facially disfigured person.  The vocational expert then uses these social science studies to prove that disfigurement has harmed or will harm the plaintiff’s potential earning capacity

Call, or contact us for a free consult. For more information on pain and suffering see the other pages on this site.See also the pages on Wikipedia on pain and suffering.

Contact Us For A Free Consultation

Contact Us For A Free Consultation