November 3-9, 2024, is National Pain Awareness Week – a week dedicated to drawing attention to chronic pain and the devastating impact it can have on people’s lives. The broader goal is to advocate for early, effective treatment of this condition and promote further education to better understand it.
I am astounded by the number of people living with chronic pain in our country. According to Health Canada, it’s nearly 8 million people – that’s one in every five people.[1] In 2019, between $15.1 and $17.2 million was spent to treat this condition. That’s in Canada alone.[2]
Sadly, living with this condition can have a devastating impact on people’s physical functioning, mental health, sleep, relationships, ability to work to support themselves and their family and their capacity to do their everyday activities that they would typically do without any trouble.
In 2019, Health Canada created the Canadian Pain Task Force to provide guidance to the federal government about improving the approach for preventing and managing chronic pain. In 2021, the task force concluded that chronic pain is a “Public Health emergency in need of action”.[3]
But what exactly is chronic pain and how is it different from other types of pain?
Chronic pain can stem from many causes, including ongoing underlying conditions such as arthritis, cancer or even a pinched nerve.[4] Those are just some examples. In other cases, people suffer from this condition without any known underlying cause – that is, no known injury and no evidence of any illness.[5] For instance, someone may suffer from persistent migraine headaches without a clear explanation. In other cases, it can be caused by an initial injury or illness that has been fully resolved on a physical level and yet the pain remains.[6] For instance, a person may suffer a whiplash injury in a car crash and continue to be in pain every day for the rest of their life, well after the damaged tissue has completely healed. There is even something called phantom limb pain. It’s astounding and proves the human body is a wonder. It’s a condition where people feel pain or some other sensation in the very body part that has been surgically amputated. In other words, people with this condition feel pain in a body part that no longer exists! In some cases, this pain persists.[7]
Not surprisingly, chronic pain is recognized as a complex condition. The Canadian Pain Task Force and the World Health Organization (WHO) have all concluded it is a disease in and of itself.[8] The Canadian Pain Task Force says this condition is best understood from a biopsychosocial perspective – as opposed to a biomechanical perspective.[9] The outdated biomechanical perspective assumes that all pain has a physical cause.[10] For instance, you put your hand in a fire and you feel sharp pain in your fingers and reflexively pull your hand back. According to the American Medical Association, chronic pain can rarely be understood in that way, and in fact, biological, psychological and social factors can cause pain to persist and even worsen.[11]
Chronic Pain in Personal Injury Cases
As a plaintiff personal injury lawyer, I have represented many people suffering with chronic pain. I know it’s real. In many cases, it is caused by soft tissue injuries to the neck, back or some other part of the body after a bad fall, motor vehicle collision or some other incident causing physical trauma.[12] Often during a lawsuit, the defending insurance company will hire a medical expert to assess my clients and write a report. Not uncommonly, these experts conclude my clients do not suffer from chronic pain because they should have healed by now. I never understand these conclusions. Chronic pain for soft tissue damage is, by definition, pain that persists beyond the typical 3-month healing period. In other words, these hired experts are saying my client does not suffer from chronic pain because they meet the definition of chronic pain. How does that make sense?
Many of these same hired medical experts also often conclude that my clients do not suffer from chronic pain because there is no “objective evidence” of any injury or because they are experiencing more pain than would be expected. I find these conclusions both baffling and frustrating when chronic pain is the issue. I often wonder if they would come to those same conclusions if my clients were patients of theirs. These experts either know or ought to know that pain can persist well after the injured tissue has fully healed, that there is no way to objectively calculate pain, and that everyone experiences pain differently. What is painful to one person may not be as painful to another, and no one can actually feel another person’s pain.
Persistent pain can have a monumental impact on people’s quality of life. It can impact their mobility and stamina, disrupt their concentration and memory, and affect their sleep as well as their capacity to work and do their usual everyday activities – things as simple as cleaning their house, going grocery shopping or even getting out of bed. In some cases, they may avoid doing things they need to do or love doing because they are afraid of making their pain even worse. Chronic pain can even lead people to withdraw from their friends, family and colleagues, making them feel isolated and alone. And, yes, as mentioned, it can lead to anxiety or depression or worsen those conditions in people who already have them, and there can be horrible side effects to taking the prescribed medications that are supposed to help them feel better.
As someone who often represents people who suffer from this horrible condition because of someone else’s wrongdoing, I hope that both the medical and legal community continue to make progress in understanding and treating this complex illness.
[1] Canadian Pain Task Force Report: March 2021.
[2] Canadian Pain Task Force Report: March 2021.
[3] Canadian Pain Task Force Report: March 2021.
[4] John Hopkins Medicine website article, “Chronic Pain” and Mayo Clinic website article, “Chronic pain: how it works” and American Medical Association Guides to the Evaluation of Permanent Impairment, Sixth Edition, p. 32-34.
[5] John Hopkins Medicine website article, “Chronic Pain”
[6] Canadian Pain Task Force Report: March 2021, John Hopkins Medicine website article, “Chronic Pain”
[7] Cleveland Clinic website article, “Chronic Pain”.
[8] Canadian Pain Task Force Report: March 2021.
[9] Canadian Pain Task Force Report: March 2021.
[10] American Medical Association Guides to the Evaluation of Permanent Impairment, Sixth Edition, p. 32.
[11] American Medical Association Guides to the Evaluation of Permanent Impairment, Sixth Edition, p. 32 and 34.
[12] Soft tissue damage is just another way of saying damage to the muscles, ligaments, tendons, or connective tissue (fascia) in the body.
