PAIN: THE OBJECTIVE AND SUBJECTIVE SIGNS
According to Dr. Joel Saper, Director of the Michigan Head Pain and Neurological Institute, 15-20% of patients are faking pain or, at least, are not as incapacitated as they claim. Evaluating patients’ pain is becoming a more difficult issue than ever for physicians given two opposing health care trends. First, pain killers, the most commonly prescribed medications in the United States, have become a major drug of abuse. Pain medications are now the country’s second most cause of accidental deaths, following only car crashes. This is according to the Office of National Drug Control Policy. Secondly, according to The Institute of Medicine, which advises the Government on various health care issues, pain is often all too undertreated in the United States.
Many physicians claim they have to look at every patient as a potential drug abuser, but there are suspicious patterns. Doctors have to look at the individual signs to determine whether or not a patient is or may become a pain medication abuser.
Thirty-eight states allow doctors to check prescription registries to determine whether patients are getting similar drugs from other physicians in the same state.
Experts also say it is imperative for primary care physicians (PCPs) who treat 80% of pain issues, to take time to know a patient’s history and circumstances. For example, a patient’s low back complaints may be a result of an unhappy work environment or personal issues at home. However, with increased health care costs, PCPs are being pushed to the limit and have limitations as to the amount of time they can spend with each patient, which typically lasts less than 12 minutes.
According to a recent article in the Wall Street Journal, chronic pain affects 116 million Americans and costs over a half trillion dollars per year in medical bills and lost productivity. The most common types of chronic pain people reported in a survey are as follows:
• Low back pain 28%
• Knee pain 20%
• Severe headache or migraine pain 16%
• Neck pain 15%
• Shoulder pain 9%
• Finger pain 8%
• Hip pain 7%
In personal injury matters, chronic pain can become a hotly contested issue which insurance companies and defense attorneys hone in on. Once a matter is in litigation, injured parties are vigorously interrogated regarding their complaints. Physicians are constantly questioned as to the underlying neurological or orthopedic components to verify or disprove the party’s complaints. Objective findings through radiological reports, including x-rays, CT scans, PET scans, and MRIs, all help to substantiate an injured party’s pain complaints.
Conversely, insurance companies and their attorneys will often require an injured party to undergo a medical examination by a doctor of their choosing. Most of these examinations are brief and the doctor’s routinely dispute the injured party’s claimed injuries and complaints. To the extent that objective findings through neurological or radiological tests can substantiate the injuries, this is a good tool in disproving the defense medical examiner’s opinions.