There's no gain when government nickels-and-dimes long-term pain

"Subsequent to Martin, the insult continues in a different guise. Now patients must be found to exhibit no objective findings, or to exhibit pain that is out of keeping with, or unusual, in light of the injury or findings, in order to qualify for access to compensation for chronic pain. These statements smack of patient-blaming and fly in the face of research regarding chronic post-traumatic pain, much of which is related to a neural response to tissue injury . . . Many of those left with chronic pain will not be able to recover loss through the tort system and the costs will come back to our health care and social assistance systems."

These statements smack of patient-blaming and fly in the face of research regarding chronic post-traumatic pain, much of which is related to a neural response to tissue injury. The pain field has advanced rapidly. Bedside and quantitative sensory testing demonstrate that many of these patients exhibit sensory abnormalities that support a diagnosis of neuropathic (nerve injury) pain.

Labour Minister Mark Parent's estimated $12 million to cover the cost of the recent Cohen decision is only the tip of the iceberg. The Nova Scotia Court of Appeal has ruled that workers who were injured at work and developed chronic pain prior to April 17, 1985 should be assessed for benefits.

This decision follows the 2003 Martin and Laseur vs. Nova Scotia (Workers Compensation Board) Supreme Court of Canada decision that found the Nova Scotia Workers Compensation Act violated the Charter of Rights and Freedoms.

The Cohen decision will lead to a review of 1,200 cases to the tune of an estimated $12 million. The Martin and Laseur decisions necessitated a review of some 6,000 cases with a cost of approximately $190 million or more to date.

As a clinician in the trenches treating the survivors of work-related injuries, it has been a desperately sad process to witness. Prior to the Martin decision, we witnessed the impact of insult that was added to injury as injured workers, whose lives had been destroyed by pain, were told that they did not exhibit objective findings of a true injury and therefore did not deserve access to compensation.

Subsequent to Martin, the insult continues in a different guise. Now patients must be found to exhibit no objective findings, or to exhibit pain that is out of keeping with, or unusual, in light of the injury or findings, in order to qualify for access to compensation for chronic pain.

These statements smack of patient-blaming and fly in the face of research regarding chronic post-traumatic pain, much of which is related to a neural response to tissue injury. The pain field has advanced rapidly. Bedside and quantitative sensory testing demonstrate that many of these patients exhibit sensory abnormalities that support a diagnosis of neuropathic (nerve injury) pain.

When I last inquired, the Workers Compensation Board still considered sensory abnormalities "subjective." If you are confused now, join the club. Sometimes I am left feeling like a pretzel from the mental gymnastics that face us under the current chronic pain regulations.

However, it is better than it was before. Injured workers left with chronic pain now have access to the system, thanks to the Martin and Laseur decisions. Now, those injured before April 1985 will be assisted by the Cohen decision.

However, the war is not over. The previous discriminatory Workers Compensation Act was only one symptom of a broader pain-denying attitude. There will be many more battles to fight.

One big battle on the horizon, with many similar issues involves the Automobile Insurance Reform Act. This act caps what many patients with chronic pain are able to recover subsequent to a motor vehicle accident, limiting the amount to $2,500. Like the previous Workers Compensation Act, this legislation, in combination with subsequent regulations, effectively discriminates against many people with chronic pain.

Many of those left with chronic pain will not be able to recover loss through the tort system and the costs will come back to our health care and social assistance systems. And let us not forget all the folks who are suffering from chronic pain unrelated to work or motor vehicle trauma.

The most recent Canadian studies put this figure at 29 per cent; this amounts 290,000 people in Nova Scotia alone. The National Population Health Survey of 1996 found that compared to the general population, people reporting chronic pain had more disability days off work, spent more days in hospital in the past year and had 12.9 more annual physician contacts.

The economic impact in terms of lost work, clinic and hospital visits and medication costs of chronic pain was estimated to be approximately $14,744 per person. Even if only 20 per cent of those with chronic pain were bad enough to be disabled and require treatment, this puts us in the range of $855 million.

Studies have demonstrated that if you treat pain early, you can decrease the chance of it becoming chronic. In addition, once pain becomes chronic, treatment will decrease suffering, improve function and decrease costs. In fact, even one visit to a multidisciplinary clinic will decrease costs by half.

Would it not be much more cost-effective to acknowledge the reality of chronic pain and provide appropriate timely multidisciplinary treatment? An investment in good pain management services now will spare so much suffering and will save money in the future.

'Studies have demonstrated that if you treat pain early, you can decrease the chance of it becoming chronic.'

Mary Lynch, MD, FRCPC, is director of the Pain Management Unit, Capital District Health Authority, and president-elect of the Canadian Pain Society.

© 2007 The Halifax Herald Limited