By Amanda Pustilnik | University of Maryland Legal Studies Research | 10 March 2014

Abstract:

Legal doctrines and decisional norms treat chronic claims pain differently than other kinds of disability or damages claims because of bias and confusion about whether chronic pain is real. This is law’s painful disparity. Now, breakthrough neuroimaging can make pain visible, shedding light on these mysterious ills. Neuroimaging shows these conditions are, as sufferers have known all along, painfully real. This Article is about where law ought to change because of innovations in structural and functional imaging of the brain in pain. It describes cutting-edge scientific developments and the impact they should make on evidence law and disability law, and, eventually the law’s norms about pain. It suggests that pain neuroimaging will solve current legal problems and also open the door to reconsiderations of law’s treatment of other subjective phenomena like mental states and emotions, going to the theoretical heart of legal doctrines about body and mind.

Read the full paper here.

By Philip Pizzo, MD | New England Journal of Medicine | September 2013

Philip Pizzo, MD, was Dean of the Stanford University School of Medicine from 2001-2012. He is also the Heckerman Professor of Pediatrics and Professor of Microbiology & Immunology.

When I chaired an Institute of Medicine (IOM) committee on “Relieving Pain in America” (1) and then coauthored a Perspective article about the vast human toll and financial burden imposed by chronic pain, (2) I believed I understood the impact of chronic pain. Not only did I have experience caring for children with life-threatening and frequently painful disorders, I also had relatives with chronic pain syndromes and had witnessed the limitations of the medical care system. But it wasn’t until my own year-long journey with chronic pain that I received a higher-level education on the topic.

I was loading a suitcase onto an airport conveyor belt, when an unexpected twist led to my first twinge of back pain. I assumed it would be self-limited, especially since I was in good physical shape: for the past several decades, I’d been running one to three marathons a year and working at demanding jobs, most recently as a medical school dean. I felt impervious to stress and was almost always optimistic. Chronic pain changed all that. Continue reading »

By Frank Porreca and Theodore Price | Scientific American Mind | September 2009

Imagine you are a doctor treating a patient who has been in nearly constant pain for four years, ever since the day he sprained his ankle stepping off a curb. Physical therapy only briefly dulled the agony. Painkillers were not much better, and the most effective drugs made your patient exhausted and constipated. He is now depressed, sleeping poorly and having difficulty concentrating. As you talk with him, you realize that his thinking also seems impaired. Your exam confirms that the original injury has healed. Only pain and its consequences remain—and your options for helping this man are running out.

This scenario plays out every day in doctors’ offices around the world. Fifteen to 20 percent of adults worldwide suffer from persistent, or chronic, pain. Half the primary care patients who develop a chronic pain condition fail to recover within a year, according to surveys conducted by the World Health Organization. Common causes of such unrelenting discomfort include physical trauma, arthritis, cancer, and metabolic diseases such as diabetes that can damage nerves. In many cases, however, the pain’s origins are mysterious. Continue reading »