• David Martin

Is Disproportional Pain Real?


Pain does not always directly correlate to the extent of an injury. In “Amplified Pain – A Helpful Diagnosis,” published recently in JAMA Pediatrics, Dr. David Sherry gave the example of pricking one’s finger in his discussion of disproportional pain. The damage is minor, but the pain is real. In response, the body shuts down blood to the area which causes increased pain. He explains it as being similar to having a rubber band on your finger for too long. While there may not be any real damage, your finger hurts nonetheless. Aside from the actual prick, there are new signals of pain that are fed into the cycle – which leads to more pain. He describes it as being akin to feedback in a microphone when the microphone gets too close to a speaker.


Dr. Sherry notes that fellow physician, Dr. John Monica, the founder of the world's first pain clinic, has often remarked that "all pain is in the head". Certainly pain is real, no one denies its existence. From a scientific basis, of course it is in your head, but the implication that the recipient is malingering or imagining the pain is false and unhelpful. Likewise, the often-heard label “disproportional pain” may be accurate but should not be interpreted as invalidating the existence of pain. The body's response to injury may magnify the level of pain beyond that caused by the actual injury, but that does not make it any less real. While this is important in children, who are often accused of faking or seeking attention, the unintended consequence of such labels is minimizing the actual pain experienced. The same is true for adults who may be accused of seeking attention or having a financial motive for claiming pain. The mere fact that pain is disproportional should not confirm such suspicions. The body does in fact amplify pain.


Pain can be validated with credible indicators. So, while labeling pain as disproportional may be accurate from a medical or scientific viewpoint, it is inaccurate and improper for a layperson (such as an insurance adjuster or its lawyer) to argue that this is label means malingering. Dr. Sherry notes that one should not presume that someone with a fractured finger is in pain. But there is a credible basis to understand the source of the pain and further to understand that the pain signal may be amplified beyond the extent of the original injury as part of the body's response. A more helpful terminology for such pain is “amplified pain.” That explains that the body is taking a normally nonpainful signal and amplifying it to an extremely painful level for a physical purpose. Where the amplification occurs is immaterial, it is the experience that is important.


This is why hiring an experienced ERISA attorney as early in the process as possible is so important. It is important that an attorney submit evidence and information to the insurance company as if they were already in a trial. Let us know if we can help.

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