Chronic Pain Assessment is a perplexing task. How can one possibly verify the existence of a subjective, highly individual experience? That is possibly why numerous experts retreated to a typical formula stating that “from a purely physical” or “strictly psychological” point, nothing can support the client’s complaints. Although it can be convenient, these pleas do not hold well from philosophical (i.e., dualism), legal (i.e., court obligations), or medical (i.e., establishing diagnosis) aspects. Moreover, as the Supreme Court of Canada said in Nova Scotia (Workers’ Compensation Board) v. Martin; Nova Scotia (Workers’ Compensation Board) v. Laseur, [2003] 2 S.C.R. 504, 2003 SCC 54: “There is no authoritative definition of chronic pain. It is, however, generally considered to be pain that persists beyond the normal healing time for the underlying injury or is disproportionate to such injury and whose existence is not supported by objective findings at the site of the injury under current medical techniques. Despite this lack of objective findings, there is no doubt that chronic pain patients are suffering and in distress and that the disability they experience is real... Despite this reality, since chronic pain sufferers are impaired by a condition that cannot be supported by objective findings, they have been subjected to persistent suspicions of malingering on the part of employers, compensation officials, and even physicians”.

One of the best examples of such misconception is the so-called “whiplash-associated disorder.” While most insurance-hired experts prefer to label it “neck sprain/strain,” the majority of pain doctors name the condition “chronic cervical facet joint syndrome.” The difference is not just semantical. The former “diagnosis” is considered a minor injury and no extensive treatments are recommended. The latter is a more severe form of the same disorder that requires complex rehabilitation and interventional methods. Two case-law decisions supported diagnostic image-guided nerve blocks to differentiate between these two diagnoses. Positive results (pain reduction) can strengthen the evidence provided to courts of law and tribunals and state, with solid support, that there is a physical source of the pain due to the injury. These procedures should be used as a standard protocol in preparing legal cases involving cervical pain as a result of trauma. Unfortunately, Ontario lawyers are mainly oblivious to these matters.

It is time to change the way chronic pain and related disability is assessed. Perhaps it is also time for the insurance system to acknowledge the existence of Pain Medicine and stop dismissing Pain as a symptom. Certainly, it is the right time to offer practical strategies to facilitate recovery and regain functionality. These methods exist beyond the usual one size fits all routine of rehab centres and needle shop pain clinics.