Monday, May 25, 2009

What about Pain and Workers’ compensation? (Part 1)

Pain. We all experience it. It can be mild or debilitating. Sometimes it can be controlled by medication but often, even with medication (or simply because of the medication) activities of daily living are just not possible.

With pain being such a common experience that accompanies injury and many illnesses, I thought I would look at how workers’ compensation systems deal with pain. The first place I looked was at the legislation and I was surprised that most workers’ compensation acts contain no direct reference to pain. Some make reference to “pain and suffering” but only in terms of what workers’ compensation systems will do with third party awards by courts for “pain and suffering”.

Nova Scotia’s Workers’ Compensation Act does make reference to Chornic Pain:

10A In this Act, "chronic pain" means pain
(a) continuing beyond the normal recovery time for the type of personal injury that precipitated, triggered or otherwise predated the pain; or
(b) disproportionate to the type of personal injury that precipitated, triggered or otherwise predated the pain,

and includes chronic pain syndrome, fibromyalgia, myofascial pain syndrome, and all other like or related conditions, but does not include pain supported by significant, objective, physical findings at the site of the injury which indicate that the injury has not healed.

So one Act tells us what Chronic Pain is and what Chronic Pain includes but not what pain is. Without a definition of pain in legislation, I looked to the medical and health profession. The International Classification of Disease (ICD9) has a code series for pain(338) and chronic pain (338.2) as well as chronic pain due to trauma (338.21) and ‘chronic pain syndrome (338.4). Again, that classified it but does not really define pain per se. As far as definitions go, I found many but one for pain and one for Chronic Pain that seem representative:

  • Pain: An unpleasant sensory and emotional experience associate with actual or potential tissue damage or described in terms of such damage (International Association for the Study of Pain - IASP)
  • Chronic Pain: pain that persists six months after an injury and beyond the usual recovery time of a comparable injury; this pain may continue in the presence or absence of demonstrable pathology. (Brock Smith, Report of the Chair of the Chronic Pain Panels [to the Workplace Safety and Insurance Board - WSIB], August 2000)

Most of us can identify with this definition of pain and most are likely to accept the later even without direct experience.

So, pain is real, even if it is not defined in legislation. And it is all too real to those suffering from work-related injury, illness and disease. How do workers’ compensation systems deal with pain? That’s a topic for the next post in this series.

No comments: