Helpful comments from the Court of Appeal on Chronic Pain

In reasons for judgment released yesterday, the BC Court of Appeal in Park v. Targonski, 2017 BCCA 134, made some very helpful comments on Chronic Pain.  The court wrote:

Chronic pain

[76]         Chronic pain is a complex disorder. Dr. Lu explained that it negatively impacts sleep, energy, mood, and motivation. The medical evidence established that Ms. Park’s chronic pain manifested itself as hypersensitized and widespread pain that developed over time from her physical injuries. The psychological component of her pain is made evident in her ongoing issues with sleep, lack of energy, anxiety, lack of motivation and depressed mood.

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[86]         The complexity of chronic pain was acknowledged in Martin v. Nova Scotia (Workers’ Compensation Board), 2003 SCC 54, where Mr. Justice Gonthier, for the Court, wrote:

[1]        Chronic pain syndrome and related medical conditions have emerged in recent years as one of the most difficult problems facing workers’ compensation schemes in Canada and around the world. There is no authoritative definition of chronic pain. It is, however, generally considered to be pain that persists beyond the normal healing time 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. While there is at this time no clear explanation for chronic pain, recent work on the nervous system suggests that it may result from pathological changes in the nervous mechanisms that result in pain continuing and no-painful stimuli being perceived as painful. These changes, it is believed, may be precipitated by peripheral events, such as an accident, but may persist well beyond the normal recovery time for the precipitating event. 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. …

[87]         As in Martin, the medical evidence in this case conclusively established that Ms. Park’s pain is real, even though it includes a significant psychological component, and that its ongoing nature renders her vulnerable to depression. In my view, the judge erred in rejecting the subjective component of Ms. Park’s chronic pain as not being credible when he had accepted that component of her pain as an injury that was caused by the Accident. Even rejecting her evidence, there was a substantial body of medical evidence to support the reasonableness of her reported symptoms and their effect on her motivation. This error, in my respectful view, led the judge to focus principally on the physical nature of Ms. Park’s injuries and her physical capacity to do certain tasks, while discounting the distinct but inter-related emotional and psychological components of her injury, in assessing her functional capacity.

The full decision can be found here: http://www.courts.gov.bc.ca/jdb-txt/ca/17/01/2017BCCA0134.htm