Medical jurisprudence in the context of chronic musculoskeletal nociplastic pain: the clinical medico-legal interface
Abstract. Chronic primary musculoskeletal pain is prevalent and often the cause of medico-legal dispute. Pain with an unknown etiology that occurs in the absence of substantial tissue abnormality has challenged the health care community for decades. The World Health Organization now recognizes chron...
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| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer
2025-10-01
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| Series: | PAIN Reports |
| Online Access: | http://journals.lww.com/painrpts/fulltext/10.1097/PR9.0000000000001316 |
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| Summary: | Abstract. Chronic primary musculoskeletal pain is prevalent and often the cause of medico-legal dispute. Pain with an unknown etiology that occurs in the absence of substantial tissue abnormality has challenged the health care community for decades. The World Health Organization now recognizes chronic primary pain (CPP) conditions as valid conditions that are prevalent and a cause of considerable suffering. Without an objective test or biomarker to confirm diagnosis or measure severity, CPP conditions may be brought before the Court with questions of severity, causation, functional impairment, and disablement. The many subjective symptoms that associate with CPP pain add to the total burden of illness and also to the complexity of the adjudication process. This review will discuss the responsibilities of clinicians when providing an opinion to aid a legal adjudication process. Medical information regarding CPP should be objectively and clearly stated, without bias and must remain within the practice domain of the clinician. The distinct roles of the treating clinician and the medico-legal expert will be compared. Issues concerning assessment of severity, validity measures to assess subjective symptoms, matters of causation, and impact on function are discussed. Irrespective of the legal setting, whether a regional tribunal or higher national court, the health care professional providing testimony must adhere to the highest ethical standards. Understanding the medico-legal process that functions in parallel, but differently from clinical care, will prepare health care professionals to provide relevant information that will lead to a fair and just outcome for those truly suffering with chronic pain. |
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| ISSN: | 2471-2531 |