Introduction to Special Issue on Traumatically Induced Pain: Assessing and Addressing Controversies

Abstract

This current Special Issue of Psychological Injury and Law focuses on traumatically induced pain and its medicolegal aspects. Because many individuals suffering from chronic pain have sustained their painful injuries as a result of trauma, it is common for them to become involved in litigation. As we know, chronic pain is a complex syndrome, characterized not only by persistent physical discomfort but also by a deleterious impact on numerous aspects of one’s life (potentially including vocational, financial, social, sexual, recreational, and emotional functioning). Clearly, chronic pain is not merely an affliction of a body; rather, it should be conceptualized as an illness of the person (Schatman 2010a, b). This is not to suggest, however, that psychosocial factors are necessarily at the root of chronic pain (Melzack and Katz 2006). In fact, there is as much empirical evidence supporting chronic pain as the cause of psychopathology as there is supporting the primacy of psychosocial factors in the etiology of chronic pain (Gureje 2007; van’t Land et al. 2010). Rejecting the unidirectionality argument as explanatory of the psychosocial factor-pain experience relationship, mutual maintenance models hold that physiological, affective, and behavioral components of emotional distress maintain or exacerbate symptoms of pain and, similarly, that cognitive, affective, and behavioral components of chronic musculoskeletal pain maintain or exacerbate symptoms of emotional distress. These models have been applied to, and empirically supported in, examinations of co-morbidities of chronic pain such as depression (Bair et al. 2003; Dworkin et al. 1992; von Korff and Simon 1996), post-traumatic stress disorder (PTSD) (Asmundson and Taylor 2006; Otis et al. 2003; Sharp and Harvey 2001), as well as general quality of life among chronic pain patients (Wahl et al. 2009). Relatively recent research has identified a shared biologic process underlying chronic pain and depression, in which serotonin and norepinephrine are involved in the dorsal raphe nucleus and locus ceruleus (Jann and Slade 2007). The identification of this shared mechanism lends additional support to the hypothesis of a bidirectional interaction between chronic pain and psychosocial factors. Also to be considered is the diathesis-stress model of psychopathology and chronic pain, which has ultimately developed into the dominant overarching theoretical perspective. This model, initially articulated by Gatchel and colleagues (Dersh et al. 2006, 2001, 2002; Gatchel 1991, 1996), assumes the presence of premorbid yet semi-dormant characteristics of the patient that exist prior to the onset of pain, which are then activated in response to the stress of the painful condition and its psychiatric sequelae. Moreover, the wide-ranging impact of pain becomes even more complex when injured parties choose to pursue litigation relating to their pain-producing injuries. Results of an early meta-analysis (Rohling et al. 1995), for example, suggested that receiving financial compensation was associated with a greater experience of pain and reduced treatment efficacy, with the authors positing causal attribution. However, subsequent reviews have questioned this validity of the proposed causal relationship (Kolbinson et al. 1996; Scholten-Peeters et al. 2003; Sterner and Gerdle 2004) or have suggested that it has not been adequately studied to presume that litigation has an impact on prognosis (Carroll et al. 2008). M. E. Schatman (*) Pain and Addiction Study Foundation, 1215 120th Ave. NE, Suite 201, Bellevue, WA 98005, USA e-mail: headdock@comcast.net