A blog exploring the subject of pain and giving examples of medical negligence cases relating to different type of pain.
To say pain is “all in the mind” is literally true – only the brain can generate pain, albeit that it then tells particular parts of the body that they are feeling it. Pain is a complex phenomenon, and when it is not dealt with properly, the consequences can be disastrous. Below, three instances of pain in medical negligence cases are discussed.
Most pain is caused by illness or trauma. However, sometimes, the mind can generate pain in response to emotional stress – the stress is “converted” into pain. This is surprisingly common: if you have been in a stressful situation, it is very likely that you will have experienced this. You will probably have experienced either a headache or stomach pains, possibly accompanied by diarrhoea.
Some people suffer from an extreme version of this – a condition which is known as somatisation disorder. Somatisation disorder is relatively common: virtually every GP practice in the country will have at least one sufferer registered with them. Somatisation disorder sufferers experience many different types of pain, all of which have no physical cause. Typically, their pain will flare up in response to difficult life circumstances.
Frequently, suffers of this condition are sent by their GP to medical specialists for further investigation. Doctors should always rule out physical causes for pain, but this can be double-edged in the context of specialised medicine: if they do not know the patient well, and they specialise in a particular area of medicine, doctors can consider very obscure (and often incorrect) diagnoses. At worst, this can lead to a patient having unnecessary surgery. This can be disastrous for such a patient: if there is no good basis for doing surgery, then nobody will derive benefit from it. However, for somebody suffering from somatisation disorder, surgical trauma often reinforces pain generated mentally. In turn, this leads to worsening symptoms. Unremitting pain in a patient post-operatively can cause opiate dependence, and yet more investigations and invasive medical treatment (sufferers tend to be reluctant to accept a non-physical explanation for their pain).
Most operations are performed under general anaesthetic. The aim of anaesthesia is threefold: the patient must be paralysed, sedated and rendered insensitive to pain. If all of these are not accomplished, the patient risks anaesthetic awareness – whether with or without pain. The prospect of being conscious during surgery is terrifying. People who have suffered this are frequently traumatised by the experience, suffering vivid and intrusive memories.
Anaesthetic awareness can occur non-negligently – especially where there are good clinical reasons to give fairly light anaesthetic (e.g., surgery in the setting of chronic obstructive pulmonary disease). However, there are autonomic markers of pain, which cannot be masked (e.g., high pulse rate or raised blood pressure), and these should be recorded contemporaneously on the anaesthetic chart. Anaesthetists fail to respond rapidly to these signs at their peril and these incidents can lead to patients bringing medical negligence cases.
Phantom pain can occur after amputation of a limb. Often, sufferers will describe sensations either of itching or pain in the limb – even though they are well aware that it is no longer attached. The explanation for this curious phenomenon is set out above: pain is generated by the brain. If the brain does not receive signals from a limb, then it can assume there should be some there, and “fills in the gaps”.
Amputations often feature in clinical negligence claims – usually, it is alleged that the limb could have been saved with different or simply more rapid treatment. However, in addition to these considerations, it is also important to consider whether the patient was consented properly. Patients with particularly intractable pain in a limb often contemplate amputation as a solution. Whilst this is an understandable response, it is not a guaranteed solution, and patients in that position should be advised of that before they consent to surgery. Informed consent is therefore an important consideration in these cases. If the patient was not informed properly, then there could be a claim.
Unsurprisingly, pain also leads to litigation. If it could have been avoided (or at least better controlled) with different or simply more rapid treatment, then there may be a case. In complex claims of this variety, you should always approach a suitably specialised firm, with appropriate levels of expertise. We have a very wide variety of experience in the field. If you think you have such a claim please contact me or one of my colleagues for further advice.