How does a person's mental state effect pain in soft tissue injuries?

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Ongoing Chronic Pain following soft tissue injury has to be among the most controversial in medico legal work.

Whilst rare, us lawyers occasionally face a case whereby the Claimant describes pain intensity that does not correlate with their soft tissue injuries. So what is the explanation? There are various studies to determine people's pain thresholds and these vary according to people's psychological state and their fear of pain.

Chris Worsfold, an expert witness, has written an article in the Apil PI Focus summarising how people's mental state can affect their ability to feel pain.

He states that for example, PTSD sufferers appear to have lower pain thresholds and lower levels of the body's natural pain relieving substances (endorphins). However, there is a neurobiological pathway shared between stress responses, negative mood and pain in the neurotransmitter systems of the brain, and when we are stressed hormones are released that make our pain nerve endings more sensitive. He also says that even in complete absence of physical trauma, this pain can be present.

On the other hand he states that stress-related genes may also play a large part in the response of the stress pathways but there are calls for more in depth studies into this.

Another explanation may be that soft tissue injuries may cause chronic ongoing pain in those claimants whose nerves and spinal cord are vulnerable or have hypersensitivity of the spinal cord and this correlates with the stress related responses and genetic factors which have been implicated as a cause.

Suffice to say, it is evident that regardless of the severity of the physical injury, people can suffer ongoing chronic pain as a result of the psychological impact and stress measures. It is clear that whilst such pain may not be able to be explained on physical examination it does exist and can be assessed by specialist Chronic Pain experts who have an understanding of the psychological impact.

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