Pain — continued from Previous Page
stimulus. This can be explained to the jury as follows: When they walk into the courthouse, they go through a metal detector. With a very small piece of metal such as metal in a ballpoint pen, the alarm will not go off. If the sensitivity of the metal detector is changed from nor- mal to extreme, the alarm will go off for all non-threatening pieces of metal, no matter how small. In a security line, this becomes an annoyance. In the body, changes in sensitivity can be a living hell. The changes in the spinal cord will
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lead to changes in the brain. The brain manufactures more sensors and more chemicals in the body to activate the sen- sors. When the brain is sensitized, it is more than the experience of pain that is produced. It leads to persistent changes in the sympathetic and parasympathetic nervous systems, endocrine system, immune system and motor system. Sensitization of the brain and spinal cord is called central sensitization. Sensitization is an increased responsive- ness to stimuli. Pain-related nervous sys- tem neurons become hyper-excitable. The descending pathway also undergoes changes in response to chronic pain. These changes impair its ability to decrease the pain that is experienced. When sensitization results, the brain is
told that the body is in danger and the brain therefore makes more of the body hurt in an attempt to protect it. Unfortunately, the more the body attempts to protect itself, the more pain the person feels. Not only is the area of the pain increased, but the frequency and severity of the pain increases. The physical changes in the nervous system explain why the per- son experiences hyperalgesia, an increased response to a normally painful stimulus and allodynia, pain response to a stimulus that does not normally produce pain. Unless the plaintiff’s physicians can
explain the physiologic changes that occur in response to chronic pain, the jury will likely believe the defense physi- cian’s explanation that the injury should have healed within three or four months, and that therefore, the plaintiff should not be in pain.
76— The Advocate Magazine JULY 2011
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