Phantom limb pain One might consider using the
defense expert to support the plaintiff’s physician’s testimony that ongoing pain isn’t always the direct response to an injury that has not healed. An explana- tion of phantom limb pain can drive this point home. Many amputees have described pain
in a limb that had been previously ampu- tated. Some amputees report feeling a phantom limb almost immediately after amputation of an arm or leg. The phan- tom limb is usually described as having a tingling feeling and a definite shape that resembles the real limb before amputa- tion. As time passes, however, the phan- tom limb begins to change shape. Some phantom limbs are painless while others are painful. The pain is described as cramping, shooting, burning or crushing, and may start immediately or appear weeks, months or even years later. The pain may endure long after the healing of the injured tissues. Trigger zones may spread to healthy areas on the same or opposite side of the body. Gentle pressure or a pin prick on one limb may trigger terrible pain in the phantom limb. It was believed that phantom limb pain always had a psychiatric basis but
that hypothesis is untenable. People suf- fering from phantom limb pain can expe- rience sudden relief produced by nerve blocks. Studies have indicated that patients with phantom limb do not have a greater incidence of neuroses than those without pain in the phantom limb. Emotional factors probably contribute to the pain, but are not a major cause. Paraplegics, who have lost motor func- tions and sensation in their lower extrem- ities, may also suffer from severe phantom body pains. This can occur even when the spinal cord is known to be totally transect- ed. It is believed that the cause of the pain must lie in the neural changes that are the result of the massive loss of senso- ry input from the body to the brain. Even the most jaded defense doctor will have to agree that phantom pain is real.
Characteristics of chronic pain Patients who suffer chronic-pain syn-
drome often have the following character- istics: Poor response to conventional anal- gesic regimes; multiple surgical and/or pharmacological treatments; conflicts with health-care providers; increased feelings of helplessness, hopelessness and mean- inglessness; decreased physical capacity due to disuse and interpersonal conflicts.
These characteristics often result in an unlikeable plaintiff. The jury needs to understand that these unlikeable charac- teristics are the result of the chronic pain. When patients suffer from chronic
pain, the prognosis is poor. These patients will seldom be pain free. The hope of treatment is to decrease the use of narcotic pain medication, improve function and modify their lifestyle. Chronic pain takes away one’s enjoyment of life.
John F. Denove specializes in major
injury, medical malpractice and insurance bad faith litigation. He was named Consumer Attorneys Association of Los Angeles’ Trial Lawyer of the Year in 1993 and received the Ted Horn Memorial Award in 2001. He also received the CAOC/CTLA Presidential Award of Merit in 1994, 1996 and 2000, CAOC’s Outstanding President of the Year Award in 2000 and the Edward I. Pollock Award in 2006. He is a Past President of CAALA; Member of CAOC’s Board of Directors; Diplomate of the American Board of Trial Advocates; Executive Committee Member of the Los Angeles Chapter of ABOTA; Past President of the Italian American Lawyers Association; Member of AAJ; Member of Trial Lawyers for Public Justice; and Past President of the Cowboy Lawyers Association.
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JULY 2011 The Advocate Magazine — 77
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