Legal MDs Consulting Response:
One of the most challenging aspects of personal injury cases involving motor vehicle accidents is explaining to a jury or adjuster why a client continues to experience significant pain months or years after the initial injury, even when the original tissue damage appears to have healed. The medical concept that explains this phenomenon is central sensitization, and understanding it can be the difference between an adequate settlement and a case that is undervalued.
Central sensitization refers to a state in which the central nervous system amplifies sensory input, effectively lowering the pain threshold so that stimuli that would not normally be painful become painful (allodynia) and painful stimuli produce an exaggerated response (hyperalgesia). Woolf published a foundational paper on this topic in Pain (2011, Volume 152, Supplement 3, pages S2–S15), describing how persistent nociceptive input following tissue injury can lead to maladaptive changes in spinal cord and brain processing. These changes can outlast the initial injury and become self-sustaining.
From a clinical perspective, Nijs et al. in Pain Physician (2014, Volume 17, Issue 5, pages 447–457) identified clinical criteria that suggest central sensitization is present. These include pain that is disproportionate to the tissue pathology identified on imaging, widespread pain distribution, hypersensitivity to sensory stimuli beyond the area of injury, and psychological features such as sleep disturbance and cognitive difficulties. Importantly, the authors emphasized that central sensitization is a neurophysiological phenomenon, not a psychological disorder — a distinction that is critical in the medicolegal context.
The legal significance cannot be overstated. In many jurisdictions, the defense will attempt to frame persistent pain as psychological, malingered, or exaggerated. However, the American Medical Association Guides to the Evaluation of Permanent Impairment (6th Edition, 2008) acknowledges that chronic pain can represent a distinct impairment category. Additionally, in Kumho Tire Co. v. Carmichael, 526 U.S. 137 (1999), the Supreme Court extended the Daubert reliability standard to all expert testimony, including clinical medical opinions. A well-credentialed pain specialist testifying about central sensitization based on peer-reviewed literature meets this standard.
We recently assisted on a case where a 39-year-old woman involved in a highway collision was experiencing widespread pain, sleep disruption, and difficulty concentrating eighteen months post-accident. Her treating orthopedist had discharged her, stating her fractures were healed. The insurance adjuster argued she was at maximum medical improvement with no ongoing impairment. Our review of the medical records and interview with the client identified signs consistent with central sensitization. We cited the Woolf and Nijs criteria in our report and recommended referral to a pain management specialist who confirmed the diagnosis. This reframing of the case from “healed fractures” to “ongoing central nervous system dysfunction” materially changed the trajectory of the case.
If your client has persistent pain that seems out of proportion to the imaging findings, our physician consultants can evaluate whether central sensitization may be a factor, connect the clinical picture to the mechanism of injury, and provide the medical foundation for your theory of ongoing damages.
References
Woolf CJ. “Central sensitization: implications for the diagnosis and treatment of pain.” Pain. 2011;152(3 Suppl):S2-S15.Nijs J, Torres-Cueco R, van Wilgen CP, et al. “Applying modern pain neuroscience in clinical practice: criteria for the classification of central sensitization pain.” Pain Physician. 2014;17(5):447-457.Kumho Tire Co. v. Carmichael, 526 U.S. 137 (1999).American Medical Association. Guides to the Evaluation of Permanent Impairment, 6th Edition. Chicago: AMA; 2008.
This situation is another example of how we can assist you with all the medical issues in your cases. Call (954) 649-5739 or email DrC@legalmds.com to schedule a time to talk about one of your cases.
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