North West Pain Seminar 2013

Fiona Ashworth presented the 2013 North West Pain Seminar on the 11th April 2013 at the Renaissance Hotel in Manchester. She spoke about the link between trauma and chronic pain conditions including Complex Regional Pain Syndromes, Chronic Pain Syndromes, Fibromyalgia and Chronic Fatigue Syndromes,

She was joined by Tim Johnson, Pain expert at Salford Royal Foundation Trust, and Frank McKenna, expert Rheumatologist at Trafford NHS Trust.



Frank Mckenna explained that despite scepticism by some members of the medical profession, Fibromyalgia has been recorded in literature for over 150 years. He described the triad of Chronic widespread Pain, non-restorative sleep and tender points which has been accepted for many years.

He explained that the World Health Organisation listed Fibromyalgia in the ICD10. 2% of the population is believed to have Fibromyalgia. Some people have psychological vulnerability to Fibromyalgia. There are numerous triggers including viral, physical and psychological insults.

It is possible to detect abnormalities in the way that Fibromyalgia sufferers react to pain on a MRI scan. This can detect that, not only do different parts of the brain react to pain in a Fibromyalgia sufferer than in a control volunteer but also the Fibromyalgia sufferer reacts to lower levels of pain.

It is believed that lack of slow wave sleep lowers the pain threshold. People with poor sleep are  more likely to develop Fibromyalgia and an individual is five times more likely to develop a Chronic Widespread Pain Syndrome if he or she suffers from insomnia. Sleep studies show that people suffering from Fibromyalgia demonstrate different sleep patterns than in a control group with a lack of slow wave sleep.

Trauma can trigger Fibromyalgia. The amount of impact does not dictate whether a patient will go on to develop Fibromyalgia.

There is very little effective treatment. Sodium oxybate can restore deep sleep which improves the fatigue, but this is not freely available.



Tim Johnson said that there was a link between pain and psychological factors. There is a medical and psychological side to pain. Chronic Pain was classified as a disease by the World Health Organisation in 2004. There is a distinction between Acute Pain and Chronic Pain. If the nervous system is not working properly, then it becomes more sensitive because of loss of inhibiters from the brain. There are bio-psycho-social factors which continue to drive the pain.

On occasions Doctors do not have an explanation for the pain and therefore dismiss it as being real. However, the patient does continue to experience pain. There can be an amplification of pain caused by trauma which can be persistent.

The best chance for treatment is to recognise and address the problem early.



Fiona Ashworth described how trauma can induce Chronic Pain conditions. She explained how it is vital to spot the warning signs that a Chronic Pain condition is evolving. Failing to do so would lead to the Claimant being undercompensated and the Solicitor potentially facing a professional negligence action. It is essential to recognise the potential of a Chronic Pain syndrome developing from relatively minor trauma within the Portal Scheme.

She explained that the average time gap between a patient developing a Chronic Pain condition and receiving satisfactory diagnosis is 2.7 years. The Lawyer dealing with a Minor Trauma case which has developed into a Chronic Pain condition must therefore be alert to the possibility, notwithstanding that a diagnosis has not been made by the treating practitioner.

She explained that the Courts are becoming more ready to accept that a severe and debilitating Chronic Pain condition may arise from relatively minor trauma. She explained that the most recent 11th edition of the Judicial College Guidelines for the Assessment of General Damages in Personal Injury cases now has an entire section devoted to Chronic Pain cases.

She explained the definition of Fibromyalgia by the American College of Rheumatology in 1990 as varied by Wolfe in 2010.

She explained the definition of Chronic Fatigue Syndrome in accordance with the Fukuda criteria she also explained the definition of Complex Regional Pain syndrome in accordance with the Budapest Criteria

She stated that Claimant Solicitors should not be overly dependent on the initial medical report in portal cases and suggested that they should device their own questionnaire which should be sent to Claimants which could identify whether an individual Claimant was likely to develop a Chronic Pain Syndrome.

Fiona gave tips and guidance as to how to identify and to run Chronic Pain cases.

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