Chronic pain due to a specific medical condition or injury can provide the basis for a social security disability benefits approval. Chronic pain is distinguished from acute pain where it is easier to understand the intensity and duration of the pain based upon the extent of the physical injury. The so-called ‘specificity theory’ of pain recognizes what we know from common sense that, for example, pain from a finger prick is less intense and long-lasting than that resulting from a toe amputation.
Social security law requires that pain symptoms be the result of a “medically determinable impairment that could reasonably be expected to produce your symptoms”. This is, I think, a codification of the ‘specificity theory’: excruciating and long-lasting pain can hardly be “reasonable expected” from a finger prick.
The ‘specificity theory’ as an explanation of pain duration and intensity seems to break down, however, when it comes to chronic pain. Often there is little relation between the extent of physical injury and the debilitating nature of chronic pain. My father-in-law lost both legs in the Korean War, yet often complained of pain in his toes, an example of Phantom Limb Syndrome. Reflex Sympathetic Dystrophy Syndrome (RSD), now called Complex Regional Pain Syndrome (CRPS), is a chronic pain condition triggered by physical injury, but the intensity and frequency of the chronic pain often is not qualitatively related to the severity of the physical insult.
While both Phantom Limb Syndrome and RSD were well know when Kentucky senator Rand Paul went to medical school, his recent comment about social security disability reflect an all too common misunderstanding of chronic pain on the part of doctors. He said that “[o]ver half the people on disability are either anxious or their back hurts. Join the club.”
These are some of the reasons that chronic pain victims seeking social security disability face challenges. That challenge is heightened in Texas where our conservative politics may encourage an attitude that a strong self-reliant person cannot be disabled due to chronic pain. Here are my 5 tips, based upon 23 years of handling only social security disability cases in North Texas, for winning a social security disability case based upon chronic pain.
1. Secure Treatment with a Pain Management Doctor
Social security law requires medical treatment for the condition alleged to be disabling. Social security finds allegations of disabling pain more credible when the claimant is seeing a pain management doctor. Social security also affords more deference to the medical opinions of specialists.
2. Follow Medical Advice
Chronic pain victims are understandably frustrated with medical treatment has not afforded a return to a normal work life. This frustration often leads a feeling of hopelessness and an unwillingness to follow medical advice for additional treatments and procedures.
The wide—spread abuse of narcotic prescription medications often leads those in chronic pain to refuse narcotic pain medications. Many times well-meaning family members, while wanting the chronic pain victim to be free of debilitating pain, are opposed to prescribed narcotic pain medications, worrying that their loved one will end up like their pill-popping cousin.
Dr. Theodore Price, a pain researcher and faculty member at the University of Texas at Dallas puts it very well:
“Very few people understand that when used appropriately for pain, opioids very rarely become addicting,” Price said. “In practice, this means that people suffer needlessly and may develop chronic pain because they avoid opioid therapy that could alleviate their pain. We need better education in this area.”
3. Secure Psychiatric Treatment for Depression and Anxiety
Depression and anxiety are often the handmaidens of chronic pain. Yet many with chronic pain secure no psychiatric treatment. There are many reasons for this, but none of valid for purposes of securing social security disability. Many with chronic pain wrongly feel that securing psychiatric treatment is an admission that their pain ‘is all in their heads”. Other reasons that, since they are depressed/anxiety because of the chronic pain, there is no point in treating their depression/anxiety.
4. Pursue Pain Alleviation strategies beyond medication
It has been my experience in Dallas Fort Worth that pain management doctors are primarily focused on a narrow set of pain alleviation tools such as opioid medications, spinal stimulators/implants, nerve blocks and steroid injections. Typically pain management doctors are anesthesiologists by training, so it is no surprise their focus is on those techniques.
Yet there are a wide range of other pain treatment options that research shows to be helpful, including yoga, exercise, stretching, acupuncture and biofeedback. The more efforts you make to alleviate your pain, the more credible your allegations of disabling pain will look to an Administrative Law Judge.
5. Hire Local, Specialized Attorney Representation
I hope by now the 4 points above make this as obvious as the fact that I, as a local social security disability attorney in Dallas Texas handling only social security disability for 23 years, make it! Chronic pain social security disability required personal and experienced representation, not the “one size fits all“ representation you will get from the national TV-ad disability firms.