I have contemplated this question this week, still stewing over the workers comp. dr.'s perception of me. A comfortably seated lady in no acute distress. Until he touches my foot, then I cry and jerk. But he does not document that.

So I am wondering what does a chronic pain patient look like to each of you?

I guess I haven't given that much thought, alt...

but the lady who comes to mind attends my church (when she can). She's not in a W/C, but suffers from fibromyalgia. Her face is full of worry lines (she's in her early 60's). Nice lady -- doesn't complain unless you press her, then she'll come clean. I feel so bad for her.

Sounds like Worker's Comp needs a more compassionate and perceptive Dr. Sorry for your troubles. Hope you get the help you need.

I've seen estimates that as many as 1/3 of Americans are in chronic pain, but there's chronic pain, and there's chronic pain. Some can be described as an annoyance easily treated with a couple OTC pills, and are pretty high functional. Then there are those of us who are truly disabled to one extent or another.

Chronic pain, like many other disabilities, is often invisible, so we're going to look like anybody else.

http://www.chronicpain.org/articles/tsocp.html

I can remember in the days BCP seeing someone pull into a handicapped parking space, jump out of their car, and walk briskly into a store, and thinking, "OK, what's wrong with that guy/gal? S/he's just cheating someone who really needs that space." Then came the day that, without my asking, complaining, or anything, my doctor handed me a form to get a handicap tag for my rearview mirror. He knew how much pain I was in walking around, though you'd never know it to look at me. There were some days I was pretty spry too. Then there were the other days I couldn't even drive, and my wife would need to drop me off at the door... That was a very introspective day for me. In those early days I can also recall getting that same look I used to give some others. Nowadays, not so much. I need a cane to get around and keep myself from falling over, I'm not nearly so spry at all, and when that cane comes out, they just keep driving by...

We can't tell by looking if someone is really in pain or not, and it's always going to be a matter of degree. Unfortunately, just as there are a small number of drug addicts who try to get narcotics for the wrong reasons, there is also a small number of people who are trying to bilk the system (though it makes even less sense, considering the hoops we are forced to jump through). These WC doctors, almost by definition, are going to be adversarial. The burden of proof is on the patient to prove the disability and the cause.

Just to play devil's advocate for a moment, how would someone who's faking an injury/illness act in the same circumstance? A comfortably seated lady in no acute distress. Until [the doctor] touches [her] foot, then [she] cries and jerks (as if in pain)(?)

Now please remember, I'm just playing devil's advocate here. I do not believe you are faking, shirking or anything like that. I'm just trying to step back and examine both sides of the situation - the broader picture.

Since the burden of proof is on the patient, we must do our homework, and arm ourselves with the best knowledge and evidence we can (and I'm not assuming you did any less!) Medical records, written opinions from our own doctors, and while I can't locate any at the moment, I'm sure there must be websites offering tips & information on how to best get through these exams/interviews. I wish I could post some. In looking, I did come across some mention that these exams & their outcomes are sometimes challengeable/appealable.

So the best I can suggest is try to find this kind of info, and go as best prepared as you can, and knowledgable that you will be in an adversarial situation.

HTH,

Doc

I've got one of those handicap placards for my mirror too. Sometimes I'm in my wheelchair and sometimes I'm using my quad cane, slowly with the help of my wife, walk when I can for short distances.
If there's a parking spot just as close I have my wife not take the handicap spot so someone who needs it more than I can have it.
It really aggravates me to see someone unthinkingly take that spot when they clearly don't need it.
But then again, it doesn't exclude integrity!

Ugh...I really don't like going to work comp doctors. The biggest problem is that they are there to evaluate you in that ONE moment. Chronic pain has to present quite a problem generally because how do you really evaluate a chronic condition in ONE visit like that? They can look through records, they can ask you questions, and they can examine you. But everyone handles pain differently so how can you judge a person's pain level? just because you are seated and coherent with no visible signs that you are suffering...doesn't mean that you are not in agony.

They always ask for your pain level...scale of 1-10. The best I am ever at in my BEST moments is a 6 these days...but does that mean that I cry every second of the day? No...the awful thing is that you get a new sense of "normal" and when you get to the point where you don't even remember what it felt like to NOT be in pain then you are probably less likely to look like you are "suffering" even when you are. The best you can do is try to explain how it feels to the doctors. I refuse to put on a show or act out my pain because I am NOT faking it and I will not act any differently than normal in ANY doctor's appointment. But while a doctor I have never met before may not "see" the pain, my boyfriend can tell when my pain level is up to an 8, 9, or 10 because he can see the change in my eyes. When it's a 10 he always says I look "green" like I'm going to be sick. But would a doctor notice the differences? Probably not. My physical therapist can now after working with her for months...but I don't think she could have on my first visit.

But this is the sort of thing that a lawyer could take to a judge and fight to get your benefits reinstated. Is it harder when you have a bad work comp evaluation against you? Of course, but if your doctors support that you are in the amount of pain that you are, it becomes a matter of deciding which doctor's reports are more credible in determining you level of disability (the ones who you see regularly or the one who saw you ONE time).

What I really hate is when they try to say that you "made your doctor take you off work." What? I put a gun to his head and said you write this note to take me off work or else? Please. But...some judges will buy into this sort of thing because they don't understand how chronic pain works and that's probably just luck of the draw. Unless they have experienced it themselves or have a loved on who has it's a hard concept to really understand...especially because in theory it would be easy to fake by just lying every time you see a doctor.

Of course...anyone with a real chronic pain injury who has to go through all the mess with work comp would probably think, "Why on earth would I put myself through all of this ON PURPOSE?" I am of the opinion that anyone who is faking an injury will generally just want to take a settlement, get out, and move on. Those of us who need continued medical care, meds, therapy, etc...we have an entirely different situation. Since work comp doesn't allow you to collect for pain and suffering, we worry about being able to pay our bills, not about getting rich off of our injury. Who out there wouldn't trade all the money they have just to be healthy again and not have this pain? But how do you PROVE this?

Grrrr...can you tell I've been dealing with work comp frustrations lately? The problem is...I don't really know how to make the work comp laws better. It's not really a great situation for either side right now because companies DO have a lot of people milking the system and there are also a lot of people with REAL problems that can't get the benefits they should. The system needs a major reform but I honestly have not been able to come up with a plan to make it better because so much relies on the integrity of people (insurance companies, doctors, employers, and employees) and that's just so variable. There are many examples where the system works like it is supposed to...but these are generally in cases where both the employer and employees have integrity where the goal is the same on both sides (to get the employee the medical care they need to return to their job). Oh...if only that were the situation I was in...

Sorry for the rant...guess I needed to vent more than I thought...

I held off on getting one of the cards for a long time because I always thought that I would feel really bad if I took the space and then some little old lady broke a hip or something because she had to park farther away. But I have one now because with the wheelchair and now with my walker, I need the extra space to get in and out of the car (not to mention just needing to be closer). But then I know that if I am able to get to the point where I don't think I need it, I just won't use it.

Not everyone is like that though. I yelled at my mother a number of times when she tried to use her uncle's placard when she was with me. She always said that she could get one herself if she wanted to and my reply was always if you need one then get one but don't use someone else's. To this day she does not have her own. Does she have a hard time walking? Sometimes...so I'm sure she COULD get one...but I just do not have any tolerance for people who use the cards fraudulently (and that was BEFORE I had RSD).

Whenever I see someone park in a handicap spot then get out, maybe a passenger too, and walk completely fine I want to ask them just exactly which one is handicapped?
But my wife stops me lol...

catra,

I agree with everything you wrote. I would give you anything to remember a day without pain or be able to go back to my job. I can honestly say, for one day, I would wish this on someone from wc. Just one day, so they would know what the rest of us feel.
My thought process is like yours, it seems the more pain and persisent the more tolerance. However, when I am above an 8 you can tell. I can barely move, very quite and my face says it all.

Dr. Smith,

I remember those days of thinking about the handicap person and wondering the same thing. I know have a rollabout, but before that my husband didn't want to use the handicap card for me. While everystep hurt, he kept me going.
When the weather is good, I can still go without my rollabout for short distance, but sometimes, I find it would be better to crawl back because the pain is so bad. Even the mailbox on some days are to much. (about 200 ft or so)

My husband and friends joke with me all the time. I now have a shirt that says "If you don't limp you ain't SH?T"
Feels good that they know longer pitty me, but except the changes.