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A Journal on Forensic Medicine
Minerva Medicolegale 2006 March;126(1):55-71
How much is physical pain worth? Chronic pain as an independent element in the evaluation of biological damage
Iorio M., Santovito D.
Dipartimento di Anatomia Farmacologia e Medicina Legale Università degli Studi di Torino, Torino
Clinical experience teaches us that most patients go to health professionals seeking a remedy for pain. It is the pain symptom that sends them to the physician who is asked to find the cause and impart relief. The interest of the clinician is to resolve the patient’s symptomatology and discover its aetiopathogenesis so as to treat the pathology that has triggered the pain and prevent it developing, becoming chronic or recurring. As a reported symptom, pain often becomes a pointer to pathologies that limit the quality of life and the physician thus has the obligation to provide an adequate commitment of resources and know-how to mitigate it and/or resolve it, even in the absence of a clear-cut therapeutic response to the basic pathology, and permit, as far as possible, the patient to return to normal everyday activities. If pain is a symptom experienced by a human being as a personal experience, how can another human being assess it? When this assessment is associated with legal claims, the legal physician has to address a by no means easy problem. The starting point is the meaning that the most up-to-date medical knowledge and the scientific community in general attribute to pain as a clinical element, as an index of the physical suffering of the patient. The bibliographic data collected demonstrate that this pain-physical suffering is a factor that exacerbates invalidating somatic impairment or is an independent source of damage to health. The damage tables used in forensic medicine do not contemplate either of the 2 hypotheses: it follows that there is no biological damage due to physical pain, in contrast with the ruling norm that imposes the restoral of every aspect of damage to health. The present paper addresses the question to remove obsolete barriers and give new vigour to clinical legal medicine, which is the only discipline able to correctly define damage to persons, an area that has thus far been managed by forensic medicine alone.