Is your IME claiming that you exaggerate your pain?

IME-and-pain

Fact, quite a few independent medical examiners (IMEs) often attempt to minimise the injured worker’s condition and allege the injured worker is “exaggerating” his/her pain. Some claim or imply that the only thing that will cure you  is money. It’s happened to me, it’s happened to countless other injured workers. I have amused myself compiling a list of questions we should ask those ignorant IMEs. For example: “Dear IME, if money cures the condition and takes away the pain, then does that mean that you regularly prescribe “money” to your own patients suffering from these same conditions? Enjoy!

The IMEs do this in different ways, such as writing in the IME report (or testifying in Court for that matter) that the injured worker’s pain is ‘excessive’ for his/her condition, even though they usually never give or use any actual pain scale. Other IMEs will use/abuse the so-called Waddell’s signs to claim the injured worker is malingering or faking their pain. Some IMEs state that while the injured worker’s injury may cause some pain, they should not feel this much of pain or type of pain. And yet other IMEs will simply claim that your pain should have resolved by now, or -worse-, that money will cure you!

Is your IME claiming that you exaggerate your pain?

Now what on earth can you do about such false statements about your pain?

You may recall our previous article “Tips to defend an IME opinion or report” – and well, you can quite easily challenge a biased IME’s opinion about your pain by writing a letter (to the workcover insurer and IME) and stating the many reasons as why the IME’s opinion is flawed. That’s not to say the IME (or insurer) will ‘rectify’ or ‘correct’ their opinion, but at least you’ll have a record. In addition, if you need to dispute the pain-matter, your lawyer and barrister can use your ‘reasons’ (such as those set out below) to defend your position and to have the IME concede that you do in fact have pain.

Possibly the best way to make a case on the issue of your pain is to:

  1. Get the IME to agree that our underlying condition or injury CAN cause pain
  2. Get the IME to acknowledge that pain is subjective; in other words that people feel or perceive pain differently
  3. Then use the rationale/reason(s) the IME is relying on to allege you don’t have pain, or are exaggerating your pain.

General questions you could put to the (biased) IME could include the following:

question-workcoverDear IME, have you ever had pain in your life?

question-workcover[Assuming s/he says yes]Wouldn’t you agree (then) that pain is very real?

question-workcover On a scale of 1 to 10, with 10 being the worst pain imaginable, what would you say your worst pain (in your life) was?

question-workcoverAlthough you say pain is subjective, it really is not that “subjective” to the person experiencing the pain, is it? I mean you could rate your own pain on a pain scale, right?

question-workcoverWould you agree that a person/injured worker who is feeling pain is in the best position to know what s/he is actually feeling?

question-workcoverIn terms of how much pain a person/injured worker is experiencing, again, would you agree that this person is in the best position to know?

question-workcoverIn terms of frequency of pain (how often a person feels pain), again, would you not agree that person is in the best position to know?

question-workcoverIn terms of how long a person / injured worker has/had pain – wouldn’t you agree that only that person would be in the best position to know the answer to this question?

question-workcoverWhat activity exacerbates the pain, what causes or triggers the pain— again, the person experiencing the pain is in the best position to know, wouldn’t you agree?

question-workcoverYou would agree that pain can exist without tissue damage? (i.e. CRPS, Fibromyalgia, Migraines etc)

question-workcoverAnd you would agree that it is impossible to understand the pain that another person is feeling or experiencing?

Specific questions: Pain scales

Many IMEs will ‘assess’ your pain and opine about your pain, but they will do so without even using any tools such as pain scales! It is likely that your IME did not use any pain scale during his/her assessment.

If the IME did not give any actual pain scales to rate the level of your (perceived) pain, you could question the IME using the following questions.

question-workcoverDear IME, how did you actually determine my (the injured worker’s) pain level to be disproportionate or exaggerated?

question-workcoverDid you actually use a pain scale(s) to determine my (the injured worker’s) pain level? For example, did you use the Numeric Rating Scale? (1 to 10, with 10 being the worst imaginable pain). Did you use any other pain scale or pain tool? Did you use any pain scales at all?

question-workcoverAh, you didn’t have a pain scale. Did you try to download any free pain scales from the Internet? Do you even know which pain rating scales exist and how they are used and interpreted?

question-workcover Dear IME, did you ask my me (the injured worker) about pain medications I (s/he) had taken that day? [Note: Often, injured workers believe they are not supposed to take pain medications on the day of the IME  examination. This can also change the ‘level of perceived pain’, and for example an injured worker whose pain is reasonably well controlled (let’s say 3/10) on Oxycontin and Lyrica would inevitably rate a 6 or 7 (or more) when off that medication, which could explain a ‘variance’.]

question-workcover Dear IME, are you educated on pain rating? For example are you a pain specialist? Do you research peer articles on the topic of pain and, if so, could you please share them?

question-workcover Do you actually deny that I (the injured worker) am/is actually experiencing/feeling pain?

question-workcoverIf so, what do you believe causes my pain?

question-workcoverIs any pain the injured worker (I) experienced / feels related to my (the injured worker’s) injury/condition?

question-workcoverWhen precisely was it related?

question-workcover And when did my (the injured worker’s) pain become suddenly unrelated?

question-workcoverAnd, in your opinion, what then exactly caused my (the injured worker’s) pain to become unrelated to my (the injured worker’s) injury/condition?

Specific questions: How much pain is this much pain?

Quite often IMEs will agree that an injured worker’s injury/condition may cause some pain, however they will state or opine that your injury/condition should or does not cause “this much” pain.

Well, to begin with you could refer to studies that have been undertaken that show that pain is subjective. For example a rigorous study was done on in which people were given the exact same painful stimulus, and (functional) MRIs of their brains revealed these people experienced the pain differently. Individuals feel/perceive/experience pain differently (and most doctors agree with this). How then can an IME  claim that there is a defined /precise/quantifiable amount, defined frequency or defined intensity of pain that the injured worker (I) should feel. where is the supporting documentation and evidence? There isn’t any!

question-workcover Dear IME, before you decided I (the injured worker) wasn’t really feeling “this much” of pain, or even this type of pain (i.e. neuropathic pain such as burning), did you actually undertake any research to assess/find out what kind and ‘how much’ of pain the injured worker’s injury/ condition causes, or can cause?

question-workcover Could you please show me peer articles which show that this injury/condition does not cause this kind of pain?

question-workcover Dear IME, on a 1 to 10 pain scale, with “1” being minimal pain and “10” being the worst pain imaginable, what exact level of pain should I / the injured worker be feeling?

question-workcover [Let’s assume the IME did says a “2.”]Dear IME, do you believe that the injured worker’s perceived pain is the same [2] every day?

question-workcoverWould you not agree that some days can be ‘good days’ and cause the injured worker’s pain to be less?

question-workcover Conversely, dear IME, if on some days my (the injured worker) may be feeling less pain, then some days the same injured worker may well be feeling more pain, no? [Note: if the IME denies the possibility of having different pain levels on different days, s/he is really caught lying! If the IME states/alleges your painful injury/condition is such that you can only have periods of “less pain” and never more pain, it is so illogical that it beggars belief.]

question-workcoverShould the IME agree with the previous question, then you could ask him/her: So you agree that on some days my (the injured worker) pain may be less than a level 2. Is it possible then that on some days my pain level may be slightly more that a 2/10?

question-workcoverLet’s assume the IME agrees to the above statement. Ask him then what pain level (on a scale of 1 to 10) is the pain level beyond which I (the injured worker) should not be feeling pain? Is it a pain level of let’s say 4? A 5? Or a pain score of 8?

question-workcoverLet’s say the IME opines you (the injured worker) should not be experiencing pain beyond let’s say level 5. Ask him/her to show you any scientific and peer-reviewed research to back up his/her (pathetic) statement? [Note: if the questioning occurs in a Court of law, then your barrister may actually tell the IME (or “defense expert witness”)”You can use my laptop or iPad. It’s connected to the internet and you can search through pubmed or whatever research websites you use for research. There won’t be any such research!]

question-workcover [You may even go as far as telling the IME that you have actually done some research and found several articles in peer-reviewed medical journals authored by well-respected medical doctors like him/her and show /share these articles. Ask him/her if these articles (you researched) indicate that described symptoms of a particular condition such as “burning” and “tingling” are in fact expected with the type of injury/condition you (the injured worker) have. [But the IME denies you could possibly feeling a certain type of pain]

question-workcover Again, dear IME can you find or show me an article that supports your position/opinion? State for example that When you typed in the words “herniated discs” you got 147 thousand hits. Ask the IME why s/he is unable to find at least one article to support your /the injured worker’s claim?

The IME alleges the injured worker should be pain-free (by now)

In this case, IMEs or “defense expert witnesses” agree that the injured worker’s injury/ condition actually exists, but claim that it (the pain) should have resolved by now.

Fact: Pain can continue after the painful stimulus is removed, or even after an obvious ‘injury’ has healed. This means even simple sprains or strains, or minor injuries from which patients should recover quickly sometimes do continue to cause pain— even forever. This can in essence be explained by an altered pain pathway, where a person with chronic pain, will continue to feel pain because the pain is somehow ‘remembered’ (a pain loop is created). Pain normally travels from the area which is stimulated with pain up pathways right up to the brain. When those (pain) pathways are continuously sending the message of pain to the brain, the brain can get stuck in a (pain) receiving mode. This is a little bit like not being able to get a particular song out of your head, and hear it over and over in your head, especially when you are not distracted. Nights are generally the worst time for individuals (incl. injured workers) who suffer from chronic pain, because at night (i.e. in bed) they are not distracted and can’t get the “song” out of their head.The same logic applies to the “chronic pain” including conditions labelled such as CRPS (Chronic Regional Pain Syndrome), formerly known as RSD (Reflex Sympathetic Dystrophy).

If an IME does not believe in “chronic pain” or conditions such as CRPS, you could always ask him/her if s/he has ever heard of the condition called “phantom pain”. This is a very real condition whereby people who have lost a limb (i.e. though traumatic or elective amputation) still perceive and feel pain in their missing limb. In fact, I had my ring finger partially amputated some 15 years ago, following a horse riding accident, and at times still feel that the side of my missing ring finger’s nail area is “itching” or “burning”. Go figure, but the condition is very real and quite prevalent (the WHO estimates that around 70% of those who suffered amputations experience phantom limb pain).

If the IME claims you (the injured worker) is malingering because the “cause for the pain” no longer exists (e.g., if you had a discectomy) then this ignorant IME completely ignores the anatomy of pain, particularly “remembered” pain as described above.

The myth that the only thing that will cure an injured worker is MONEY (settlement)

How many times have you heard a (biased) IME claim or imply that the only thing that will cure you (the injured worker) is money by means of a compensation settlement? Well, make the IME prove it! The following questions may be of help:

question-workcover Dear IME, does this “monetary compensation cure” also apply to other medical conditions? Such as brain damage, paralysis, nerve injuries, a completely destroyed shoulder or knee?

question-workcoverCan you tell me how money actually causes a herniated lumbar disc to become normal or “un-herniate”? Can you tell me how a destroyed shoulder (which needed a total reverse shoulder prosthesis) – or whatever condition – can become “whole” again with money?

question-workcoverCan you tell me how does money make a destroyed knee or herniated disc less painful?

question-workcover Can you tell me how $ cash causes paralysis (i.e. quadriplegia, hemiplagia) to disappear?

question-workcoverCan you please tell me how money cures brain damage? I would really like you to walk me through the anatomy of how $ cash causes damaged brain cells to repair themselves; or how a destroyed shoulder joint regrows itself (like a lizard’s tail)?

question-workcoverDear IME,  If the (the injured worker) were your own private patient, and s/he had this injury/condition, and you were treating him/her, you would tell him/her that his/her pain would go away if he got money?

question-workcoverCan you tell me what exact symptom will be miraculously “cured” by means of cash?

question-workcoverHow to you apply the money to heal the person’s injury/condition/pain? Do you apply bank notes (of a certain denomination) directly onto the affected body part, like a poultice? Or does money need to be swallowed?

question-workcoverDear IME, you have already stated/opined or testified that my (the injured worker’s) underlying condition/injury can cause pain, right?

question-workcoverSo, now you are really saying that I/ the injured worker is lying about my/his/her pain to get money, aren’t you?

question-workcoverCan you please clarify what exactly I/the injured worker is lying about—is it the location of the pain, it’s frequency, or perhaps the duration of the pain?

question-workcoverDear IME, if money/settlement/cash cures the condition or injury and takes away the pain, then does that mean that you regularly prescribe “money” to your own patients suffering from these same conditions/injuries?

Why don’t you measure my (the injured worker’s) pain?

Most IMEs (even the biased ones) are likely to agree that each individual experiences or feels pain differently. However, IMEs, particularly those who are asked to be the ‘expert witness’ for the defense often try to turn the fact that pain is “subjective” against the injured worker by arguing that because pain is a subjective complaint, which is not verifiable, it is, therefore, a questionable complaint (insinuating you are exaggerating/faking etc).

This is erroneous because in fact pain is very verifiable! With, for example, special (functional) MRI scans, doctors can actually see the brain as it experiences pain and as such objectively verify pain (pain-related activations are clearly identified in the cortex and thalamus of the brain). You could always ask the IME to conduct these tests to prove you do feel pain! You can go as far as alleging that the IME did not want to ‘verify’ your pain because the IME started his/her examination disbelieving you (the injured worker); because the IME purposefully ignored your (pain) symptoms, and because the IME failed to properly diagnose your condition, or worse, deliberately ‘altered’ your diagnosis.

 

[Post dictated by WCV and manually transcribed on her behalf]



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12 Responses to “Is your IME claiming that you exaggerate your pain?”

  1. Oh how right you are…
    add in facet joint pain as well as disc herniation’s, and tears to muscles / ligaments… Muscle spasms… Head aches caused by nerve injury
    I actually find it difficult to rate pain by area… When I’ve gone to any IME they find it difficult to believe I have so many areas affected… and generally they only cover a third to half in the reports.
    I’ve offered to swap their issues for mine, but of course they decline…
    I couldn’t believe this one Dr telling me she had knee pain and went to demonstrate how much her knees were stuffed.. I said if it was just my knees I could cope quite well (I have Chondromalacia stage 2 in both knees) but with everything else factored in its not so easy… I asked her if she had children and had gone through labor, because on a bad day I would rate my pain at worse than that…
    The hardest I have had to deal with was at the hospital pain management team, one in particular… Had a broken bone and had ongoing pain for 6 months or so… Now thinks they knows what we all go through…. If my pain lasted even 12 months it wouldn’t be so bad, but as most of us know, having pain day in day out for years wears one down…
    I must say a new Dr has given me some stronger medication to try, if I do nothing I have great pain relief, but alas, life doesn’t go on with no movement.. but at least I am getting some relief, I’m tempted to give him a big hug next time I go in… 🙂
    Another thing that annoys the crap out of me is when they say depression causes pain… I didn’t have depression before the pain, but now the worse the pain, the worse the depression… but I still start each day anew, each morning is the start of a new day, and I take each day as it comes…
    I would rather have my life back as it was than have to suffer, no amount of money can really compensate for the loss of ones independence, and the ability to have a full life.

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    • @WooWoo- Well said! Yep I would give anything to go back to how life was before. The constant pain, lack of sleep and stupid drugs just have you wrapped up in a fuzzy nightmare! If I do ABSOLUTELY NOTHING for the whole day (no shower, no feeding myself, no moving, just nothingness) my pain will sit at around 3-4. That’s without all the weird “spikes of shooting pain or the unbearable burning of joint pain. Apparently, after my last Medical Panel of 3, they seem to think that this is okay- REALLY?? Are those bast*rds in (real) pain day after day after month after year. NO they are not, I’m willing to bet if they were their medical situation would be FIXED. It’s exhausting, demoralizing and depressing being stuck in a situation that you cannot get away from. I loved being well and healthy- I didn’t even have a Dr before all this as it had been so long since I needed one (2002). Why would we make this sh*t up- you STUPID IME’s!
      MadChef ranting

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      • OH my god you sound like me I never sleep I don’t go out I don’t bother to eat I do shower I hate them and nerve pain is well lets just say if I had a gun but I have thought of cutting my leg off many times

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  2. I recall over a decade ago the GIO rigged ‘IME’ orthopaedic surgeon named Dr Smith who had retired from surgery a long time ago (and was well on his way out – I hope he is dead now the unethical old bastard) firstly berating me for running late by fifteen minutes and as punishment made me wait 1/2 hour as I watched him through a gap in the door just pacing about the office. He called me in and asked me to squat which I did in severe pain and we could clearly hear the audible cracking and grinding under my right knee after the motor vehicle collision. He said “there’s nothing wrong with you”. I said “What?” in total disbelief! He then went on to say that the collision was my fault “wasn’t it?” and “You were speeding weren’t you?” in an attempt for me to make some sort of admission to him that he would then give to GIO. What a joke. Another IME they sent me to stated, “Oh my knee makes the same cracking noises” whilst downgrading my pain and disability to my right leg – obvious muscle atrophy had also occurred because of it.
    Luckily my ‘real’ orthopaedic surgery armed with MRI scans showing the significant damage to ligaments and knee cap performed surgery after the insurer conceded defeat.
    To rub salt in the wound though was the settlement on the steps of court after my barrister stated to me that the presiding judge hates cops so it was better to take the offer which I did, despite feeling very angry. But that is the reality of the ‘justice system’. JOKE.

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    • Dear Joe, I read your post and was as always disguisted ,I have heard this a lot if the just or magistrate is in a bad mood the people before them usually wear it.But what pisses me off more was his attitude towards Police Officers what for example if he went out to go home that day and his car was stolen who would he call yes the Police.I would hate to think what it would be like without the Police.

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      • When I got sent to an IME, his report stated “With the patient undressed” ……………………….hell the only thing I was asked to remove was my shoes and socks. Mmmmm.

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        • Just Me, I share your pain. I have a neurological injury and my insurance co sent me to an orthopaedic surgeon. He was a bastard from the start and was not writing what I was saying. I had on a skirt, shirt and thongs. He asked me to stand on my toes, which I did with pain holding the wall, bend down and stand on one leg, all with pain. He then asked me to get on the table which I did like a massive gallapagus turtle and all he did was get me to lie on my back and then he stuck pins in my feet and checked my reflexes. I reported him to my case worker as soon as I got out and low and behold when his report came he stated that I undressed and dressed with no problems and no resistance, I bloody only took thongs off. Then as I had developed depression as a result of this he stated that since my injury was clearly made up there must be another reason for my depression and that maybe they should look into my personal life as I may be having problems with my marriage. I blew up, was on fire. They are all full of shit.

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  3. I would also like to ask the IME these questions
    Why do you consider your opinion about my condition more authoritative than the specialist who has actually operated on me?
    Why as a GP with an associative diploma do you think you know more than a specialist with years of experience and much higher degree status?
    Why do you think looking at MRIs and X Rays that are many years old will give you the diagnostic ability to make an assessment of my condition today?
    Why do you think getting me to raise my leg and tapping on it once will give you the ability to assess me thoroughly?
    Why do you think telling me to have an operation but pretending you never said that will not be remembered, especially when my witness heard it? And finally –
    How the hell do you sleep at night?

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  4. I would happily go back to my old life pre-injury and live as a homeless and destitute person than putting up with what I do now. It really shits me too when you have kids and have no choice sometimes but to do things for them and with them and so they say there is nothing wrong with you. What the hell do they think happens when you get injured, do your kids just bloody disappear or start looking after themselves, NOT. I stopped doing things with my kids early on and was always in bed and in pain and my son developed depression and my daughter took on a mother role at the age of 9 and was getting in trouble at school because of it. She ended up having to see a psychologist due to her behaviour. As soon as this happened I decided that regardless of what pain I was in I would take as many painkillers as I could and just bear the pain and look happy until I did what I had to and then went home and broke down. I don’t run around telling every Tom, dick and Harry what has happened to me and what I’m going through. In fact I tell no one apart from some close family and my really close friends and I shouldn’t have to. I’m sick to death of being told I should be in no pain now by these twits who specialise in something totally different. I have said to numerous IME’ s after they have given their talk about they are only there to do the report, not treat me ” please , if you know of something that can fix this or help me I will do anything to get rid of it or treat it ” of course they can’t come up with anything. I was one of those people who said, “yeah, a back injury, sure you do” but now after getting a back injury I sympathise with every single person who has one or who has chronic pain, you can not imagine this if you tried.

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    • @Bronni,
      I found the pain management unit at the local hospital quite helpfull. They give you many tools and ways of dealing with your pain. They understand how the body works and how nerve pathways can become irritated and confused. There are also private pain management program’s around, just try to get into one that offers IMPACT and mindfulness.

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