Chronic pain is defined as pain that persists beyond normal tissue healing time, typically lasting three months or longer. Unlike acute pain, which serves as a warning signal following injury or illness, chronic pain often continues after the original injury has healed or develops without a clearly identifiable cause.
Medical authorities like the Centers for Disease Control and Prevention and the National Institutes of Health recognize chronic pain as a disease process rather than a symptom alone.
Common chronic pain diagnoses include complex regional pain syndrome (CRPS), chronic low back pain, post-traumatic headaches, radiculopathy, fibromyalgia, and persistent pain following orthopedic or spinal injuries.
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Nociceptive pain is the most traditionally recognized form of chronic pain. It arises from ongoing tissue damage, inflammation, or mechanical stress that activates pain receptors called nociceptors. In injury cases, this type of pain often follows fractures, ligament tears, joint damage, disc injuries, or post-surgical complications.
When nociceptive pain becomes chronic, it typically reflects incomplete healing, degenerative changes, or persistent inflammatory processes. Common examples include chronic knee pain after a traumatic injury, low back pain associated with disc degeneration, or shoulder pain following rotator cuff damage.
Clinically, nociceptive pain is often described as aching, throbbing, sharp, or pressure-like. It tends to worsen with movement or use of the affected body part and may improve with rest. Imaging studies such as X-rays, MRIs, or CT scans are more likely to show correlating abnormalities in nociceptive pain cases, which can make these claims more straightforward to document in personal injury litigation.
Neuropathic pain results from direct injury or dysfunction of the nervous system, rather than damage to muscles, bones, or soft tissues. This type of pain is common after spinal cord injuries, herniated discs compressing nerve roots, crush injuries, surgical nerve damage, or severe burns.
Patients often describe neuropathic pain as burning, shooting, electric, stabbing, or tingling. It may radiate along a nerve pathway and is frequently accompanied by numbness, weakness, or altered sensation.
Unlike nociceptive pain, neuropathic pain may persist even after the original physical injury has healed. Diagnostic tools such as EMG studies, nerve conduction testing, and neurological exams are often used to support these diagnoses. From a legal perspective, neuropathic pain carries significant weight because it is frequently permanent and resistant to conventional treatment, leading to long-term impairment and ongoing medical needs.
Centralized pain, sometimes referred to as central sensitization, occurs when the brain and spinal cord amplify pain signals, even in the absence of ongoing tissue damage or nerve injury. In these cases, the central nervous system remains in a heightened state of pain processing long after the initial injury or triggering event.
This form of chronic pain is increasingly recognized in modern pain medicine and is supported by research from institutions such as the National Institutes of Health. Patients with centralized pain may experience widespread pain, heightened sensitivity to touch or pressure, and pain responses that appear disproportionate to physical findings.
Centralized pain explains why some injury victims continue to experience severe pain despite normal imaging or resolved structural injuries. In personal injury claims, this mechanism is often misunderstood or challenged by insurers, despite strong medical support. Proper documentation from pain specialists and longitudinal treatment records are essential to substantiate these cases.
The CDC does recognize fibromyalgia as a legitimate and disabling medical condition, despite the stigma. It may develop independently or be triggered or aggravated by physical trauma, severe stress, or injury.
Fibromyalgia is a chronic pain disorder characterized by:
It is classified as a centralized pain condition, meaning it stems from abnormal pain processing within the central nervous system rather than localized tissue damage.
Fibromyalgia pain is often diffuse, persistent, and difficult to localize. Patients may report flare-ups, weather sensitivity, cognitive symptoms often referred to as “fibro fog,” and reduced tolerance for physical activity. Because standard imaging and laboratory tests are typically normal, fibromyalgia claims frequently face skepticism from insurers.
In injury-related cases, fibromyalgia becomes particularly relevant when an accident is shown to have triggered or significantly worsened the condition. Establishing causation requires detailed medical histories, consistent symptom reporting, and expert opinions linking the onset or exacerbation of symptoms to the traumatic event.
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A common source of confusion in chronic pain cases is the lack of correlating findings on imaging studies. X-rays, CT scans, and MRIs are designed to detect structural abnormalities, not nervous system sensitization or altered pain processing. In this sense, chronic pain is very much subjective (levels of pain, ability to endure pain) with objective outcomes (quality of life, side-effects of loss of sleep, etc).
As a result, a patient may experience severe, disabling pain despite normal or improving imaging results. From a medical standpoint, this does not undermine the legitimacy of the pain. Our job as lawyers in these cases is to demonstrate that this discrepancy reflects the limitations of imaging in capturing functional nervous system changes.
Chronic pain is a recognized compensable injury in personal injury claims when it can be medically linked to a traumatic event. However, insurers fight these claims because pain is subjective and often not readily medically verifiable. Unfortunately, there are also a number of people that try to “ham up” or overrepresent their claims of chronic pain. These bad actors make it even more difficult for clients to receive the compensation they need.
Chronic pain often begins with a discrete traumatic event, but the biological response to that injury can outlast visible healing by months or years. Motor vehicle collisions, falls, workplace accidents, industrial incidents, and crush injuries can all initiate processes that fundamentally alter how the body perceives and processes pain.
In the acute phase following trauma, damaged tissues release inflammatory mediators such as prostaglandins, cytokines, and bradykinin. These substances activate pain receptors and serve a protective function by limiting movement and promoting healing. When injuries involve direct nerve trauma, compression, stretching, or ischemia, the pain response becomes more complex and more likely to persist.
Even injuries that appear moderate at the outset can disrupt nerve signaling. Disc herniations, ligament tears, fractures, and severe soft tissue injuries may place sustained pressure on nerve roots or peripheral nerves. In some cases, microscopic nerve damage occurs that does not immediately appear on imaging but later manifests as chronic pain.
Under normal conditions, pain diminishes as inflammation resolves and tissues repair. Chronic pain develops when this process is disrupted. Persistent inflammation, inadequate stabilization, delayed treatment, or repeated stress on injured structures can prevent full recovery.
Scar tissue formation, joint instability, and altered biomechanics place ongoing stress on surrounding tissues. Muscles may compensate for injured structures, leading to secondary pain sites. Over time, these mechanical changes create a self-sustaining pain cycle that persists long after the original injury should have resolved.
After injury, pain receptors in the affected area may become hypersensitive, a process known as peripheral sensitization. Nerves begin to fire more easily and respond to lower thresholds of stimulation. Movements or sensations that were once painless may trigger significant discomfort.
This sensitization explains why patients often report increasing pain with normal daily activities such as walking, lifting, or sitting. Peripheral sensitization is common following soft tissue injuries, surgical trauma, and nerve compression injuries and serves as a gateway to more complex chronic pain syndromes.
In some individuals, the pain response extends beyond the injured area and becomes centralized. Central sensitization occurs when the spinal cord and brain amplify pain signals and fail to return to baseline after the injury has healed. This process involves changes in neurotransmitter activity, altered pain modulation, and structural reorganization within pain-processing regions of the nervous system.
Once central sensitization develops, pain may persist without ongoing tissue damage. Patients may experience widespread pain, heightened sensitivity to touch, temperature, or pressure, and exaggerated pain responses to minor stimuli. Research supported by the National Institutes of Health has shown that these changes represent a physiological condition, not a psychological reaction.
Traumatic injuries often carry psychological consequences that influence pain processing. Anxiety, depression, sleep disruption, and post-traumatic stress can intensify pain perception and interfere with recovery. Stress hormones such as cortisol and adrenaline affect inflammation and nervous system regulation, further entrenching chronic pain pathways.
These factors do not create pain but magnify existing pain signals and reduce the body’s ability to modulate them. This interaction between physical injury and psychological stress is well recognized in pain medicine and underscores the need for comprehensive treatment.
Chronic pain is truly debilitating. Unfortunately, it is also one of the most difficultly compensable claims without a lawyer. If you have been in a workplace, truck or automobile accident that has resulted in uncontrollable or chronic pain, you need to contact an experienced lawyer immediately.
The Law Offices of Hilda Sibrian have served Houston’s clients for over 21 years. Hilda Sibrian serves the Houston metropolitan area, including Sugar Land, Missouri City, La Porte, Beaumont, Pasadena, The Woodlands, The Heights, Bellaire, Kingwood, Baytown and of course Houston proper. Call our office today at 713-714-1414 or fill out our online contact form for a free consultation.
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