Articles

I was raised in North America – a culture and society in which the education emphasizes knowledge about science, its methods and its principles. The scientific method of understanding, coupled with the rudimentary knowledge that I was taught in high school biology, resulted in my conceptualization of pain as an objective truth. Pain, as I believed for a long time, was a bodily sensation with an expression that was more or less universal; to me, pain was simply the sensation that the brain experiences as a response to noxious stimuli.

On January 1, 1995, Saskatchewan adopted a radical, no-fault system for motor vehicle accident insurance. Virtually no room was left for injured victims to sue for damages, whether for pain and suffering or for economic compensation. In fact, the no-fault system removed benefits for pain and suffering altogether. Apart from the concern that arose at the denial of justice in relation to economic matters and the blanket denial of pain, there was concern over the arrangements for medical care.

Recent investigations of dysfunctional pain processing in the central nervous system have contributed much knowledge about the development of chronic musculoskeletal pain. Many common chronic musculoskeletal pain syndromes – including regional myofascial pain syndromes, whiplash pain syndromes, refractory work-related neck-shoulder pain, certain types of chronic low back pain, fibromyalgia and others – may essentially be explained by abnormalities in central pain modulation.

Descriptive analyses showed that 88.9% of patients reported as least one problem with disturbed sleep. Correlation analyses showed that greater sleep disturbance was associated with greater pain, disability, depression and physical symptoms, and less daily uptime. Hierarchical regression analyses showed that sleep disturbance predicted disability, daily uptime and physical symptoms independent of pain or depression.

The psychological predictors of pain and disability were examined in a sample of people who sustained whiplash injuries during rear-end motor vehicle accidents. Sixty-five patients referred to a specialty pain clinic with a diagnosis of whiplash injury completed measures of depression, anxiety, catastrophizing, pain and perceived disability. Regression analysis revealed that psychological variables accounted for 18% of the variance in pain ratings.