The evaluation and understanding of pain: clinical and legal/forensic perspectives.

The evaluation and proper clinical and legal management of pain clients defy simple remedies. Historically, human pain has challenged the most sophisticated of philosophical, theological, and biomedical explanations. Following an historical overview of pain concepts and treatment, this paper discusses the prevalence in and influence of pain on the modern world. One perspective for viewing multifaceted pain issues is a model developed by John Loeser. This four-level model addresses not only tissue damage (Nociception), but also the patient's perception of such damage (Pain), the negative emotional reactions to such perceptions (Suffering), as well as the pain activity stemming from such damage (Pain Behavior)--all issues critical in medical management as well as in personal injury litigation. Several methods for classifying pain are discussed, including acute vs chronic pain, benign vs cancer pain, "real" vs psychogenic pain, and a multiaxial coding schema for pain which encompasses a number of professional disciplines. Clinical pain assessment is then reframed and translated into a legal format more relevant to forensic discovery and case development.