When assessing injury cases from a vocational standpoint, it is common to find that a client may not be determined permanently disabled on a physical basis alone, but is permanently disabled when combined with other factors.  One of the most common examples of this is the relationship between chronic pain and the effects it can have on a person psychologically.

Dr. Srini Pillay, M.D., touches on this subject in the Harvard Health Publications, stating:  “When pain first occurs, it impacts your pain-sensitivity brain circuits. But when pain lasts, the related brain activity switches away from the “pain” circuits to circuits that process emotions. That’s why emotions like anxiety often take center stage in chronic back pain. And it’s why emotional control becomes that much more difficult.”  In this article, he references a study conducted by the U.S. National Library of Medicine, which found “… that brain representation for a constant percept, back pain, can undergo large-scale shifts in brain activity with the transition to chronic pain.”

The Intergrative Pain Center of Arizona explains how this can alter a person’s activities of daily living (ADL):  “Some recent studies have also shown that chronic pain can actually affect a person’s brain chemistry and even change the wiring of the nervous system. Cells in the spinal cord and brain of a person with chronic pain, especially in the section of the brain that processes emotion, deteriorate more quickly than normal, exacerbating many of the depression-like symptoms. It becomes physically more difficult for people with chronic pain to process multiple things at once and react to ongoing changes in their environment, limiting their ability to focus even more. Sleep also becomes difficult, because the section of the brain that regulates sense-data also regulates the sleep cycle. This regulator becomes smaller from reacting to the pain, making falling asleep more difficult for people with chronic pain.”

Understanding and identifying these types of connections is integral from a vocational standpoint because, in many cases, it can be the determining factor that renders a client 100% disabled.