Canadian Memorial Chiropractic College, Toronto, ON M2H 3J1, Canada.
Department of Graduate Education and Research, Canadian Memorial Chiropractic College, Faculty of Health, Medicine and Life Sciences, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands.
Int J Environ Res Public Health. 2020 Oct 29;17(21):7932. doi: 10.3390/ijerph17217932.
A commonly disputed medicolegal issue is the documentation of the location, degree, and anatomical source of an injured plaintiff's ongoing pain, particularly when the painful region is in or near the spine, and when the symptoms have arisen as result of a relatively low speed traffic crash. The purpose of our paper is to provide health and legal practitioners with strategies to identify the source of cervical pain and to aid triers of fact (decision makers) in reaching better informed conclusions. We review the medical evidence for the applications and reliability of cervical medial branch nerve blocks as an indication of painful spinal facets. We also present legal precedents for the legal admissibility of the results of such diagnostic testing as evidence of chronic spine pain after a traffic crash. Part of the reason for the dispute is the subjective nature of pain, and the fact that medical documentation of pain complaints relies primarily on the history given by the patient. A condition that can be documented objectively is chronic cervical spine facet joint pain, as demonstrated by medial branch block (injection). The diagnostic accuracy of medial branch blocks has been extensively described in the scientific medical literature, and evidence of facet blocks to objectively document chronic post-traumatic neck pain has been accepted as scientifically reliable in courts and tribunals in the USA, Canada and the United Kingdom. We conclude that there is convincing scientific medical evidence that the results of cervical facet blocks provide reliable objective evidence of chronic post-traumatic spine pain, suitable for presentation to an adjudicative decision maker.
一个普遍存在争议的医学法律问题是受伤原告持续疼痛的位置、程度和解剖来源的记录，特别是当疼痛区域在脊柱内部或附近，并且症状是由相对较低速度的交通事故引起的。我们撰写本文的目的是为医疗和法律从业者提供识别颈椎疼痛来源的策略，并帮助事实裁决者（决策者）做出更明智的结论。我们回顾了颈椎内侧支神经阻滞在疼痛性脊柱关节突关节中的应用和可靠性的医学证据，以及这种诊断性测试结果作为交通事故后慢性脊柱疼痛证据的法律可采性的法律先例。争议的部分原因是疼痛的主观性，以及医疗记录疼痛投诉主要依赖于患者提供的病史。可以客观记录的病症是慢性颈椎关节突关节疼痛，这可以通过内侧支阻滞（注射）来证明。内侧支阻滞的诊断准确性已在科学医学文献中得到广泛描述，并且在美国、加拿大和英国的法庭和仲裁庭中，已经接受了关节突阻滞来客观记录慢性创伤后颈部疼痛的证据，认为其在科学上是可靠的。我们的结论是，有令人信服的科学医学证据表明，颈椎关节突阻滞的结果为慢性创伤后脊柱疼痛提供了可靠的客观证据，适合提交给裁决决策者。
