Medical-legal pain documentation · St. Louis
Pain is real and invisible. Everything in a claim turns on that gap — and it is not a gap either side gets to fill with an assumption.
STLInjuryAndSpine.com is the medical-legal arm of an interventional pain practice in St. Louis. We identify which structure is generating a patient’s pain, corroborate it with something measurable, and document the terrain the injury landed on. We do that the same way whoever is asking, because a finding that changes with the requesting party was never a finding.
We are not on a side. We are on the patient’s side.
This practice takes case reviews from plaintiff firms, from defense firms, from workers’ compensation carriers and from private insurers. Dr. Padda has done extensive work for carriers and the defense, concentrated on recovery, alongside the treating work that plaintiff firms refer here.
That is not neutrality as a marketing posture. It is the working condition for being any use at all. An obligation that runs to the patient’s health and safety is the same obligation that makes it impossible to hold a position that would prevent seeing what is actually in front of you — and an expert who has only ever reached one side’s conclusion has stopped being able to see it.
WHAT THAT MEANS IN PRACTICE
The same tests, read the same way, reported the same way. A diagnostic block either abolishes the pain or it does not. A nerve either conducts or it does not. A metabolic panel reads identically on both sides of a caption. Where the evidence does not support the claim, that is what the record says, and the party who asked is told so before anyone is engaged. See independent case review.
The argument both sides get wrong
Strip away the adjusters and the records review and most spine and soft-tissue disputes reduce to one sentence and its mirror image.
ONE SIDE SAYS: IT WAS ALREADY THERE
The imaging shows degeneration, there was a prior complaint, the pain is out of proportion to the property damage — therefore the collision did not cause this. The premise is usually true and the conclusion usually does not follow, because degeneration is nearly universal and is a poor predictor of pain.
THE OTHER SIDE SAYS: THE SCAN PROVES IT
The MRI shows a bulge at L4-5, therefore the bulge is the injury and the injury is the pain. Same error, opposite direction. A finding present in most pain-free adults of the same age cannot, on its own, establish anything about why this person hurts.
Both are arguments about a photograph. The question neither answers is which structure is actually generating the pain in this patient, which is a question with a testable answer — see objective corroboration.
What happens in a medical-legal pain evaluation?
We are a treating and reviewing practice, not a source of opinions. A patient is evaluated, diagnosed and treated the way any patient is. What differs is that the diagnostic sequence used for clinical reasons happens to be the sequence that produces evidence anyone can check.
- Diagnostic nerve blocks — anesthetize one candidate structure under fluoroscopic guidance and record what the pain does. The closest thing pain medicine has to a controlled experiment on a single patient.
- Electrodiagnostics — EMG and nerve conduction measure whether a nerve is actually injured, independent of what anyone reports.
- Imaging read against the patient — not instead of the patient. A finding that does not match the examination is not evidence of anything.
- Quantitative sensory testing — standardized thresholds against published reference values.
- Inflammatory and metabolic markers — the terrain, in numbers, from blood drawn at the visit.
Every one produces a number, an image, a waveform or a recorded response. A meaningful minority come back negative, and those go in the record too. That is the only reason the positive ones are worth anything.
Why is one person sore for weeks and another in pain for years?
Two people take the same rear-end impact at the same closing speed. One is sore for three weeks. The other is still in pain two years later. It is tempting for one side to call that difference character and for the other to call it proof of severity. The medicine says it is usually terrain.
under 7%
of U.S. adults met criteria for optimal cardiometabolic health in the most recent national data — down from under 12.2% on the 2009 to 2016 survey. That is the general population, not a pain clinic’s.
A body running on insulin resistance and low-grade systemic inflammation heals slower, hurts more for the same stimulus, and sensitizes faster. That is not a moral failing, and it is not proof of anything on its own either. It is the tissue the injury landed on, and it is measurable rather than arguable.
Where this fits in a case
Most of what happens here is ordinary clinical care. The medical-legal value is a by-product: a record built contemporaneously, using tests that were indicated anyway, written so that it reads the same way after anyone has gone through it line by line — including us.
This practice is not aligned to a side. Its obligation runs to the patient’s health and safety, which is the same reason it is not beholden to any position that would keep it from seeing what is actually there. We do not offer opinions on liability, we do not accept a referral or a review conditioned on reaching a particular conclusion, and we will say plainly when the evidence does not support the claim — whichever party was hoping otherwise.
Common questions
Do you work for plaintiffs or for the defense?
Both, on the same terms. The fee does not vary with the side, the outcome or the content of the finding — see independent case review.
Will you tell me if the testing does not help?
Yes, and early. A diagnostic block that does not reproduce or relieve the pain is a real result and it goes in the chart whoever asked for it.
Does a normal MRI mean there is no injury?
No. It means the injury is not one MRI resolves. Nerve injury, facet-mediated pain and sacroiliac pain are all routinely invisible on it — see imaging and correlation.
How fast can a patient be seen?
Usually within a week. Send the mechanism and the imaging through referrals and reviews and we will tell you what we test first.
What do they do at a medical-legal evaluation?
Here, the patient is evaluated, diagnosed and treated the way any patient is. The testing is chosen for clinical reasons: diagnostic nerve blocks under fluoroscopic guidance, EMG and nerve conduction studies, imaging read against the examination, quantitative sensory testing, and inflammatory and metabolic labs drawn at the visit. Each one produces a number, an image, a waveform or a recorded response that anyone can check.
What are examples of medicolegal issues?
In spine and soft-tissue claims, the usual dispute is causation. One side says the degeneration on the MRI was already there, so the collision did not cause the pain. The other says the bulge on the scan proves the injury. Both are arguing about a photograph. The question that can actually be tested is which structure is generating the pain in this patient.
Related reading
- Independent case review, either side
- What a review or a referral produces
- The eggshell plaintiff, and the medicine underneath it
- “It was pre-existing degeneration”
- Corroborating a symptom nobody else can see
Send the mechanism, the imaging and the treatment gap
We will tell you what can be tested objectively in this patient, what cannot, and what the answer is likely to be — before anyone is engaged. That conversation is free and commits neither side.
12166 Natural Bridge Rd
St. Louis, MO 63044
Monday to Friday, 8:00 a.m. to 5:00 p.m. Nothing on this page is legal advice, and nothing on it is medical advice.
Sources
- Brinjikji W et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. American Journal of Neuroradiology, 2015. PubMed 25430861
- O’Hearn M et al. Trends and disparities in cardiometabolic health among U.S. adults, 1999–2018. Journal of the American College of Cardiology, 2022. PubMed 35798448
- Araújo J, Cai J, Stevens J. Prevalence of optimal metabolic health in American adults: NHANES 2009–2016. Metabolic Syndrome and Related Disorders, 2019. PubMed 30484738
- Rikard SM et al. Chronic pain among adults — United States, 2019–2021. MMWR, 2023. PubMed 37053114
- Raja SN et al. The revised International Association for the Study of Pain definition of pain: concepts, challenges, and compromises. Pain, 2020. PubMed 32694387