Pain case review for attorneys
You do not need a provider who agrees with you. You need a record that says the same thing no matter who reads it.
For plaintiff firms, defense firms and carriers, a referral or review here produces a named pain generator or an honest statement that one cannot be named, objective corroboration where it exists, the measured pre-injury terrain, and an explicit statement of what is not established.
What this practice offers is not enthusiasm for a theory. It is a diagnostic sequence that produces findings independent of anyone’s report, documented contemporaneously, and read the same way whether the request came from a plaintiff firm, a defense firm or a carrier.
Why do pain claims fall apart?
Pain files go wrong in a small number of ways. Each of them can be committed by whoever is holding the file.
ONE — THE RECORD IS ALL SUBJECTIVE
Pain scales, a narrative and a prescription list, every line tracing back to the patient saying it hurts. A reviewer does not have to call anyone a liar; they need only observe that nothing in the chart is independent of the person claiming. The mirror failure is treating that observation as though it disproved the pain, which it does not.
TWO — THE IMAGING IS TREATED AS THE DIAGNOSIS
One side recites a disc bulge as the cause of the pain; the other recites the same finding as proof of pre-existing degeneration. Both are reading a base rate as a diagnosis. Degenerative findings appear in most pain-free adults of the same age, which makes them useless to either argument on their own.
THREE — THE GAP IS NEVER EXPLAINED
A patient waited five weeks, or stopped treatment for three months. Unexplained, a gap reads as absence of injury. Explained, it is usually the most ordinary thing in the file — no insurance, no transport, a job that could not be missed, a denial. Recorded at the time it is evidence; reconstructed later it is argument.
Both sides overreach here, in mirror-image ways, and a report that only ever corrects one of them is doing advocacy rather than medicine.
What does a pain case review produce?
- A named pain generator, or an honest statement that one cannot be named. “Chronic low back pain” is a symptom. “Right L4-5 and L5-S1 facet-mediated pain, confirmed on two separate medial branch blocks with concordant relief” is a diagnosis.
- Objective corroboration where it exists, and a clear statement where it does not. Electrodiagnostic evidence, a documented block response, quantitative sensory thresholds, inflammatory markers.
- The pre-injury terrain, measured — what this body was carrying before the force arrived, and what that predicts about the recovery curve in either direction.
- A treatment record with a rationale attached to each step, so the sequence reads as reasoning rather than accumulation — or a finding that it does not.
- An explicit statement of what is NOT established. This is the part that makes the rest credible, and it is the part most often missing on both sides.
The same terms in both directions
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.
We do not write letters of protection as a matter of routine, do not price by outcome, and do not accept instructions about what a report should conclude. If a matter needs a physician who will arrive at a predetermined answer, this is the wrong practice, and that is said on the first call rather than discovered in deposition. See independent case review.
The reading list
These pages are written for lawyers and adjusters rather than for patients. They assume you know your own field and want the medicine underneath it, stated at the level the evidence actually supports.
- Independent case review — how reviews are taken, from either side.
- The eggshell plaintiff — why prior damage is a mechanism rather than a defense, and where that argument stops.
- Pre-existing degeneration — the asymptomatic-population data, which cuts against confident claims in both directions.
- Causation and apportionment — aggravation, acceleration, coincidence, and what can honestly be apportioned.
- Objective corroboration — what each test can and cannot establish.
- Terrain — the metabolic and inflammatory state the injury landed on.
Common questions
What do you need to evaluate a potential referral or review?
The mechanism, the imaging on disc rather than the report alone, the prior records if any exist, and an honest account of any treatment gap. Start at referrals and reviews.
Do you take carrier and defense work?
Yes, extensively, including workers’ compensation and private insurance work concentrated on recovery — see independent case review.
Can you review records without seeing the patient?
Yes, and the report will say it is a records-only review and what that limits. Where the question needs an examination, the review says so instead of guessing.
What happens if the block is negative?
It goes in the record as a negative result, whoever requested it. A negative block usually redirects the diagnosis usefully — read diagnostic nerve blocks.
What does a medical-legal consultant do?
Here the work is done by a treating and reviewing physician practice, not a source of hired opinions. For plaintiff firms, defense firms and carriers, a referral or review produces a named pain generator or an honest statement that one cannot be named, objective corroboration where it exists, the measured pre-injury terrain, a treatment record with a reason for each step, and a plain statement of what is not established.
Related reading
- Independent case review, either side
- The eggshell plaintiff
- “Pre-existing degeneration”
- Causation and apportionment
- Objective corroboration
Start with the mechanism and the imaging
Send what you have. We will tell you what we would test, what it could establish, and what it will not touch — before anyone commits to anything.
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
- Cohen SP et al. Multicenter, randomized, comparative cost-effectiveness study comparing 0, 1, and 2 diagnostic medial branch block treatment paradigms before lumbar facet radiofrequency denervation. Anesthesiology, 2010. PubMed 20613471
- Raja SN et al. The revised International Association for the Study of Pain definition of pain: concepts, challenges, and compromises. Pain, 2020. PubMed 32694387
- Rikard SM et al. Chronic pain among adults — United States, 2019–2021. MMWR, 2023. PubMed 37053114