In order to palpate between healthy and damaged tissue accurately, it would be good to first understand human anatomy, etiology and pathogenesis of inflammation. This paper will also examine the anatomy of in the skin and fascia layers have special pain receptors called Nociceptors. Adrienne Dubin, Patapoutian, reviewed the nociceptive aspect of pain perception, focusing on nociceptors innervating the skin and subserving exteroception of noxious stimuli. (Nociceptors: the sensors of the pain pathway)
Payers/Insurers are lacking decisive information to evaluate soft tissue injury claims. Aitken remarked that cases of soft tissue injury are noteworthy for their lack of objective findings and propensity for subjective complaints of pain. This does not make it easier to resolve personal injury claims, given that over 70% of them in B.C. involve soft-tissue injury. (Aitken, G., (1997) Problematic Diagnosis, Recovery (ICBC), Winter; 8(4):10)
Patients need their subjective pain complaints validated especially when an injury was sustained in a motor vehicle accident or at work. Payers are to this day unable to validate subjective pain especially in soft tissue injuries.
Most claims are not for medical costs but for pain and suffering caused by soft-tissue damage, whiplash, or other medically injuries that cannot be proved. “Such claims depend entirely on the credibility of the injured party and his doctor. Going to court becomes extremely risky for both sides, which is why 95% of injury claims are settled out of court for amounts based on court decisions of similar cases. (Aitken, G., (1997) Problematic Diagnosis, Recovery (ICBC), Winter; 8(4):10)
Practitioners need objective tools to defend his or her treatment-program decisions and proof of effectiveness outcomes. Riegel explains that the American Academy has declared that pain is now considered the Fifth Vital Sign. (Riegel, Bram, M.D. (2011) The Fifth Vital Sign.” American Pain Society. )
Nurses need to accurately assess patients for pain every time they check for pulse, blood pressure, temperature and respiration. Pain is a very subjective experience and is what a person says it is. Nurses find it hard to assess pain because they have been taught to assess what they cannot see. Some patients are not good at describing their pain or some do not want to admit to pain, as this is seen as a sign of weakness.
Studies have shown that nurses who measured pain use the visual analogue scale (VAS) and the Finnish version of the McGill Pain Questionnaire (FPQ). School of Nursing, Hebrew University found that nurses with poor knowledge underestimated the patients’ most intensive experiences of pain. (School of Nursing, Hebrew University)
Patients need an accurate pain assessment so they are administered adequate pain remedies. Research is required to elucidate the way in which nurses and patients conceptualize pain and to understand better the process of pain assessment in clinical nursing practice.
Researchers need tools to objectively measure pain and the result of pain treatment. Reviews of scientific literature show that current measurement tools are inadequate and/or unreliable for measuring pain and MFTPs. Queen Mary Hospital (2008) found there is a lack of a consistent methodology for diagnosing trigger points. (Queen Mary Hospital)
Associations need to provide evidence for showing effectiveness outcomes yet we have few evidence-based tools. Accountability will be the key to survival and credibility in health care. American Academy of Pain noted that purchasers and the public are demanding data regarding the program performance of health care providers. Payers are already collecting a vast amount of such data. Collection of information regarding the efficacy of your treatment is in the best interest of yourself and of your patient and in your program’s survival. (Queen Mary Hospital)
“Two studies on whiplash-associated disorders that were generated by insurance companies were review. The Quebec Task Force (QTF) report was comprised of a cohort study, a best evidence synthesis and consensus recommendation. The British Columbia Whiplash Initiative (BCWI) propagated the QTF recommendations. (Teasell, Robert W. MD FRCPC and Merskey, Harold D.M. FRCPC Pain Res Manage Vol No 3 Autumn 1999)
The QTF recommended the following:
- Ensure quality of entries into the standardized forms and thus the content of the computerized patient record.
- Assist in the further development and validation of diagnostic, therapeutic and professional forms.
- Encourage the use of professional standardized evaluation forms.
- Application of EBP/EBM increases the payer’s willingness to provide insurance coverage resulting in recognition that massage techniques help mobilize tissue inflammatory waste and that massage therapy is an effective treatment for MFTPs ultimately have massage therapy included as an insurable treatment.