Sunday, July 26, 2009

Post-Injury CFS

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Head & Brain Injuries

Fatigue As The
Result of Personal Injury

Posted by Wayne Parsons

July 24, 2009 4:26 PM

Tags: fatigue, chronic fatigue syndrome, pain, injury,
wage loss, income, work, personal injury, Parsons,
Honolulu, Hawaii

Everyone knows about broken bones, lacerations,
traumatic brain injury [ ], loss of
vision, spinal cord injury and other physical injuries
that follow automobile accidents, medical
malpractice, construction site accidents and product

One often ignored after effect is fatigue that can
become chronic: chronic fatigue syndrome (CFS)
[ ].

Surveys of injured persons often show that fatigue is
one of the most significant long term permanent
effects of an injury and in particular injury that
results in chronic pain.

Fatigue, like pain, doesn't show up on an x-ray and
doctors rarely spend any time trying to help with
fatigue. Even when the pain is recognized as an
issue, fatigue is often left out of the list of

      Chronic fatigue syndrome (CFS) is an
      illness defined by disabling physical and
      mental fatigue and physical and mental
      symptoms that are not explained by
      conventional medical and psychiatric

      CFS affects between 400,000 and
      800,000 people in the United States and
      has an average duration of 5 years, but
      symptoms can persist as long as 20

      The prognosis for recovery of severely ill
      CFS patients is poor.

      Despite CFS's disabling, enduring, and
      prevalent nature, scant studies have
      quantified its impact on the health and
      well-being of those affected, on the
      health care system, or on society as a

      The burden of CFS is poorly recognized,
      and the illness remains an inadequately
      managed health problem.

      Two population-based studies of CFS
      have been conducted in the United
      States, and both found that CFS is one of
      the more common chronic illnesses
      among women across all racial/ethnic
      groups and that less than 20% of those
      who suffer from CFS have been
      diagnosed by a health care provider.

      Only three studies, all of which were
      clinic based, have attempted to quantify
      the impact of CFS, and each showed that
      people with the syndrome were likely to
      have lost their job or to be unemployed.

      In addition, it was shown that persons
      with CFS pose a disproportionate burden
      on the health care system and their
      families since they are sick for long
      periods of time and since there is no
      known cure for the illness.

The ability of an injured person to get back to a
functional life is often affected most severely by
fatigue. even when a person is physically able to lift
and bend and do the tasks of many jobs, the
consequence of fatigue is that the person can't keep
any job because fatigue takes them out of a 40 hour
work week.

As reported in the study The economic impact of
chronic fatigue syndrome [ ] by
Kenneth J Reynolds, Suzanne D Vernon, Ellen
Bouchery and William C Reeves, SRA International,
Inc., Arlington, U.S.A, Division of Viral and
Rickettsial Diseases, Centers for Disease Control and
Prevention, Atlanta, U.S.A, The Lewin Group, Falls
Church, U.S.A:

      The magnitude of the economic impact
      imposed on the individual and on society
      by CFS is substantial. Approximately
      one-quarter of persons with CFS, who
      would otherwise have participated in the
      labor force, ceased working. For those
      who continued to work, average income
      declined by one-third.

      This represents an estimated annual loss
      of almost $20,000 for the individual
      suffering from CFS. This magnitude of
      loss approximates half of their labor
      force and household productivity in a
      given year.

      The $9.1 billion national loss is
      comparable to that estimated for other
      illnesses, such as digestive system
      illnesses ($8.4 B) and infectious and
      parasitic diseases ($10.0 B) [19] and is
      greater than the estimated productivity
      losses from immunity disorders ($5.5 B),
      nervous system disorders ($6.4 B), or
      skin disorders ($1.3) [23].

      This estimate does not include health
      care costs, which are likely to be
      substantial and does not address
      reductions in quality of life, which are
      likely to be large due to the debilitating

      We estimated annual lost productivity.
      However, CFS is a chronic illness. The
      average duration of CFS identified in
      population studies is 5 years and most
      patients with CFS seen by health care
      providers have been ill for more than 6

      Thus, productivity losses, health care
      expenses, and reductions in quality of life
      continue for many years for most
      affected individuals and thus would have
      a substantial long-term impact on the
      standard of living of individuals with CFS
      and their family members.

It often starts with pain that doesn't go away and
lingers and tortures the injured person 24 hours a
day, 7 days a week as reported in a Time Magazine
feature article The Right (and Wrong) Way to Treat
Pain [ ] by Claudia Wallis.

      With chronic pain, however, the alarm
      continues to shriek uselessly long after
      the physical danger has passed.

      Somewhere along the line--maybe near
      the initial injury, maybe in the spinal cord
      or brain--the alarm system has broken

      What researchers have only recently
      come to understand is that prolonged
      exposure to this screaming siren actually
      does its own damage.

      "Pain causes a fundamental rewiring of
      the nervous system," says Dr. Sean
      Mackey, director of research at Stanford
      University's Pain Management Center.

      "Each time we feel pain, there are
      changes that occur that tend to amplify
      our experience of pain."

      That is why it is a mistake, despite our
      grin-and-bear-it tradition, to ignore or
      under treat severe pain.

Fatigue is often the most disabling feature of chronic
pain. The injured person is often told by the
insurance company, their employer or even their own
attorney that they can go back to work and so they
have no claim for future wage loss.
On top of that their fatigue is ignored and not
understood to be a part of the injury. It is treated
like a form of laziness or lack of initiative.

The treating doctor has probably told them that they
can physically do the work at their old job or at least
at some other less strenuous job.

What is missing in this analysis is that if the injured
person suffers from fatigue they cannot do the work
if it involves a 40 hour job.

Unless a careful workup is done of the existence of
fatigue and the connection of fatigue to the injury,
the injured person will not be compensated for what
can be a significant loss of future earnings.

What needs to be done is an analysis of the injured
person by a neuropsychologist or other doctor using
The Universal Work Skills Evaluation test.

Below is a video showing a truck driver taking the
test. Although there is no sound the test shows that
the person has chronic fatigue.

Work Skills Evaluation for Michigan Truck Accident
Victim Who Was Awarded a $5.65 Million Verdict:

Doctors have several ways of validating fatigue as a
disabling factor resulting from personal injury.

1 comment:

JoEllen said...

A completely obvious problem exists in the CDC study quoted:

"Two population-based studies of CFS have been conducted in the United States, and both found that CFS is one of the more common chronic illnesses among women across all racial/ethnic groups and that less than 20% of those who suffer from CFS have been diagnosed by a health care provider."

Um. Where do we start? CDC claims on the one hand that less than 20% of sufferers have been diagnosed - and yet that would require that CDC itself had made a definitive diagnosis! Either that, or they used the s.w.a.g. system.

Add to that the CDC's insistence on using its own standing definition requiring "unknown etiology" as a qualifier, and you automatically include virtually anything and everything in the known universe which isn't necessarily something else.

Add to that CDC's own requirement that this be "a diagnosis of exclusion", and then fail to objectively exclude all other possibilities - you get nothing more than a mish-mash of guesswork.

I'm sorry - but these estimates are just too loosey-goosey to meet any burden of real scientific inquiry. As usual, they play a darkly syllogistic game with us, insisting on blurring the lines between CFS and...well, everything else that hasn't already got a definitive lab test going for it. For example, we know that diseases such as lupus, MS, and Lyme have almost identical presentations at some points, and are missed diagnoses far more often than they are positively identified. The usual run up to an actual diagnosis is measured in years. If CDC has figured out how to get around that problem? THAT would be the big news here - not another estimate of CFS prevalence!

As much I want to see real and effective research in this area, this kind of thing is not the path to it.