Mr. Speaker, I have a return to written question asked by Mr. Braden on June 2, 2006, regarding statistical information.
Chronic pain disorder is a psychological disorder diagnosed according to the American Psychiatric Association criteria contained in the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition; DSM IV. The DSM IV provides three categories of chronic pain disorder:
- chronic pain primarily due to a medical disorder
- chronic pain due to a medical and psychological disorder, and
- chronic pain primarily due to a psychological disorder.
Those with chronic pain disorder associated with a medical disorder have an underlying physical explanation for the pain; however, the pain and dysfunction exceed what is considered normal for the physical injury. Those with the other categories of chronic pain disorder have complaints of pain lasting well beyond the expected healing time of their injury, and the pain and dysfunction is disproportionate to the injury or has no identifiable physical cause. These disorders do not respond well to medications and are resistant to most traditional therapies.
If WCB staff suspect that an injured worker is develop a pain disorder, they are obligated under policy to consult with the WCB medical advisor in the development of a preventative treatment plan. Treatment may include: pain clinics, multidisciplinary treatment facilities, and/or counseling services. This is a proactive approach and can be provided prior to a DSM IV diagnosis being established.
In the last five years, 39 WCB claimants have been diagnosed with chronic pain disorder. This disorder is in addition to the worker's primary injury, develops over time, and is, on average, diagnosed three years after the initial injury. Some of the claimants who were diagnosed with chronic pain disorder between 2001 and 2005 were injured as early as 1985.
Claimants with chronic pain disorder continue to receive the benefits they are entitled to for their original injury, and, if necessary, additional disability benefits are extended to cover participation in their chronic pain treatment plan. Benefits continue as long s the chronic pain is diagnosed.
Chronic pain disorder is an important and challenging issue for the WCB. In order for the WCB to award permanent benefits -- pensions -- a permanent medical impairment must first be determined according to the NWT and Nunavut Permanent Impairment Rating Guide. The WCB uses the American Medical Association's "Guides to the Evaluation of Permanent Impairment" 4th Edition to evaluate levels of impairment.
Permanent impairment is medically determined and is measured when there has been maximal medical recovery from a disease or injury. A state of permanent impairment is said to exist when there is a consistent measurable loss of a body part of functional ability, and when further medical treatment or the passage of time no longer results in improvement.
Those with chronic pain disorder have considerable variation and fluctuation in functional ability over time and because of this, chronic pain disorder does not have a measurable permanent impairment. However, chronic pain is recognized as compensable, and benefits can continue for as long as warranted. Although termed "temporary" benefits, chronic pain benefits would be in place as long as the condition exists, whether this is six weeks or the client's lifetime.
In the past five years, 39 WCB claimants were diagnosed with chronic pain disorder. All of them have received short-term benefits, 19 received permanent benefits for their original injury, and all of those claimants saw their benefits affected, via the extension of temporary disability benefits, when they were diagnosed as suffering from chronic pain disorder. It should also be noted that 23 claimants diagnosed with chronic pain disorder returned to work, and that 10 declined to be treated for chronic pain.
Challenges related to chronic pain disorder are not specific to our WCB, but are equally shared by every board in Canada, as well as the medical community. The WCB strives to provide the fairest compensation possible based on current medical evaluations. Thank you, Mr. Speaker.