Clarification of the concept of pain in forensic expertise

Abstract

Quantification of pain and its cause-consequence relation to event of interest in medical expertise
are the most common tasks for medical experts. A precise and detailed analysis of all aspects of pain (location,
intensity, manner, incidence, periodicity, dependence on other factors….) are necessary in order to answer
the forensic question.
There are no pathways for transmitting pain, nor a center for pain. A pain is the result of complex mechanisms
of perception, it is highly subjective and complex, and its perception is changed by current attention and
emotions. Except for the patient’s testimony, there is no test that will prove the existence of pain.
All tests available today can only prove conditions that are accompanied by pain. Our medical knowledge
and clinical experience link testimony and examination. When taking a medical history, it is very important
to insist on a detailed description of the pain: is it discomfort, stiffness, fatigue or is it real pain (type of pain).
Further, it is necessary to obtain data on the origin and duration of pain, its occurrence (related to injury, load,
gait, periodicity…) and severity (VAS pain scale 0-10) - to get answers on where, how, when and how much
does it hurt. Determining all the characteristics of a pain allows us a more realistic insight into the level of pain
and a more secure cause-consequence relationship with the event of interest.