Some say a paper cut is the most painful thing in the world. Others would vouch for bullet wounds. Many men moan that a swift kick in the pants trumps it all. Who’s right? No one. Pain is notoriously difficult to assess because many factors play a part in the overall sensation. But that hasn’t stopped us from trying to understand its secrets with new technology.

Functional magnetic resonance imaging (fMRI) allows us to peep inside a brain in action to see what processes and pathways light up during sensation. Pain-specific work with fMRI technology inches closer to a possible objective assessment of pain by carefully studying what happens in the brain during a painful event. This possible objective assessment of pain offers more than just proof that you’re in more pain than your friend with a paper cut. It could change the way we prescribe medications and alter the way we practice law–especially in personal injury cases.

To win a personal injury case, victims must prove that their injury resulted in damages like pain and suffering. You can easily find evidence to support that you’re in pain, but try to apply a price tag and it gets tricky. How do you put a value on pain if you can’t know exactly what the person feels other than what they say? Enter the fMRI pain scan, which provides tangible evidence of a victim’s pain and suffering.

The technology’s critics argue that we have too much to learn about fMRI pain scans before we allow them in court as a valid measure of pain. Proponents wonder if the sophisticated new technology could usurp otherwise primitive methods of assessing pain.

Here’s what you need to know about the intersection of pain, brain, and law to decide your stance.

Pain and the Brain

Pain blinds some people, sending them to bed at the first flutterings of a headache. Yet professional athletes and exercise fanatics actually find it manageable, and even exciting. Some can even meditate their way to a weakened perception of pain. Individual differences like these make pain assessment a jungle, especially when you’re shooting for precision worthy of the courtroom.

Despite these differences, researchers hope we might be able to measure pain more precisely because all human pain begins with a universal neurological process.

Say you’re stung by a bee. The moment that stinger pops through your skin, nerve cells called nociceptors send alert signals racing through your spinal cord and up to your brain. The brain then decides how to react to the alert signals. It activates your motor pathways so you automatically swat the bee away and releases endorphins and other chemicals to help you regulate and reduce the pain you feel. The same process happens in everyone, but the specific competence of your own personal brain circuits and systems determines exactly how you experience the pain. That’s why your friend can brush aside the same bee sting that makes you wail.

How do we assess pain now?

As individuals, the way we evaluate our own pain muddies up assessments. When we feel pain, we want to tell everyone how it makes us feel, which is sometimes like…well, you get the picture. We immediately react to pain with guttural and meaningless expletives like “ouch!” and many other choice words. When prompted, we might be able to describe our pain as “dull” or “sharp,” but these methods could benefit from more precision.

The way professionals evaluate our pain isn’t too much better.  A doctor will usually ask you to rank your pain on a scale of one to ten and then point to the emoticon the best represents your state of mind.

If you’re trying to win a personal injury case with nothing but a number five and a half-frowny face to prove your pain and suffering, you might not see the best results. Wouldn’t it be better if they could just plug you into a machine that described your pain in terms of brain waves instead of your unreliable human emotions and descriptors?

That’s why many believe fMRIs hold the key to objective assessment of pain and would lead to more fair court outcomes.

What fMRIs Teach Us About Pain

All roads leading to pain travel the same neural pathways and fMRIs let us watch those pathways in action. There must be something from those processes we can measure.

A few years ago, researchers from multiple universities came one step closer to pain assessment by finding a marker pattern specific to physical pain stable enough for interpretation. Even if someone can’t talk (like a baby), the pattern they discovered would help us understand their pain using brain scans. The marker distinguished physical pain from other aversive events, meaning they can use brain scans to measure the actual pain experienced as a result of stimulus instead of the clouded emotional judgment that comes with it.

The discovery accelerated understanding and interpretation of fMRI brain scans.

Implications in the Law

We’ve just started to explore the intersection of neuroscience with law–aptly named neurolaw–and the treasure trove of evidence to be found in it.

In the Supreme Court decision in Roper v. Simmons, brain scans revealed distinct differences between adult and juvenile brains in briefs submitted to the court. The court eventually ruled against the use of the juvenile death penalty in that case. On the other hand, judges have ruled against fMRI-based lie detection in the 2010 case, U.S. v. Semrau.

Since many personal injury cases settle outside of court, it’s difficult to find a personal injury case using brain scans that has actually been tried in a courtroom. However, in Carl Koch & Tracee Koch vs. Western Emulsions Inc, a truck driver named Carl Koch sued past employer, Western Emulsions, for damages from a melted asphalt-induced wrist burn. A year after the injury, Koch was still in pain.

The case involved a face off between neuroscientists. Koch’s neuroscientist tested him with a method she developed that distinguishes real, chronic pain from imagined pain by hooking him up to the scanner and lightly tapping both of his wrists to see the different fMRI readings produced by each. The neuroscientist in the Western Emulsions corner disputed the evidence produced by the tests, saying that the mere expectation of pain could have produced the same results.

Ultimately, the judge allowed the scan as evidence and the case settled for more than Western Emulsions originally offered. Koch benefited from evidence provided by the brain scan, but many critics echo the dissenting neuroscientist’s concerns about fMRIs in the courtroom.

What are the problems with fMRIs in court?

Cautious critics serve up many reasons why fMRI scans should not yet be allowed in court. Here are some of the top arguments.

Brain Scans Can Sway a Jury

Evidence shows that neuroscientific evidence interferes with a person’s ability to interpret logic. People receive poor arguments with open minds when they’re backed with illogical neurological evidence. It seems that the mere presence of neurological evidence satisfies people into credulity.

Many Lawsuits Deal with Chronic Pain, a More Difficult Study Than Acute Pain

Scientists breeze through the study of acute pain with fMRIs. Acute pain results immediately from a stimulus. If you’re hooked up to a scanning machine and researchers prod you with a hot poker, there’s no doubt about what action causes the pain patterns in the scan. Most people pursuing personal injury lawsuits aren’t hooked up to machines at the time of their accidents. Chronic pain that comes after the accident often mingles with other issues, like depression, which might interfere with neurological scans and make it harder to attribute to one specific cause.

The Technology is New and Untested

Despite numerous discoveries, neuroscientists still disagree on the reliability of pain scans.

Many believe even the expectation of pain or a slight tilt of the head is enough to skew the results of an fMRI pain scan. Even simply blurting out “ow” has an effect on pain. In a National University of Singapore study, researchers had people sink their hands into alarmingly cold water. People who allowed themselves to say “ow” withstood the pain longer than the silent ones. They believe the effort of forming the expletive might be enough to interfere slightly with brain activities dealing with perception of pain and lessen the effect. Fluctuations like this lead people to question the validity of the scans and demand years of tests before admitting them as evidence.

The Scans Can Be Tricked by Your Emotions

In the NPR story above, David Linden, a neuroscientist at Johns Hopkins University, explains that two different brain systems process the feeling of pain. One system looks at pain with nothing but logic, evaluating where the pain came from and if the sensation burns, stabs, or aches. The other, more emotional, system tells us how to feel as a result of the pain. He also explains that emotions can steer your perception of pain. Negative emotions can make pain feel more intense. Torturers have used this fact to their advantage to make their victims’ pain worse by mixing emotions like humiliation in with already excruciating torture methods. This suggests pliability in a person’s reaction that could twist fMRI scan results.

How will we assess pain in the future?

During the nomination hearing for Chief Justice John Roberts in 2005, then-Senator Joe Biden posed a prescient,yet rhetorical, question:

“Can brain scans be used to determine whether a person is inclined toward criminality or violent behavior?”

His question centered on violent behavior, but now we can replace the last phrase with many other possible scenarios. Can brain scans be used to determine how much pain a person feels? As the technology becomes more widespread, more courts will surely face this question. Pain assessments and pain scans have further to go before they become a precise and trusted method, but they’re on the way. It’s exciting and scary to think of the ways our brain activity might be interpreted in another ten years.

Resources

Primary

New England Journal of Medicine: An fMRI-Based Neurologic Signature of Physical Pain

Journal of Cognitive Neuroscience: The Seductive Allure of Neuroscience Explanations

Additional

NPR: Pain Really is All in Your Head and Emotion Controls Intensity

Telegraph: Saying ‘Ow’ Really Can Ease Pain

Slate: Neuroscientists: Mercenaries in the Courtroom

WebMD: MRI Shows People Feel Pain Differently

Wall Street Journal: Doctors’ Challenge: How Real is That Pain?

All Law: Two Ways to Calculate a Pain and Suffering Settlement

Brainfacts: Neurolaw: Neuroscience in the Courtroom

Duke: Proof and Evaluation of Pain and Suffering in Personal Injury Litigation

Nature: Neuroscience in court: The painful Truth

Ashley Bell

Ashley Bell communicates about health and wellness every day as a non-profit Program Manager. She has a Bachelor’s degree in Business and Economics from the College of William and Mary, and loves to investigate what changes in healthy policy and research might mean for the future. Contact Ashley at staff@LawStreetMedia.com.

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It can be a very traumatic experience suffering from a personal injury, whether it be from a trip and fall, automobile accident, or otherwise. As someone who has suffered injuries, you want an attorney who will be on your side and fight for you. As in any profession, there are those professionals who are ethical, and those who might fall short of that. As a client, it is important to know what side of the spectrum your attorney falls on, in order to see whether you really are in the best hands.

Attorneys must abide by the American Bar Association’s Model Rules of Professional Conduct. These model rules are meant to keep attorneys in check, and hold the profession to a high ethical standard. If they fail to abide by the rules they could run the risk of some sort of penalty, or in the worst-case scenario, disbarment. As a Personal Injury client, you should be aware of some of the basic model rules in order to determine if your attorney is really the best fit for you.

Rule 1.4 Communication

Under this rule, lawyers must promptly inform their clients of material developments in the matter including settlements or plea offers, reasonably consult with the client about the means by which the client’s objectives are being accomplished, and keep the client reasonably informed about the status of the matter.

For you, this means that your attorney should be keeping you in the loop. Many times clients want to seek an update on their lawsuit and the attorney should be calling the client back promptly and updating them on a regular basis. Realistically, that is not to say that the attorney should be calling the client every day to report to them, since it is most likely that the attorney has other cases to work on as well. However, if the client feels that they haven’t been updated in a significant period of time, and have not had calls returned to them, they should consider taking their lawsuit elsewhere.

Rule 1.7 Conflict of Interest

Under this rule, a lawyer cannot represent a client if the representation involves a concurrent conflict of interest. That is, if an attorney represents Client A and Client B, if the representation of either client will be directly adverse to the other client, then there is a conflict of interest.

If an injured client is in an automobile accident, and the attorney is representing both drivers of each respective car, that is absolutely a conflict of interest. Clients should be aware of this rule, as it might not be as obvious of a conflict, like the situation with the automobile accident. If the client feels that an attorney’s representation of another client is directly adverse to their case, they should bring it to the attorney’s attention.

Rule 4.2 Communication with Person Represented by Counsel

Under this rule, an attorney cannot communicate with an individual whom he knows to be represented by counsel, unless counsel gives permission or unless there is a court order.

As a client, if an attorney who is not the attorney representing your case tries to contact you, it is important to notify your attorney right away to see what is going on. The client should not give any information to other attorneys except their own, as those individuals probably do not have the best interests for you.

Although these are just three rules of many under the ABA Rules of Professional Conduct, a client should be aware that they deserve ethical representation by their attorney. Although it is ideal to think that all attorneys are ethical, the sad truth is that not all are.  As a client, if something doesn’t feel right about your representation, you should address it.

Melissa Klafter

Melissa Klafter has a JD from St. John’s University School of Law and plans to pursue a career in Personal Injury Law. You can find her binge-watching her favorite TV shows, rooting for the Wisconsin Badgers, and playing with her kitty, Phoebe. Contact Melissa at staff@LawStreetMedia.com.

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When you hear the word “FitBit,” you usually associate the physical activity monitor with fitness; however, after a recent case in Canada, FitBit might very well be associated with personal injury evidence used in Litigation.

In a personal injury case in Calgary, Canada, the law firm of Mcleod Law is using the plaintiff’s FitBit activity to support her personal injury claim. The plaintiff, who was a personal trainer, was injured in an accident four years ago. The attorneys representing her are seeking to demonstrate that her activity levels are lower than the baseline of a woman her age and profession, in order to prove damages. Among other things, Fitbit monitors physical activity by measuring steps taken by the individual wearing the device. The plaintiff’s attorneys hope to formulate a ‘quantitative representation of the claimant’s activity during their normal weekly routine.’

Logistically, the law firm is not using the raw FitBit data, but will be using analytics company Vivameterica to analyze such data. This company will analyze the plaintiff’s information and compare the data to other databases showing average activity of an individual with similar weight, age, gender, body mass index, etc.

This case is the first of its kind in that it could set a precedent for evidence of personal data collected through wearable devices in personal injury cases; however, there are many out there who are skeptical of this type of data being used in the courtroom.

Skeptics are concerned that this kind of data could lead to potential manipulation on the part of the plaintiffs, as well as false representations of activity. For example, if a plaintiff knows their FitBit data will be analyzed in court, they might be overly active so that there wearable device could pick up on such activity, in order to prove damages. In the alternative, individuals take off their Fitbit device throughout the day for various reasons. This could lead to a false read of an individual’s true physical activity.

Although this type of evidence does raise some issues, it could be an excellent tool for attorneys in proving damages, or in the alternative, for mitigating such damages. As technology advances, so too must our litigation system. It is very possible that we will be seeing data from wearable devices being used in the future.

Melissa Klafter

Melissa Klafter has a JD from St. John’s University School of Law and plans to pursue a career in Personal Injury Law. You can find her binge-watching her favorite TV shows, rooting for the Wisconsin Badgers, and playing with her kitty, Phoebe. Contact Melissa at staff@LawStreetMedia.com.

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Federal Drug Enforcement Agents (DEA) made unannounced visits on Sunday to multiple National Football League teams as part of a continuing investigation. Agents investigated the San Francisco 49ers, Tampa Bay Buccaneers, and Seattle Seahawks. This investigation was fueled by  a class action lawsuit brought against the NFL last summer.

In May 2014, the NFL painkiller lawsuit was brought by approximately 1,300 former players claiming in essence that the team doctors “intentionally, recklessly and negligently created and maintained a culture of drug misuse, substituting players’ health for profit.” Specifically, the plaintiffs claim that since 1969, team doctors have been supplying medications in ways that constituted a dangerous misuse, and that the doctors fraudulently concealed the dangers and side effects from players in order to keep them on the field. They believe that the NFL placed priority of profit before the health of the players. Plaintiffs claim that they have sustained severe injuries from this medical misfeasance, including but not limited to heart attacks, kidney failures, and addiction. The NFL has requested that the federal judge dismiss the suit.

Among other defenses, the NFL is likely to assert that the plaintiffs are barred by the statute of limitations, which is a legal device to ensure that claims are brought in an efficient matter. Specifically, these statutes set the maximum period in which a plaintiff can wait before filing a lawsuit. If the lawsuit is not brought within the time frame then the right to make a claim on that matter is lost. In some instances, however, a statute of limitations can be extended, or tolled, based on a delay in discovery of the injury. This would enable the plaintiff to have an extended period beyond the statute of limitations to bring such action upon the defendants once injury is discovered, and to prevent unjust enrichment.

In California, the statute of limitations for a personal injury suit is two years. In other words, from the time the cause of action occurred–in this case the date of injury–the plaintiffs’ have two years to bring forth a lawsuit. The NFL will likely argue that the statute of limitations has expired, and bar Plaintiffs from bringing the lawsuit. Specifically, it would argue that some of the specific actions brought within the complaint date back to 1969, which far exceeds the statute of limitations.

Under the delayed discovery rule, the statute of limitations deadline is tolled and time does not start to run until the Plaintiffs’ discover, or by the exercise of reasonable diligence should have discovered, the injuries or harm and that it was caused by the wrongdoing of the defendants. The plaintiffs’ have argued just that. In their amended complaint, they claim that the statute of limitations should be tolled, on grounds that they had not discovered, and had no good reason to know of their injuries until recently. Specifically, they argue that league doctors did not reveal the names of medications, and there were poor records regarding dispensing medication. Thus, such acts constituted concealment, which ultimately caused the plaintiffs’ injuries.

The NFL is clearly under a lot of heat at the moment. It still has the NFL Concussion Litigation going on, and the DEA’s visits last Sunday only added fuel to the fire with the current lawsuit. This case is still being heard in the northern district of California on the ruling of NFL’s motion to dismiss, but my gut tells me that there will be no dismissal. If that is the case, it will be interesting to see how the statute of limitations arguments play out, and more importantly, what actions are implemented within the NFL.

Melissa Klafter

Melissa Klafter has a JD from St. John’s University School of Law and plans to pursue a career in Personal Injury Law. You can find her binge-watching her favorite TV shows, rooting for the Wisconsin Badgers, and playing with her kitty, Phoebe. Contact Melissa at staff@LawStreetMedia.com.

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Imagine this: you’re in a car accident and as a result, break your arm. (Ouch.) You sue the individual who was driving the other car. The next month, you’re at a Jets game rooting for your team and post some pictures on Facebook, making one of them your new profile picture. A month later, your attorney calls you up, questioning if you posted pictures from the Jets game. As it turns out, the defendant’s demanding full access to your Facebook account to disprove your injuries. The big question is, are they entitled to access your Facebook account?

Discovery is an absolutely essential part of litigation. In basic terms, discovery fuels the arguments that each side of the lawsuit makes, by providing relevant information about the opponent. In the past, discovery typically consisted of documents, but as time and technology has progressed, electronic discovery has become more prevalent. This has raised some very interesting questions in Personal Injury Law, like the above situation.

Courts have a tough issue to handle. On the one hand, social media could be extremely relevant to a Personal Injury action. It could disprove a plaintiff’s injuries, or at the very least, make those injuries questionable. On the other hand, that is a plaintiff’s personal Facebook page. Why should the defendant have access to that personal account information?

The Balancing Act and Current Law: New York

New York courts have grappled with this issue and come up with a fairly reasonable standard in order to balance these competing interests. They have established a two-prong test for determining whether social media accounts are discoverable. First, courts must determine whether the content in the account is material and necessary. Second, courts must balance whether the production of the content would result in a violation of the account holder’s privacy rights.

For a defendant to successfully maintain access to discovery under this two-prong test, he must “establish a factual predicate for their request by identifying relevant information in plaintiff’s [social media] account-that is, information that contradicts or conflicts with plaintiff’s alleged restrictions, disabilities, and losses, and other claims.” In other words, the defendant must show that there is content on the plaintiff’s social media account that is not only relevant to the personal injury action, but also contradicts or conflicts with the plaintiff’s claims. If the defendant can establish that, then discovery of social media accounts should be permitted.

The courts have been fairly strict with applying this standard, however. The court will not allow a defendant to simply demand disclosure of social media accounts on the basis that access may reveal information that contradicts or conflicts with a plaintiff’s claim of disability. The court has labeled such a request as a “fishing expedition” and will not allow it.

The Car Accident Revisted

So, is the defendant entitled to access your Facebook account? The answer lies within the specific facts. In the original car accident example, the content of the photograph is key. If the defendant is simply asking for access to the Facebook account because it might reveal activities that contradict with the your claim, that probably will not be sufficient for the court to demand disclosure of your account information. If your profile picture portrays you fist pumping your broken arm in the air, however, it is more likely that the court will grant access to your Facebook account, since the pictures contradict the complaint regarding your broken arm.

The interesting part about Social Media discovery is that it is an evolving area of law. As social media websites continue to develop, so too must the law. It seems that New York courts have fairly balanced these competing interests thus far, but it will certainly be interesting to see what issues arise in the future.

Melissa Klafter

Melissa Klafter has a JD from St. John’s University School of Law and plans to pursue a career in Personal Injury Law. You can find her binge-watching her favorite TV shows, rooting for the Wisconsin Badgers, and playing with her kitty, Phoebe. Contact Melissa at staff@LawStreetMedia.com.

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