The task is therefore not to prove pain through one test. It is to decide whether the account is medically plausible, internally consistent and compatible with the person’s history, function and progress over time.
Objective Findings Are Only Part of the Assessment.
Imaging and physical examination provide useful information, but neither gives a complete measure of pain.
Some painful conditions produce obvious structural findings, while others do not. Musculoskeletal pain may persist after tissues have healed, and symptoms can remain troublesome even where imaging shows only minor changes. The opposite can also occur, with substantial degenerative findings appearing in someone who reports relatively little discomfort.
An expert should therefore avoid treating imaging as a direct measurement of symptom severity.
A normal or relatively unremarkable scan may reduce the likelihood of certain structural diagnoses, but it does not establish that the person has no pain. The more useful question is whether the reported symptoms can reasonably occur without major structural abnormality and whether the rest of the evidence supports that explanation.
Clinical examination should be approached in the same way. Findings such as restricted movement, tenderness, weakness or altered gait may support the account, but their absence does not automatically resolve the issue.
Consistency Matters More Than a Single Finding.
When objective evidence is limited, consistency becomes increasingly important.
The expert should look at whether the description of pain remains broadly similar across the history, medical records and examination. The location, pattern, triggers and effect on activity should make clinical sense when considered together.
This does not require every account to be identical.
People describe symptoms differently over time, and medical records may use different terminology. Someone may also struggle to remember precise dates or changes in severity.
Minor differences are therefore unsurprising. More significant inconsistencies deserve closer attention, particularly where they affect the nature or duration of the claimed symptoms.
For example, an individual may report continuous severe back pain from the date of an accident, while contemporary records repeatedly describe normal activity and no relevant complaints. That does not automatically disprove the later account, but it may affect the weight the expert gives it.
The important point is to explain the significance of the discrepancy rather than simply label it an inconsistency.
Function Often Provides the Most Useful Context.
Pain becomes easier to understand when the expert considers what the person can and cannot do.
A pain score on its own provides limited information. Two people who both describe pain as severe may function very differently. One may continue working and exercising with some difficulty, while another may struggle with basic household activities.
The expert should therefore explore how symptoms affect ordinary life, including work, travel, sleep, mobility and recreation where relevant.
Changes over time can be particularly informative. If the person gradually returns to normal activity despite continuing discomfort, that may indicate functional recovery even though the pain has not fully resolved. If substantial restrictions persist across several life; of daily life, the prognosis may require more caution.
Function should not become a test of whether pain is genuine. People can continue working despite significant symptoms, while others may stop activities for reasons unrelated to physical incapacity.
It simply provides another part of the overall clinical picture.
The Medical Records Need Careful Interpretation.
Medical records can help establish chronology, but they should not be treated as a perfect diary of pain.
A claimant or plaintiff may not seek medical attention every time symptoms occur, particularly where they have already received advice or believe further appointments will make little difference. A short clinical note may also focus on the main reason for attendance without recording every ongoing complaint.
A gap in treatment therefore does not necessarily mean a gap in symptoms.
However, prolonged silence can still matter, especially where the person describes severe or disabling pain throughout the same period. Repeated medical appointments with no reference to significant symptoms may carry more weight than one isolated omission.
The expert should distinguish between an absence of documentation and evidence that symptoms were genuinely absent. That difference can materially affect the final opinion.
Persistent Pain May Need a Broader Explanation.
Where symptoms continue well beyond the expected recovery period, the expert may need to consider whether the original injury still explains the whole presentation.
Persistent pain can become more complicated over time. Sleep disturbance, anxiety, reduced activity and fear of movement may begin to influence how symptoms are experienced and managed. These factors do not mean the pain is fabricated or purely psychological.
They may simply form part of the reason recovery has become prolonged.
The expert should also consider whether another diagnosis needs investigation. Persistent pain with few objective findings should not automatically be attributed to the original accident because no better explanation has yet emerged.
If the evidence is insufficient, it may be more appropriate to recommend further assessment than to force a definite conclusion.
Behaviour During Examination Needs Caution.
Experts sometimes place considerable weight on how a person behaves during examination, but this area requires care.
Apparent discomfort, guarded movement or reluctance to perform a particular manoeuvre may support the history, although these findings still depend partly on the person’s response.
Equally, someone who appears comfortable during a short consultation may continue to experience substantial symptoms at other times.
Pain often fluctuates with activity, fatigue and time of day. A single examination captures only a small part of that experience.
Where examination findings differ markedly from the reported level of disability, the expert should describe the difference accurately and consider whether there is a reasonable explanation. The report does not need to convert every mismatch into a judgement about credibility.
Experts Should Avoid Two Opposite Errors.
The first mistake is assuming that pain must be insignificant because there is little objective evidence.
The second is accepting severe reported symptoms without examining whether the wider evidence supports them.
Both approaches oversimplify the assessment.
A more useful opinion considers the mechanism of injury, chronology, examination findings, records, treatment response and functional history together. The expert can then explain which parts of the account are well supported and where uncertainty remains.
That often produces a more balanced conclusion than searching for one investigation that either proves or disproves the symptoms.
The Same Clinical Principle Applies Across Four Countries.
The medico-legal systems of the UK, South Africa, United States and Australia differ, and the terminology used for the injured person may change between jurisdictions. The clinical problem, however, remains broadly the same.
Pain is a subjective experience, while medico-legal opinion requires the expert to evaluate the available evidence objectively.
That does not create a contradiction. It simply means the expert must assess the reliability and medical plausibility of the account rather than expect pain to appear on a scan.
Across all four countries, the strongest reports explain how the reported symptoms fit with the injury, records, examination and functional course, while identifying any areas where the evidence does not provide a clear answer.
Few Objective Findings Do Not Mean No Evidence.
The absence of major abnormalities can be clinically relevant, but it should never become the entire assessment.
A person can experience genuine pain without striking imaging or examination findings. At the same time, the severity and duration of that pain still need to make sense when considered against the wider evidence.
The expert’s role is not to choose between believing the individual and believing the scan.
It is to understand what each source of evidence can genuinely show, identify where they agree or differ, and reach an opinion that reflects the whole clinical picture.
When objective findings are limited, careful reasoning becomes more important, not less.
