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 defects. 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 disabilities.
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 diagnoses. 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 years. 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 whole.
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 fatigue.
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 years. 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 down. 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.
http://www.youtube.com/watch?v=DphPP1EHj9M
Doctors have several ways of validating fatigue as a disabling factor resulting from personal injury.
