{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T13:48:00Z","timestamp":1792072080570,"version":"4.4.0"},"reference-count":77,"publisher":"Cambridge University Press (CUP)","issue":"3","license":[{"start":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T00:00:00Z","timestamp":1776384000000},"content-version":"unspecified","delay-in-days":106,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Law. Med. Ethics"],"published-print":{"date-parts":[[2026]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Patients living with nociplastic pain are at particular risk of being unfairly judged because their symptoms are subjective and occur without measurable abnormalities. Nociplastic pain, now recognized as a third category of pain alongside nociceptive and neuropathic pain, arises in the absence of tissue damage sufficient to explain the clinical presentation. This \u201cunseen\u201d pain affects at least ten percent of the population, commonly involves the musculoskeletal or visceral systems, and leads to substantial suffering and functional impairment. Validation of these chronic symptoms is often contentious because no objective biomarker or physical sign can reliably confirm their presence or severity. The concept of illness without measurable parameters challenges clinicians and conflicts with legal systems that rely heavily on objective evidence in adjudicating health-related questions. Most clinicians have limited training in medicolegal principles, standards of impartiality, or the ethical distinctions between patient advocacy and objective reporting. These challenges are amplified in cases involving chronic nociplastic pain, where the lack of observable findings complicates clinical interpretation and may conflict with traditional expectations for legal evidence. Bias, whether conscious or unconscious, may occur at multiple stages of the medicolegal process. Inaccurate, incomplete, or biased information from patients, treating clinicians, independent medical experts, insurers, or legal representatives can influence fairness, credibility, and decisional outcomes. This review summarizes key considerations in the adjudication of chronic nociplastic pain and examines how various sources of bias may shape medicolegal decision-making. Improving awareness of these risks and implementing strategies to reduce bias may promote a more reliable and equitable interface between clinical assessment and legal adjudication.<\/jats:p>","DOI":"10.1017\/jme.2026.10261","type":"journal-article","created":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T08:23:38Z","timestamp":1776414218000},"page":"278-289","source":"Crossref","is-referenced-by-count":1,"title":["Beyond the Benefit of Doubt: Biases and Credibility in the Adjudication of Chronic Pain"],"prefix":"10.1017","volume":"54","author":[{"given":"Rodrigo Deamo","family":"Assis","sequence":"first","affiliation":[{"name":"Centre Int\u00e9gr\u00e9 de Sant\u00e9 et Services Sociaux de l\u2019Abitibi-T\u00e9miscamingue"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven P.","family":"Cohen","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/000e0be47","id-type":"ROR","asserted-by":"publisher"}],"name":"Northwestern University Feinberg School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hance","family":"Clarke","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/03dbr7087","id-type":"ROR","asserted-by":"publisher"}],"name":"University of Toronto"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nimish","family":"Mittal","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/03dbr7087","id-type":"ROR","asserted-by":"publisher"}],"name":"University of Toronto"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary-Ann","family":"Fitzcharles","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/01pxwe438","id-type":"ROR","asserted-by":"publisher"}],"name":"McGill University"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2026,4,17]]},"reference":[{"key":"S1073110526102617_r56","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-018-3481-3"},{"key":"S1073110526102617_r29","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.131509"},{"key":"S1073110526102617_r46","doi-asserted-by":"publisher","DOI":"10.1016\/j.pmn.2023.04.003"},{"key":"S1073110526102617_r35","doi-asserted-by":"publisher","DOI":"10.1177\/0272989X14547740"},{"key":"S1073110526102617_r61","unstructured":"61. Robert D. Rodinelli et al., Guides to the Evaluation of Permanent Impairment, 6th ed. (American Medical Association, 2008); Towards a Common Language for Functioning, Disability, and Health: ICF (World Health Organization, 2002), https:\/\/cdn.who.int\/media\/docs\/default-source\/classification\/icf\/icfbeginnersguide.pdf."},{"key":"S1073110526102617_r10","doi-asserted-by":"publisher","DOI":"10.1038\/s41582-024-00966-8"},{"key":"S1073110526102617_r15","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000002242"},{"key":"S1073110526102617_r38","doi-asserted-by":"publisher","DOI":"10.1071\/AH17244"},{"key":"S1073110526102617_r3","first-page":"579","article-title":"Sued, Subpoenaed or Sworn In: Use of a Flipped-Classroom Style Medicolegal Workshop for Emergency Medicine Residents","volume":"25","author":"Williams","year":"2024","journal-title":"Western Journal of Emergency Medicine"},{"key":"S1073110526102617_r65","unstructured":"65. Law 101: Legal Guide for the Forensic Expert: Important Traits That Enhance Expert Witness Credibility (National Institute of Justice, 2023), https:\/\/nij.ojp.gov\/nij-hosted-online-training-courses\/law-101-legal-guide-forensic-expert\/trial\/direct-examination\/important-traits-that-enhance-expert-witness-credibility."},{"key":"S1073110526102617_r12","doi-asserted-by":"publisher","DOI":"10.1016\/j.semarthrit.2020.10.006"},{"key":"S1073110526102617_r16","unstructured":"16. Fitzcharles, \u201cNociplastic Pain.\u201d."},{"key":"S1073110526102617_r23","doi-asserted-by":"publisher","DOI":"10.36076\/ppj.2009\/12\/811"},{"key":"S1073110526102617_r69","doi-asserted-by":"publisher","DOI":"10.1179\/oeh.2004.10.1.1"},{"key":"S1073110526102617_r43","doi-asserted-by":"publisher","DOI":"10.1016\/j.pain.2010.04.031"},{"key":"S1073110526102617_r34","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.331.7514.448"},{"key":"S1073110526102617_r47","doi-asserted-by":"publisher","DOI":"10.3109\/09638288.2010.515285"},{"key":"S1073110526102617_r54","doi-asserted-by":"publisher","DOI":"10.1097\/JOM.0000000000001274"},{"key":"S1073110526102617_r17","doi-asserted-by":"publisher","DOI":"10.1097\/PSY.0000000000001181"},{"key":"S1073110526102617_r73","doi-asserted-by":"publisher","DOI":"10.1136\/practneurol-2014-000985"},{"key":"S1073110526102617_r45","doi-asserted-by":"publisher","DOI":"10.1007\/s11019-021-10040-5"},{"key":"S1073110526102617_r66","unstructured":"66. Schofferman, \u201cOpinions and Testimony of Expert\u201d;"},{"key":"S1073110526102617_r9","doi-asserted-by":"publisher","DOI":"10.1016\/j.pnpbp.2018.01.017"},{"key":"S1073110526102617_r8","doi-asserted-by":"publisher","DOI":"10.3390\/life13030694"},{"key":"S1073110526102617_r40","doi-asserted-by":"publisher","DOI":"10.1177\/00258172241285986"},{"key":"S1073110526102617_r60","doi-asserted-by":"publisher","DOI":"10.1111\/j.1526-4637.2007.00318.x"},{"key":"S1073110526102617_r75","unstructured":"75. Ky et al., \u201cIndependent Medical Examinations\u201d; \u2013Brigham et al., \u201cIndependent Medical Evaluation Best Practices.\u201d."},{"key":"S1073110526102617_r49","doi-asserted-by":"publisher","DOI":"10.1192\/j.eurpsy.2022.155"},{"key":"S1073110526102617_r28","article-title":"General Practitioners and Sickness Certification for Injury in Australia","volume":"100","author":"Mazza","year":"2015","journal-title":"BMC Family Practice"},{"key":"S1073110526102617_r55","doi-asserted-by":"publisher","DOI":"10.1136\/ewjm.173.3.198"},{"key":"S1073110526102617_r25","first-page":"3","article-title":"Independent Medical Evaluation Best Practices","volume":"22","author":"Brigham","year":"2017","journal-title":"AMA Guides Newsletter"},{"key":"S1073110526102617_r27","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2024.111965"},{"key":"S1073110526102617_r30","doi-asserted-by":"publisher","DOI":"10.1016\/j.jviscsurg.2019.04.001"},{"key":"S1073110526102617_r33","doi-asserted-by":"publisher","DOI":"10.1007\/s12262-012-0538-0"},{"key":"S1073110526102617_r67","unstructured":"67. Ebrahim et al., \u201cEthics and Legalities Associated with Independent Medical Evaluations.\u201d"},{"key":"S1073110526102617_r32","doi-asserted-by":"publisher","DOI":"10.2190\/CCB6-7M8M-0CA9-6YYE"},{"key":"S1073110526102617_r58","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.8827"},{"key":"S1073110526102617_r13","unstructured":"13. Fitzcharles, \u201cNociplastic Pain.\u201d."},{"key":"S1073110526102617_r63","unstructured":"63. Currey and Sprogis, \u201cConceptualising the Quality Experience.\u201d"},{"key":"S1073110526102617_r31","doi-asserted-by":"publisher","DOI":"10.1007\/s00101-005-0934-y"},{"key":"S1073110526102617_r1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1525-1497.1999.09148.x"},{"key":"S1073110526102617_r41","doi-asserted-by":"publisher","DOI":"10.1007\/s12207-020-09375-w"},{"key":"S1073110526102617_r20","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbspin.2024.105750"},{"key":"S1073110526102617_r71","unstructured":"71. Currey and Sprogis, \u201cConceptualising the Quality Experience.\u201d"},{"key":"S1073110526102617_r19","doi-asserted-by":"publisher","DOI":"10.1177\/19476035221087698"},{"key":"S1073110526102617_r22","first-page":"147","article-title":"The Medico-Legal Expertise: Solid Medicine, Sufficient Legal and a Measure of Common Sense","volume":"9","author":"Sullivan","year":"2006","journal-title":"McGill Journal of Medicine"},{"key":"S1073110526102617_r4","doi-asserted-by":"publisher","DOI":"10.1111\/j.1526-4637.2004.04012.x"},{"key":"S1073110526102617_r62","unstructured":"62. R V Mohan. Supreme Court, 1994. https:\/\/decisions.scc-csc.ca\/scc-csc\/scc-csc\/en\/item\/1131\/index.do?utm_source=chatgpt.com."},{"key":"S1073110526102617_r53","doi-asserted-by":"crossref","first-page":"817","DOI":"10.1097\/AJP.0000000000000342","article-title":"Giummarra et al.,\u201cChronic Pain Following Motor Vehicle Collision: A Systematic Review of Outcomes Associated with Seeking or Receiving Compensation","volume":"32","author":"Melita","year":"2016","journal-title":"Clinical Journal of Pain"},{"key":"S1073110526102617_r64","unstructured":"64. Schofferman, \u201cOpinions and Testimony of Expert.\u201d"},{"key":"S1073110526102617_r77","unstructured":"77. Guidelines of Conduct (American Board of Independent Medical Examiners, 2022), https:\/\/www.abime.org\/guidelines-of-conduct\/."},{"key":"S1073110526102617_r74","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1111\/j.1742-6723.2009.01233.x","article-title":"Current Level of Training, Experience and Perceptions of Emergency Physicians as Expert Witnesses: A Pilot Study","volume":"21","author":"Williams","year":"2009","journal-title":"Emergency Medicine Australasia"},{"key":"S1073110526102617_r57","doi-asserted-by":"publisher","DOI":"10.1111\/j.1526-4637.2006.00215_2.x"},{"key":"S1073110526102617_r70","unstructured":"70. Ky et al., \u201cIndependent Medical Examinations.\u201d"},{"key":"S1073110526102617_r11","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(21)00392-5"},{"key":"S1073110526102617_r14","doi-asserted-by":"publisher","DOI":"10.1016\/j.semarthrit.2017.12.011"},{"key":"S1073110526102617_r39","doi-asserted-by":"publisher","DOI":"10.1007\/s10926-019-09844-3"},{"key":"S1073110526102617_r5","unstructured":"5. Kulich et al., \u201cSurvey of Medico-Legal Practice.\u201d."},{"key":"S1073110526102617_r76","doi-asserted-by":"publisher","DOI":"10.1111\/j.1526-4637.2004.04012.x"},{"key":"S1073110526102617_r24","unstructured":"24. Assis et al., \u201cMedical Jurisprudence.\u201d"},{"key":"S1073110526102617_r36","volume-title":"StatPearls","author":"Shah","year":"2023"},{"key":"S1073110526102617_r59","doi-asserted-by":"publisher","DOI":"10.23907\/2017.044"},{"key":"S1073110526102617_r26","unstructured":"26. Rondinelli and Eskay-Auerbach, \u201cIndependent Medical Examination\u201d; Ky et al., \u201cIndependent Medical Examinations.\u201d"},{"key":"S1073110526102617_r52","doi-asserted-by":"publisher","DOI":"10.1016\/S0363-5023(03)00178-3"},{"key":"S1073110526102617_r21","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0157235"},{"key":"S1073110526102617_r2","doi-asserted-by":"publisher","DOI":"10.1097\/PR9.0000000000001316"},{"key":"S1073110526102617_r48","doi-asserted-by":"publisher","DOI":"10.1007\/s12207-014-9208-9"},{"key":"S1073110526102617_r72","unstructured":"72. Kulich et al., \u201cSurvey of Medico-Legal Practice.\u201d"},{"key":"S1073110526102617_r37","first-page":"e35266","article-title":"Evidence-Based Medicine: History, Review, Criticisms, and Pitfalls","volume":"15","author":"Iqbal","year":"2023","journal-title":"Cureus"},{"key":"S1073110526102617_r18","doi-asserted-by":"publisher","DOI":"10.1097\/01.j.pain.0000460350.30707.8d"},{"key":"S1073110526102617_r44","doi-asserted-by":"publisher","DOI":"10.1097\/pq9.0000000000000425"},{"key":"S1073110526102617_r51","doi-asserted-by":"publisher","DOI":"10.1037\/0033-2909.97.1.74"},{"key":"S1073110526102617_r50","doi-asserted-by":"publisher","DOI":"10.1097\/00002508-200411000-00004"},{"key":"S1073110526102617_r6","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijlp.2007.11.006"},{"key":"S1073110526102617_r7","doi-asserted-by":"publisher","DOI":"10.1002\/ajim.22708"},{"key":"S1073110526102617_r42","doi-asserted-by":"publisher","DOI":"10.1097\/01.NURSE.0000823252.50782.45"},{"key":"S1073110526102617_r68","unstructured":"68. Dean et al., \u201cScoping Review of Claimants\u2019 Experiences\u201d; Aamland et al., \u201cIndependent Medical Evaluation.\u201d"}],"container-title":["Journal of Law, Medicine &amp; Ethics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S1073110526102617","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T13:11:19Z","timestamp":1792069879000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S1073110526102617\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026]]},"references-count":77,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026]]}},"alternative-id":["S1073110526102617"],"URL":"https:\/\/doi.org\/10.1017\/jme.2026.10261","relation":{},"ISSN":["1073-1105","1748-720X"],"issn-type":[{"value":"1073-1105","type":"print"},{"value":"1748-720X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026]]}}}