Back pain can be disabling - even when imaging shows no clear cause. In this INNEG webinar, pain expert Dr Rajiv Malhotra explains how to interpret chronic pain claims, navigate causation and prognosis, and when to bring in a pain specialist.

About the Speaker

Dr Rajiv Malhotra is a Consultant in Pain Medicine at Liverpool with specialist expertise in spinal and nerve-related pain. His clinical work is embedded within a spinal surgical unit, giving him a unique perspective on post-surgical and degenerative spinal pain. He has authored multiple peer-reviewed articles on radiofrequency ablation and guides regional pain training in the UK.

Webinar Highlights - Key Medico-Legal Insights

• MRI ≠ Causation
  Many spinal pain cases show degeneration without symptoms - or symptoms without clear imaging. Experts must look beyond scans and evaluate history, function, and mental health.
• The ICD-11 Shift
  Chronic primary pain diagnoses (e.g. bodily distress disorder) now give legal weight to symptom-based conditions lacking structural findings.
• Early Psychological Screening
  Especially critical in minor RTAs or whiplash claims - conditions like PTSD can worsen long-term recovery.
• National Guidance
  NICE and GIRFT discourage repeated imaging or opioids. Evidence supports CBT, radiofrequency ablation, and early intervention.
• Role of the Pain Expert
  Pain consultants clarify prognosis, medication misuse, functional limits, and realistic treatment plans - especially in chronic, high-value claims.

Case Examples from the Webinar

• RTA with Normal MRI
  Despite no new imaging findings, Dr Malhotra showed how PTSD and myofascial pain influenced disability and treatment.
• Delayed Cauda Equina Diagnosis
  Focus on neuropathic pain, mental health impact, and long-term loss of function.
• Pre-Existing DISH Exacerbation
  Discussed how trauma may ‘tip over’ previously asymptomatic spinal disease - and when it becomes compensable.
• Exaggeration vs Amplification
  Encouraged deeper records review to distinguish conscious exaggeration from unconscious functional overlay.

Clinical Tips for Solicitors

> Chronic pain is real, even without scan findings
> Pre-existing issues may still be aggravated
> ICD-11 helps with diagnosis and causation
> Early referral and tailored treatment = better outcomes

Read the full medico-legal article here >