Chronic pain is one of the most challenging conditions to prove to Social Security. I’m going to be upfront about why: pain is invisible.
There’s no blood test for pain. You can’t see it on an X-ray. It doesn’t show up on an MRI. It’s subjective, based on what you feel and report, not on objective evidence.
Here’s the tough part: Social Security judges hear from people every day who claim they’re in too much pain to work. They need a way to determine who’s telling the truth. They need credibility factors beyond just your word.
This doesn’t mean you can’t get approved for disability based on chronic pain. People do it all the time. But you need to understand what Social Security is looking for and how to build a case that stands up to scrutiny.
How Social Security Views Pain
Social Security does recognize that pain can be disabling. But here’s what they say in their rules: your statements about pain must be supported by objective medical evidence.
You can’t just say, “I hurt too much to work” and expect approval. You need medical evidence of a condition that would reasonably cause the type of pain you’re experiencing.
They evaluate pain claims by asking:
- Is there medical evidence of an underlying condition that could reasonably produce your pain?
- Do your statements about pain seem credible based on the overall evidence?
- Is your pain consistent with other evidence in your file?
The Foundation: Objective Medical Evidence
Even though pain is subjective, you need objective evidence of the condition causing it.
This includes:
- Diagnostic test results (MRIs, CT scans, X-rays showing structural problems)
- Physical examination findings (limited range of motion, muscle atrophy, swelling, abnormal reflexes)
- Medical diagnoses (fibromyalgia, degenerative disc disease, neuropathy, etc.)
You need regular treatment with doctors documenting your condition. If you haven’t seen a doctor in over a year but claim constant debilitating pain, Social Security will question your credibility.
Example: Let’s say you claim severe back pain. Social Security sees MRI showing multiple herniated discs, orthopedic notes documenting limited range of motion, neurologist confirming nerve damage, and regular treatment including injections and physical therapy. This creates a credible foundation.
Compare that to just one X-ray from three years ago showing mild arthritis, a handful of doctor visits, and no treatment beyond occasional ibuprofen. Much harder to prove your pain is as severe as you claim.
Treatment Compliance: You Have to Try
If you’re not following your doctor’s treatment recommendations, Social Security will question whether your pain is really as bad as you say.
Think about it. If someone is truly in debilitating pain, wouldn’t they be doing everything possible to get relief?
Now, there are legitimate reasons why someone might not follow treatment:
- Can’t afford it
- Side effects are unbearable
- Tried everything and nothing helps
- Afraid of surgery
- Religious beliefs prevent certain treatments
These are valid reasons, but you need to explain them to your doctor and get those explanations documented.
Have conversations like:
- “I can’t afford the medication. Is there a less expensive alternative?”
- “This medication makes me so drowsy I can barely function. Can we try something different?”
- “I’m afraid to have surgery because [specific concern]. Can you help me understand the risks?”
When these conversations are in your records, they show you’re not refusing treatment because your pain isn’t that bad. You have legitimate barriers.
Medication Management: Document Everything
Social Security looks closely at what medications you’re taking and how well they work.
What hurts your credibility:
- Saying you’re in severe, constant pain but only taking ibuprofen occasionally
- Not taking medication as prescribed
- No documentation of side effects
What helps your credibility:
- Trying multiple medications with documented conversations about what works
- Being honest about side effects (“The medication helps, but makes me so drowsy I can’t safely drive”)
- Following your prescribed medication schedule
- Explaining when pain breaks through medication
Side Effects Matter A Lot
The side effects of pain medications can be just as disabling as the pain itself.
Maybe your medication helps manage pain to a tolerable level. But now you’re drowsy all the time. Your thinking is foggy. Your reaction time is slowed. You’re nauseous regularly.
Can you work a full-time job like this? Probably not.
Make sure your doctor documents:
- What side effects you experience
- How severe they are
- How they affect your daily functioning
- Why you continue taking the medication despite side effects
Describing Your Pain (Be Specific!)
Instead of: “I hurt all the time.”
Be specific: “I have constant burning pain in my lower back radiating down both legs. It’s usually a 6 or 7 out of 10, but several times a week it spikes to a 9. The pain is worse when I stand for more than 20 minutes or try to bend or lift anything. Sitting helps somewhat, but after 30-45 minutes, the pain and stiffness get so bad I have to stand up. I can never get comfortable.”
Include information about:
- Location (where exactly?)
- Type (sharp, burning, aching, stabbing?)
- Frequency (constant, intermittent, how often?)
- Intensity (use 1-10 scale)
- What makes it better (medication, rest, heat?)
- What makes it worse (activity, standing, sitting, weather?)
- How it affects daily activities (specific examples)
Pain and Function: What You Can’t Do
Social Security isn’t just asking whether you have pain. They’re asking whether your pain prevents you from working.
Explain how pain affects:
- Standing and walking (how long before pain forces you to sit?)
- Sitting (do you need to shift positions frequently?)
- Lifting and carrying (what’s the most you can lift?)
- Concentration and focus (does pain make it hard to concentrate?)
- Sleep (is pain affecting your sleep? How many hours do you get?)
Be honest and specific. Give concrete examples from daily life.
Instead of: “I can’t do much around the house anymore.”
Try: “I used to do all our grocery shopping, but now my spouse has to go because I can’t stand long enough to get through the store. I have to sit down multiple times, and I can’t lift anything heavier than a gallon of milk. It takes me twice as long to do dishes because I have to take breaks. I can’t vacuum at all because the pushing and bending aggravate my back too much.”
Good Days vs. Bad Days
Most people with chronic pain don’t hurt the same amount every day. Don’t hide this. Explain it.
“On a good day, my pain is around a 5 out of 10. I can do basic things if I take frequent breaks. But even on good days, I can’t stand for more than 20-30 minutes.
On bad days, which happen at least 2-3 times per week, my pain is 8-9 out of 10. I can barely get out of bed. I can’t cook or clean. I spend most of the day lying down. These flare-ups last anywhere from a day to a week.”
This is credible because it’s realistic. It acknowledges you have better days, but makes clear that even good days involve significant limitations, and bad days are frequent and severe.
Supporting Evidence
Your Activities of Daily Living (ADL) form is critical for pain claims. Social Security looks at whether your reported pain is consistent with your daily activities.
Be thorough on your ADL form. Explain what tasks you can’t do, describe tasks that take longer or require rest breaks, mention help you need from family, note assistive devices you use, and describe how pain affects sleep, personal care, and social activities.
The key is consistency. What you tell Social Security needs to match what you tell doctors and what’s in your medical records.
Third-party statements from people who know you well can strengthen a pain claim. Your spouse, adult children, or friends can write about what you were like before vs. now, activities you can no longer do, how often they see you struggling, help they provide, and specific examples of you having to stop activities due to pain.
Common Questions
Q: My pain is real, but I don’t have much objective evidence. Can I still win?
A: It’s harder, but not impossible. Focus on building the strongest case with what you have. See doctors regularly, follow all treatment recommendations, be specific and consistent about symptoms, and consider getting evaluations from specialists.
Q: My doctor doesn’t believe my pain is as bad as it is. What should I do?
A: If your doctor is skeptical, that will be documented and hurt your case. Consider getting a second opinion. You need doctors who take your complaints seriously and document them appropriately.
Q: Will my pain claim be stronger if I’ve had surgery?
A: Not necessarily. Surgery is objective evidence of a serious problem, but if the surgery was successful and your pain improved significantly, that might actually hurt your claim. What matters is your current level of pain and limitation.
How a Representative Helps
Pain claims are some of the toughest cases, but they’re where my experience really makes a difference. When I review a pain case, I’m looking for gaps in treatment, inconsistencies between what you’re reporting and what’s documented, missing evidence like undocumented side effects, and ways to strengthen your testimony.
At your hearing, I help you present your case credibly by being consistent with medical records, giving specific examples instead of vague generalizations, acknowledging good days while making clear even those involve limitations, and explaining any treatment gaps.
Building Your Pain Case the Right Way
Chronic pain is a legitimate basis for disability, but you need to build a credible case.
That means regular medical treatment with documented conditions causing your pain, following treatment recommendations or documenting why you can’t, being specific and consistent about pain and its effects, making sure medication side effects are documented, showing how pain limits daily functioning, and having corroborating evidence from third parties.
If you’re dealing with chronic pain and thinking about applying for disability, let’s talk. Give me a call at 417-812-6698 or schedule a free consultation. I’ll review your situation, identify weaknesses, and help you develop a strategy to get the benefits you deserve.
