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Association between workers' compensation and outcome following multidisciplinary treatment for chronic pain: roles
J W Burns1, M L Sherman, J Devine
1Finch University of Health Sciences, Chicago Medical School, North Chicago, IL 60064, USA.
Objective:
To determine whether the tendency for chronic pain patients who receive Workers' Compensation to show a poorer response than non-compensated patients to pain treatment can be accounted for by mediating factors; to assess whether moderating factors can distinguish subgroups of Workers' Compensation recipients who react very poorly to treatment from compensated patients who respond well.
Design:
Outcome study based on archives.
Setting:
Multidisciplinary pain treatment center.
Patients:
Of 214 patients, 158 had complete data.
Outcome Measure:
Blind ratings of narrative discharge summaries written by the Pain Treatment Center staff.
Results:
A significant negative relationship between receiving Workers' Compensation and outcome was mediated by a pessimistic belief in the ability to return to former occupation. Moderator effects showed that Workers' Compensation recipients with high initial pain and a history of pain-related surgery fared worse than any other group. Moreover, Workers' Compensation recipients not characterized by high pain and a history of surgery responded as well as noncompensated patients.
Conclusions:
The inadequate response to pain programs shown by Workers' Compensation recipients may be partly understood in terms of well-defined mediating factors, which may admit to amelioration via clinical intervention. Moreover, Workers' Compensation patients should not be considered high risks for failure by sole virtue of their compensation status. Multifactor assessment methods may be needed to identify that portion of compensation recipients who are actually at appreciable risk for treatment failure so that appropriate adjustments in treatment regimen may be made.