The Influence of Compensation on Pain Treatment Outcome
According to a report from The Royal Australasian College of Physicians, published in 2001, “although most people who have compensable injuries recover well, a greater percentage of these people have poorer health outcomes than do those with similar but non-compensable injuries”. This has been shown, in particular, to apply to conditions in which pain is a major symptom.
A systematic review of the influence of compensation on surgical outcome, published in 2005, examined 211 studies, and found that “compensation status is associated with poor outcome after surgery. This effect is significant, clinically important, and consistent”.
Numerous studies have shown that the same is true for conservative treatment of a variety of work-related musculoskeletal injuries. A small number of published reports have demonstrated that structured treatment programmes for injured workers can improve the return-to-work rate.
A recent Australian review, undertaken for the South Australian WorkCover Corporation, concluded that “Work disability and return-to-work are multi-determined outcomes that cannot be accurately predicted just from knowledge of the medical or physical dimensions of the injury or condition. On the contrary, a very wide range of determinants of return-to-work have been identified in the research reviewed”. Among these “determinants” the authors have included “the insurance or workers’ compensation scheme and … the prevailing legal framework”.
Qualitative research undertaken by Lynette Guy at the WorkCover Research Centre of Excellence, School of Health Sciences, Newcastle University, (and earlier at the School of Public Health, Griffith University) has indicated that “losing control, remaining helpless and dependent on others, or becoming intent on revenge and validation of their pain and suffering” were all associated with failure of rehabilitation following a musculoskeletal injury and onset of persistent pain.
This presentation will review the various factors that influence treatment outcome following a compensable injury. Chronic pain is the most frequent reason for prolonged absence from work, and – as noted above - it is recognised that recipients of workers’ compensation and litigants have worse outcomes from both conservative and surgical treatments than those who are not receiving compensation benefits or involved in litigation.
The challenge for health care professionals working in this field is how to minimise the adverse influences following compensable injuries that promote prolonged disability and, conversely, how to maximise those factors that allow injured workers to maintain or regain a sense of independence and control over their lives.
References
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Guy L. “If only they (the employer) would pick up the phone & show you that they care”: The role of social support in determining successful recovery from workplace injury. (Personal communication, December 2006.)
Guy L, Short SD. Rehabilitation of workers with musculoskeletal injury and chronic pain. Health Sociology Review 2005; 14: 77-83.
Harris I, et al. Association between compensation status and outcome after surgery. A meta-analysis. JAMA 2005; 293: 1644-52.
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Mendelson G. Compensation and motivation in relation to musculo-skeletal pain. IN Vaeroy H, Merskey H (Eds). Progress in Fibromyalgia and Myofascial Pain. Amsterdam: Elsevier Science Publishers, 1993, pp. 101-112.
Mendelson G. Psychiatric aspects of litigation and pain. IN Schmidt RF, Willis WD (Eds): Encyclopedia of Pain, Heidelberg: Springer-Verlag, 2007, pp. 1998-2003.
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The Royal Australasian College of Physicians. Compensable Injuries and Health Outcomes. Sydney: RACP, 2001.
Watson PJ, et al. Returning the chronically unemployed with low back pain to employment. European Journal of Pain 2004; 8:359-69.
Wiesel SW, Feffer HL, Rothman RH. Industrial low-back pain: a prospective evaluation of a standardized diagnostic and treatment protocol. Spine 1984; 9: 199-203.
Time of Presentation
1330
