Association between workers' compensation and outcome following multidisciplinary treatment for chronic pain: roles of mediators and moderators.
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.


METHODS
Outcome study based on archives.


METHODS
Multidisciplinary pain treatment center.


METHODS
Of 214 patients, 158 had complete data.


METHODS
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.
Burns
J W
JW
Finch University of Health Sciences, Chicago Medical School, North Chicago, IL 60064, USA.
Sherman
M L
ML
Devine
J
J
Mahoney
N
N
Pawl
R
R
D000328:Adult; D001290:Attitude; D002908:Chronic Disease; D003131:Combined Modality Therapy; D004185:Disability Evaluation; D006801:Humans; D007348:Insurance, Health; D009784:Occupational Diseases / Q000523:psychology / Q000628:therapy*; D010146:Pain / Q000523:psychology; D018710:Pain Clinics; D059408:Pain Management; D010147:Pain Measurement; D016896:Treatment Outcome