The context of litigation in evaluating physical and psychological outcomes from pain management programmes

Abstract

Objectives: There has been extensive research in evaluating chronic pain in the context of litigation while considering the implications that it can have on healthcare outcomes and rehabilitation progress. The aim of this article is to present retrospective observational data about the levels of disability and distress reported by patients with ongoing litigation at the start and following a UK-based multidisciplinary pain management programme (PMP) when compared with those without litigation. Method: Between June 2014 and September 2017, 859 patients attended and completed a 16-day PMP at a tertiary-level National Health Service (UK) pain clinic. Patients were split into two groups: (1) litigation (n = 110) and (2) non-litigation (n = 749). As a part of the assessment procedure, the patients were given a battery of psychological and physical measures to complete over two time points. Results: Patients with litigation are statistically significantly more distressed at assessment but make comparable clinically meaningful change in PMP intervention when compared with a non-litigation sample. A very small proportion of the variance in depression scores post-treatment is accounted for by the context of litigation (0.5%), which may be accounted for by employment status. There was no effect of litigation on physical outcome post-intervention. Discussion: This article concludes that it is not appropriate to merely assume that the context of litigation results in limited positive psychological and physical outcomes post-PMP. There are some limitations to the clinical sample presented in respect to the conclusions.

Effects of seeking compensation on the psychological health and recovery of injured patients: the role of stress vulnerability and injury-related disability

“…Our analyses support and strengthen these findings. Unlike past studies that found psychological factors to partially (Giummarra et al, 2017a; Grant et al, 2014; O'Donnell et al, 2015; Twiddy et al, 2018) or fully (Giummarra et al, 2017b) mediate long-term psychological and recovery outcomes in compensation groups, our analyses indicate that long-term psychological distress associated with compensation is better explained by the concurrent level of functioning and disability. In other words, it is the injury-related disability and vulnerability that best explains any detrimental effect to psychological health, and not the compensation process itself.…”

“…Similar to our findings, most studies consistently found poorer health, mainly psychological health, in compensation groups at all time points (Elbers et al, 2013; Murgatroyd et al, 2016; Twiddy et al, 2018), while some recovery does occur over time (Elbers et al, 2013; Murgatroyd et al, 2016; Twiddy et al, 2018). Rates of recovery, however, varied across studies, being lower (Elbers et al, 2013), or similar to non-compensation groups (Twiddy et al, 2018). These inconsistencies could reflect selection biases, that is, differences in pre-injury and injury characteristics and other sources of heterogeneity (Elbers et al, 2013; Spearing et al, 2012b; Twiddy et al, 2018).…”

“…The above conclusion, however, was questioned (Spearing & Connelly, 2011; Spearing et al, 2012a) given it could be attributable to poorer pre-existing psychological health. Those few studies that have addressed reverse causality suggested a circular, possibly cumulative, relationship exists between compensation and health, prior to and post-claim (Elbers et al, 2013; Grant et al, 2014; Twiddy, Brown, & Waheed, 2018), but failed to provide convincing evidence. We believe our study provides this evidence and addresses previous gaps in knowledge in this area.…”

“…Multiple studies have found significant differences exist between injured people with and without a claim (Elbers et al, 2013; Giummarra et al, 2013, 2016; Murgatroyd et al, 2015b, 2016; Twiddy et al, 2018). Similar to our findings, most studies consistently found poorer health, mainly psychological health, in compensation groups at all time points (Elbers et al, 2013; Murgatroyd et al, 2016; Twiddy et al, 2018), while some recovery does occur over time (Elbers et al, 2013; Murgatroyd et al, 2016; Twiddy et al, 2018). Rates of recovery, however, varied across studies, being lower (Elbers et al, 2013), or similar to non-compensation groups (Twiddy et al, 2018).…”

“…Rates of recovery, however, varied across studies, being lower (Elbers et al, 2013), or similar to non-compensation groups (Twiddy et al, 2018). These inconsistencies could reflect selection biases, that is, differences in pre-injury and injury characteristics and other sources of heterogeneity (Elbers et al, 2013; Spearing et al, 2012b; Twiddy et al, 2018).…”