is associated with greater pain and resistance to treatment. A meta-analysis1
of 32 studies, nearly 4000 patients and a similar number of controls, showed a
highly significant effect of litigation on pain severity and prognosis. This study,
mainly of chronic low back pain, echoes the greater abnormality and disability
seen in Mild Traumatic Brain Injury with financial
incentive (Medical Litigation News Volume 2, Issue 1).
from the United States documents both a surge in fraudulent claims for
chronic pain and a capriciously wide range of jury awards for comparable
pain and suffering with no objective findings.
POINT Compensation adversely affects severity
and prognosis of chronic pain|
contrast, 98% of patients referred for treatment of chronic pain
were given a diagnosis of organic origin after multidisciplinary clinical
assessment and exhaustive investigation3.
They were seen by between two and 9 (average 3-4) specialists, and routinely underwent
such investigations as Electromyography (EMG), Magnetic Resonance Imaging
(MRI), Computed Tomography (CT), diagnostic nerve blocks and
measurements of regional blood flow in different positions. The most frequent
new diagnoses were Nerve Entrapment, Temporomandibular Joint (TMJ)
pain, Thoracic Outlet Syndrome and Spinal Stenosis.
POINT Multidisciplinary assessment and fuller
investigation have led to organic diagnoses in almost all patients with a previous
diagnosis of chronic pain|
Are psychological treatments
of chronic pain and insomnia effective? A multidisciplinary medical panel weighed
the evidence4. There was strong
empirical support for various relaxation techniques in many types of chronic
pain, and for hypnosis in cancer pain, but only moderate evidence for cognitive-behavioural
and biofeedback treatment. Relaxation and biofeedback techniques
improved some aspects of sleep, but effects on sleep onset and total sleep time
were of doubtful clinical benefit.
POINT When considering costs for specific psychological
treatments of chronic pain, use the new estimates of efficacy|
Copyright © 2008 Electronic Handbook of Legal Medicine