Article: Chronic Pain 1995-6 - Medical Litigation News

CHRONIC PAIN

Compensation 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).

PRACTICE POINT Compensation adversely affects severity and prognosis of chronic pain

Another paper² 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.

PRACTICE POINT Multidisciplinary assessment and fuller investigation have led to organic diagnoses in almost all patients with a previous diagnosis of chronic pain

In 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.

PRACTICE POINT When considering costs for specific psychological treatments of chronic pain, use the new estimates of efficacy

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.