Dworkin Robert H, Handlin David S, Richlin David M, Brand Leonard, Vannucci Charlene
Department of Anesthesiology, Columbia University College of Physicians and Surgeons, New York, NY 10032 U.S.A. Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY 10032 U.S.A. Department of Anesthesiology, Monmouth Medical Center, Long Branch, NJ 07740 U.S.A. Department of Anesthesiology, Mount Sinai School of Medicine, New York, NY 10029 U.S.A.
Pain. 1985 Sep;23(1):49-59. doi: 10.1016/0304-3959(85)90229-5.
Although it has often been suggested that chronic pain patients who are receiving workmen's compensation or who have litigation pending are less likely to benefit from treatment, the results of outcome studies of this question conducted by various pain clinics have been inconsistent. We hypothesized that poorer outcome in such patients may be related to the fact that they are less likely to be working and that the inconsistent results in the literature may therefore be explained by variability among studies in the percentages of patients who are receiving compensation (or who have litigation pending) who are also working. We examined the relationships among compensation, litigation, employment, and short- and long-term treatment response in a series of 454 chronic pain patients. Compensation benefits and employment status both predicted poorer short-term outcome in univariate analyses; however, when employment and compensation were jointly used to predict outcome in multiple regression analyses, only employment was significant. In additional analyses, only employment significantly predicted long-term outcome, whereas compensation and litigation did not. Our results suggest that it would be valuable to redirect attention away from the deleterious effects of the 'compensation neurosis' and toward the roles of activity and employment in the treatment and rehabilitation of chronic pain patients.
尽管人们常常认为，正在领取工伤赔偿或有诉讼待决的慢性疼痛患者从治疗中获益的可能性较小，但各疼痛诊所针对这一问题开展的疗效研究结果并不一致。我们推测，这类患者较差的治疗效果可能与他们工作可能性较低这一事实有关，因此文献中结果不一致的情况或许可以通过各研究中正在领取赔偿（或有诉讼待决）且仍在工作的患者比例存在差异来解释。我们在一组454例慢性疼痛患者中研究了赔偿、诉讼、就业与短期和长期治疗反应之间的关系。在单变量分析中，赔偿福利和就业状况均预示着较差的短期治疗效果；然而，在多元回归分析中，当将就业和赔偿共同用于预测治疗效果时，只有就业具有显著意义。在进一步分析中，只有就业显著预示着长期治疗效果，而赔偿和诉讼则不然。我们的结果表明，将注意力从“赔偿神经症”的有害影响转移到活动和就业在慢性疼痛患者治疗及康复中的作用上是有价值的。
