Melzack Ronald, Katz Joel, Jeans Mary Ellen
Department of Psychology, McGill University, Montreal, Que. H3A 1B1 Canada.
Pain. 1985 Oct;23(2):101-112. doi: 10.1016/0304-3959(85)90052-1.
Patients who receive worker's compensation or are awaiting litigation after an accident have long been regarded as neurotics or malingerers who are exaggerating their pain for financial gain. However, there is a growing body of evidence that patients who receive worker's compensation are no different from patients who do not. In particular, a recent study found no differences between compensation and non-compensation patients based on pain scores obtained with the McGill Pain Questionnaire (MPQ). Since the MPQ is usually scored by using rank values rather than more complex scale values, the negative finding might be attributable to the loss of information by using rank values. Consequently, a simple technique was developed to convert rank values to weighted-rank values which are equivalent to scale values. A study of 145 patients suffering low-back and musculoskeletal pain revealed that compensation and non-compensation patients had virtually identical pain scores and pain descriptor patterns. They were also similar on the MMPI pain triad (depression, hysteria, hypochondriasis) and on several other personal that were examined. The only differences were significantly lower affective or evaluative MPQ scores and fewer visits to health professionals by compensation patients compared to non-compensation patients. These results suggest that the financial security provided by compensation decreases anxiety, which is reflected in the lower affective or evaluative ratings but not the sensory or total MPQ scores. Compensation patients, contrary to traditional opinion, appear not to differ from people who do not receive compensation. Accidents which produce injury and pain should be considered as potentially psychologically traumatic as well as conducive to the development of subtle physiological changes such as trigger points. Patients on compensation or awaiting litigation deserve the same concern and compassion as all other patients who suffer chronic pain.
长期以来，接受工伤赔偿或在事故后等待诉讼的患者一直被视为神经质或装病者，他们为了经济利益而夸大自己的疼痛。然而，越来越多的证据表明，接受工伤赔偿的患者与未接受赔偿的患者并无不同。特别是，最近一项研究发现，根据麦吉尔疼痛问卷（MPQ）获得的疼痛评分，赔偿患者和未赔偿患者之间没有差异。由于MPQ通常使用等级值而非更复杂的量表值进行评分，这一负面结果可能归因于使用等级值导致的信息损失。因此，开发了一种简单的技术，将等级值转换为等同于量表值的加权等级值。一项对145名患有腰背部和肌肉骨骼疼痛的患者的研究表明，赔偿患者和未赔偿患者的疼痛评分和疼痛描述模式几乎相同。他们在明尼苏达多相人格调查表（MMPI）疼痛三联症（抑郁、癔症、疑病症）以及其他一些接受检查的个人特征方面也相似。唯一的差异是，与未赔偿患者相比，赔偿患者的情感或评价性MPQ评分显著更低，就诊次数更少。这些结果表明，赔偿提供的经济保障降低了焦虑，这反映在较低的情感或评价性评分上，而非感觉或MPQ总分上。与传统观点相反，赔偿患者似乎与未获得赔偿的人没有区别。造成伤害和疼痛的事故应被视为不仅可能导致心理创伤，还可能引发细微的生理变化，如触发点的形成。接受赔偿或等待诉讼的患者应得到与所有其他慢性疼痛患者相同的关注和同情。
