Twiddy Hannah, Brown Richard J, Waheed Hasan
Pain Management Programme, The Walton Centre NHS Foundation Trust, Liverpool, UK.
Manchester Academic Health Science Centre and School of Health Sciences, The University of Manchester, Manchester, UK.
Br J Pain. 2019 May;13(2):99-105. doi: 10.1177/2049463718820056. Epub 2018 Dec 18.
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 multi-disciplinary pain management programme (PMP) when compared with those without litigation.
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.
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.
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.
在诉讼背景下评估慢性疼痛并考虑其对医疗结果和康复进程的影响方面，已有广泛研究。本文旨在呈现回顾性观察数据，内容涉及参与英国多学科疼痛管理项目（PMP）的正在进行诉讼的患者在项目开始时及之后报告的残疾和痛苦水平，并与未参与诉讼的患者进行比较。
2014年6月至2017年9月期间，859名患者在英国一家三级国民健康服务疼痛诊所参加并完成了为期16天的PMP。患者被分为两组：（1）诉讼组（n = 110）和（2）非诉讼组（n = 749）。作为评估程序的一部分，患者在两个时间点接受了一系列心理和身体测量。
与非诉讼样本相比，诉讼患者在评估时的痛苦程度在统计学上显著更高，但在PMP干预中实现了具有临床意义的可比变化。治疗后抑郁评分差异中仅有极小比例（0.5%）可由诉讼背景解释，这可能由就业状况导致。诉讼对干预后的身体结果没有影响。
本文得出结论，仅仅假设诉讼背景会导致PMP后心理和身体方面的积极结果有限是不合适的。就这些结论而言，所呈现的临床样本存在一些局限性。
