Assessing benefits of the pain center: why some patients regress.

Pain centers meet success in dealing with many cases of chronic pain which had been refractory to other therapies. Unfortunately, about one-fourth of all patients who initially do well begin to deteriorate shortly after completion, and within a few months have regressed to pre-treatment levels. In an effort to understand the causes of this regression, the authors surveyed patients who completed the program in 1977 by means of mail questionnaire. The 25 most successful patients were contrasted with an equal cohort of failures (i.e., patients who had met with initial success and subsequent regression). Correlations were also performed among indices of change and other variables. The failure group demonstrated less incentive for maintaining their gains, most continuing to receive financial compensation for their pain. Differences in attitude were revealed, with the failure group more likely to assume a dependent, passive stance. Depression was more characteristic of the failure group and may be causative with respect to deterioration. Most strinkingly, it appeared that the failure group had done little to change their environments, and continued to find reinforcement for pain behavior following discharge. The survey suggests the need for changes in the area of employment for injured workers, as well as further research in attitude measurement and attitude change. More aggressive treatment of depression might reduce the tendency toward regression, as would increased effort to change family dynamics that reward the patient for overt suffering.