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Perception of traumatic onset, compensation status, and physical findings: Impact on pain severity, emotional distress, and disability in chronic pain patients

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Abstract

The primary purposes of the present study were to investigate the roles of physical findings, financial compensation, and types of pain onset (i.e., trauma vs. insidious onset) on adaptation by chronic pain patients. Comparisons between patients who were receiving or seeking compensation and those who were not revealed that, despite comparable degrees of physical findings, the compensation status was associated with reports of (a) more severe pain, (b) greater disability, (c) higher levels of emotional distress, and (d) greater life interference. The compensation status of 74% of the patients was correctly classified by combination of pain severity, perceived disability, and life interference. Objective indices of physical findings didnot significantly improve classification accuracy. In order to eliminate the possible confound of compensation, analyses of the relationship between the types of onset and chronic pain were conducted only for a subset of patients who were not receiving or actively seeking compensation. The results indicated that the patients who attributed their pain to a specific trauma reported significantly higher levels of emotional distress, life interference, and higher levels of pain severity than did the patients who indicated that their pain had an insidious or spontaneous onset, regardless of the extent of objective physical findings.

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References

  • Allodi, F. A. (1974). Accident neurosis: Whatever happened to male hysteria?Can. Psychiat. Assoc. J. 19: 291–296.

    Google Scholar 

  • American Psychiatric Association (1994).Diagnostic and Statistical Manual of Mental Disorders, 4th ed., American Psychiatric Association, Washington, DC.

    Google Scholar 

  • Chibnall, J. T., and Duckro, P. N. (1994). Posttraumatic stress disorder in chronic posttraumatic headache patients.Headache 34: 357–361.

    PubMed  Google Scholar 

  • Cioffi, D. (1991). Beyond attentional strategies: A cognitive-perceptual model of somatic interpretation.Psychol. Bull. 109: 25–41.

    PubMed  Google Scholar 

  • Cohen, J. (1988).Statistical Power Analysis for the Behavioral Sciences, 2nd ed., Lawrence Erlbaum, Hillsdale, NJ.

    Google Scholar 

  • Deyo, R. A. (1986). Comparative validity of the Sickness Impact Profile and shorter scales for functional assessment in low-back pain.Spine 11: 951–954.

    PubMed  Google Scholar 

  • Dworkin, R. H., Handlin, D. S., Richlin, D. M., Brand, L., and Vannucci, C. (1985). Unraveling the effects of compensation, litigation, and employment on treatment response in chronic pain.Pain 23: 49–59.

    PubMed  Google Scholar 

  • Fairbank, J. C. T., Mboat, J., Davies, J. B., and O'Brien, J. P. (1980). The Oswestry low back pain disability questionnaire.Physiotherapy 66: 271–273.

    PubMed  Google Scholar 

  • Flor, H., and Turk, D. C. (1988). Chronic back pain and rheumatoid arthritis: Predicting pain and disability from cognitive variables.J. Behav. Med. 11: 251–265.

    PubMed  Google Scholar 

  • Flor, H., Kerns, R. D., and Turk, D. C. (1987). The role of spouse reinforcement, perceived pain, and activity levels of chronic pain patients.J. Psychosom. Res. 31: 251–259.

    PubMed  Google Scholar 

  • Gallagher, R. M., Raugh, V., Haugh, L., Milhous, R., Callas, P., Langelier, R., and Frymoyer, J. (1989). Determinants of return to work in low back pain.Pain 39: 55–68.

    PubMed  Google Scholar 

  • Gallagher, R. M., Williams, R. A., Skelly, J., Haugh, L. D., Rauh, V., Milhous, R., and Frymoyer, J. (1995). Workers' compensation and return-to-work in low back pain.Pain 61: 299–307.

    PubMed  Google Scholar 

  • Greenfield, S., Fitzcharles, M. A., and Esdaile, J. M. (1992). Reactive fibromyalgia syndrome.Arth. Rheum. 35: 678–681.

    Google Scholar 

  • Greenough, C. G., and Fraser, R. D. (1989). The effect of compensation on recovery from low back injury.Spine 14: 947–955.

    PubMed  Google Scholar 

  • Guest, G. H., and Drummond, P. D. (1992). Effect of compensation on emotional state and disability in chronic back pain.Pain 48: 125–130.

    PubMed  Google Scholar 

  • Hair, J. F., Jr., Anderson, R. E., Tatham, R. L., and Black, W. C. (1992).Multivariate Data Analysis with Readings, 3rd ed., Macmillan, New York.

    Google Scholar 

  • Hickling, E. J., Blanchard, E. B., Silverman, D. J., and Schwarz, S. P. (1992). Motor vehicle accidents, headaches and post-traumatic stress disorder: Assessment findings in a consecutive series.Headache 32: 147–151.

    PubMed  Google Scholar 

  • Hodge, J. R. (1971). The whiplash neurosis.Psychosomatics 12: 245–249.

    PubMed  Google Scholar 

  • Jones, I. H., and Riley, W. T. (1987). The post-accident syndrome: Variations in the clinical picture.Aust. N.Z. J. Psychiat. 221: 560–567.

    Google Scholar 

  • Kerns, R. J., Turk, D. C., and Rudy, T. E. (1985). The West Haven-Yale Multidimensional Pain Inventory (WHYMPI).Pain 23: 345–356.

    PubMed  Google Scholar 

  • Leavitt, F. (1990). The role of psychological disturbance in extending disability time among compensable back injured industrial workers.J. Psychosom. Res. 34: 447–453.

    PubMed  Google Scholar 

  • Lenthem, J., Slade, P. O., Troup, J. P. G., and Bentley, G. (1983). Outline of a fear-avoidance model of exaggerated pain perception.Behav. Res. Ther. 21: 401–408.

    PubMed  Google Scholar 

  • Malt, U. (1988). The long-term psychiatric consequences of accidental injury: A longitudinal study of 107 adults.Br. J. Psychiat. 153: 810–818.

    Google Scholar 

  • Malt, U. F., Blikra, G., and Hoivik, B. (1989). The three-year biopsychosocial outcome of 551 hospitalized accidentally injured adults.Acta Psychiat. Scand. 80 (Suppl. 355): 84–93.

    Google Scholar 

  • Melzack, R., Katz, J., and Jeans, M. E. (1985). The role of compensation in chronic pain: Analysis using a new method of scoring the McGill Pain Questionnaire.Pain 23: 101–112.

    PubMed  Google Scholar 

  • Mendelson, G. (1984). Compensation, pain complaints, and psychological disturbance.Pain 20: 169–177.

    PubMed  Google Scholar 

  • Miller, H. (1961). Accident neurosis.Br. Med. J. 1: 919–925.

    Google Scholar 

  • Naliboff, B. D., Cohen, M. J., and Yellin, A. N. (1983). Frequency of MMPI profile types in three chronic illness populations.J. Clin. Psychol. 39: 843–847.

    PubMed  Google Scholar 

  • Osterweis, M., Kleinman, A., and Mechanic, D. (1987).Pain and disability: Clinical, Behavioral, and Public Policy Perspectives, National Academy Press, Washington, DC.

    Google Scholar 

  • Radloff, L. S. (1977). The CES-D scale: A self-report depression scale for research in the general population.Appl. Psychol. Meas. 1: 385–392.

    Google Scholar 

  • Rudy, T. E. (1993).User's Manual: MEDICS Microcomputer Program, Pain Evaluation and Treatment Institute, University of Pittsburgh, Pittsburgh.

    Google Scholar 

  • Rudy, T. E., Turk, D. C., and Brena, S. F., (1988). Differential utility of medical procedures in the assessment of chronic pain patients.Pain 34: 53–60.

    PubMed  Google Scholar 

  • Rudy, T. E., Turk, D. C., Brena, S. F., Stieg, R. L., and Brody, M. C. (1990). Quantification of biomedical findings of chronic pain patients: Development of an index of pathology.Pain 42: 167–182.

    PubMed  Google Scholar 

  • Sander, R. A., and Myers, J. E. (1986). The relationship of disability to compensation status in railroad workers.Spine 11: 141–143.

    PubMed  Google Scholar 

  • Sivik, T. M., and Delimar, D. (1994). Charactristics of patients who attribute chronic pain to minor injury.Scand. J. Rehabil. Med. 26: 27–31.

    PubMed  Google Scholar 

  • Skelton, J. A., and Pennebaker, J. W. (1982). The psychology of physical symptoms and sensations. In Sanders, G., and Suls, J. (eds.),The Social Psychology of Health and Illness, Lawrence Erlbaum, Hillsdale, NJ.

    Google Scholar 

  • Tabachnick, B. G., and Fidell, L. S. (1989).Using Multivariate Statistics, 2nd ed., Harper & Row, New York.

    Google Scholar 

  • Talo, S., Hendler, N., and Brodie, J. (1989). Effects of active and completed litigation on treatment results: Workers' compensation patients compared with other litigation patients.J. Occup. Med. 31: 265–269.

    PubMed  Google Scholar 

  • Tollison, C. D. (1993). Compensation status as a predictor of outcome in nonsurgically treated low back injury.South. Med. J. 86: 1206–1209.

    PubMed  Google Scholar 

  • Trabin, T., Rader, C., and Cummings, C. (1987). A comparison of pain management outcome for disability compensation and noncompensation patients.Psychol. Health 1: 341–351.

    Google Scholar 

  • Tsushima, W. T., and Stoddard, V. M. (1990). Ethnic group similarities in the biofeedback treatment of pain.Med. Psychother. 3: 69–75.

    Google Scholar 

  • Turk, D. C., and Okifuji, A. (1994). Detecting depression in chronic pain patients: Adequacy of self-reports.Behav. Res. Ther. 32: 9–16.

    PubMed  Google Scholar 

  • Turk, D. C., and Rudy, T. E. (1988). Robustness of an empirically derived taxonomy of chronic pain patients.Pain 43: 27–36.

    Google Scholar 

  • Turk, D. C., Rudy, T. E., and Stieg, R. L. (1988). Disability determination dilemma: Toward a multiaxial solution.Pain 34: 217–230.

    PubMed  Google Scholar 

  • Vidman, T., Rauhala, H., and Asp, S. (1989). Patient-handling skills, back injuries and back pain: An intervention study in nursing.Spine 14: 148–156.

    PubMed  Google Scholar 

  • Waddell, G. (1987). Clinical assessment of lumbar impairment.Clin. Orthopaed. 221: 110–120.

    Google Scholar 

  • Watson, D. (1982). Neurotic tendencies among chronic pain patients: An MMPI item analysis.Pain 14: 365–385.

    PubMed  Google Scholar 

  • Weighill, V. E. (1983). Compensation neurosis: A review of the literature.J. Psychosom. Res. 27: 97–104.

    PubMed  Google Scholar 

Download references

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Turk, D.C., Okifuji, A. Perception of traumatic onset, compensation status, and physical findings: Impact on pain severity, emotional distress, and disability in chronic pain patients. J Behav Med 19, 435–453 (1996). https://doi.org/10.1007/BF01857677

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