ASSOCIATION BETWEEN WORKERS COMPENSATION AND OUTCOME FOLLOWING MULTIDISCIPLINARY TREATMENT FOR CHRONIC PAIN - ROLES OF MEDIATORS AND MODERATORS

Objective: To determine whether the tendency for chronic pain patients who receive Workers' Compensation to show a poorer response than nonc ompensated patients to pain treatment can be accounted for by mediatin g factors; to assess whether moderating factors can distinguish subgro ups of Workers' Compensation recipients who react very poorly to treat ment from compensated patients who respond well. Design: Outcome study based on archives. Setting: Multidisciplinary pain treatment center. Patients: Of 214 patients, 158 had complete data. Outcome Measure: Bli nd ratings of narrative discharge summaries written by the Pain Treatm ent Center staff. Results: A significant negative relationship between receiving Workers' Compensation and outcome was mediated by a pessimi stic belief in the ability to return to former occupation. Moderator e ffects showed that Workers' Compensation recipients with high initial pain and a history of pain-related surgery fared worse than any other group. Moreover, Workers' Compensation recipients not characterized by high pain and a history of surgery responded as well as noncompensate d patients. Conclusions: The inadequate response to pain programs show n by Workers' Compensation recipients may be partly understood in term s of well-defined mediating factors, which may admit to amelioration v ia clinical intervention. Moreover, Workers' Compensation patients sho uld not be considered high risks for failure by sole virtue of their c ompensation status. Multifactor assessment methods may be needed to id entify that portion of compensation recipients who are actually at app reciable risk for treatment failure so that appropriate adjustments in treatment regimen may be made.