Psychological Factors Influencing Chronic Pain and the Impact of Litigation

Abstract

Understanding chronic pain requires an understanding of psychological factors related to the pain experience. This paradigm is the standard foundation for pain medicine as well as physical medicine and rehabilitation diagnosis and treatment. Pain patients with spine disease frequently present with a multifaceted array of physical and psychological aspects including depression, anxiety, traumatic stress, cognitive dysfunction, a potential for substance abuse, and regressed social functioning. An evolving standard of care mandates that prior to invasive pain therapies for spinal pain psychological suitability be determined. Spine pain disorders in the context of ongoing litigation present complex clinical situations which cannot be managed by medical treatments alone. The litigation will add stress and disruption to the medical diagnosis and treatment. The biopsychosocial model with inclusion of clinical psychologists as members of the treatment team is essential. This review will consider the important factors essential for a best practice approach to management of the spine pain patient with coexisting litigation.