Involvement in compensation litigation and outcome from an online pain management program

Objective: To report on the effect of involvement in civil litigation on outcome for patients enrolled in a validated Internet-delivered pain management program, the Pain Course. Research Method: Data from a randomized controlled trial (RCT) on the effect of varying levels of clinician support was used to examine the effect of involvement in civil litigation on outcome in a free online pain management course. Outcome measures were changes in scores on self-report questionnaires for depression, anxiety, and disability (PHQ-9, GAD-7, and RMDQ) from baseline to 3-month follow-up for those still involved in litigation and those who had completed litigation, compared with outcomes for those who did not report involvement in litigation. The use of regular and as-required opioid medication at assessment and follow-up were also compared. Results: Of the 397 patients enrolled in the pain course, 290 (73.0%) were not involved in litigation, 80 (20.2%) reported involvement in litigation that had been resolved and 27 (6.8%) reported ongoing litigation. Those still involved in litigation had the highest scores on depression scales and the highest rate of opioid use. The completion rates and symptom improvement was lower among current litigants but were still positive, with effect sizes on the outcome measures of between 0.56 and 0.73, as well as a reduction in the use of opioids. Conclusions: Current involvement in compensation litigation was associated with lower treatment completion and less symptom improvement. Nevertheless, the positive findings have significant implications for people involved in workers' compensation and other litigation who report pain as one of their symptoms.