Pain clinic management of medico-legal litigants

Abstract

A preliminary study was undertaken to determine the relationship between a patient's compensation claim and their management in pain clinics. Fifty consecutive patients with compensation claims and undergoing treatment in local pain clinics were selected from the senior author's medico-legal practice. An initial postal survey of UK pain clinics was undertaken to establish the percentage of patients in pain clinics with musculo-skeletal pain and also what proportion of clinics enquire as to the litigation status of their patients. Medical reports available from both plaintiff and defence were reviewed together with the hospital's and general practitioner's notes. Musculo-skeletal pain contributes on average 55 per cent of the pain clinic workload and the majority of pain clinics establish the litigation status of their patients. Of the patient series, the senior author assessed 98 per cent as having exaggerated disability, the local non-pain clinics identified exaggerated symptoms in 44 per cent and 20 per cent were proven to be malingering via covert video evidence. The results suggest that many patients with compensation claims seek to cloak inappropriate symptomatology with verification and medical support in pain clinics. The wisdom and expense of treating such patients in pain clinics is questioned and the need for a nationwide study on this matter identified.