St. Louis—Pain can prove costly for individuals already dealing with financial woes and problems at home, a new study has found.
According to research published in the August issue of Spine (2011;26:1402-1409), blacks, the working poor and people younger than 35 years old are more likely to suffer from financial problems and domestic issues after settling workers’ compensation claims for painful, on-the-job back injuries. The authors reached these conclusions after reviewing the court records of nearly 1,500 blacks and non-Hispanic whites who settled workers’ compensation claims in the St. Louis and Kansas City, Mo., areas.
“Patients with residual pain at the time that litigation concludes are at risk for long-term decline in function, lost earning potential and marital discord,” Raymond Tait, PhD, the study’s lead author and professor of psychiatry at Saint Louis University, told Pain Medicine News. “These findings are incompatible with long-held notions that claim settlement is curative. The pattern suggests that it represents a point from which patients continue to decline.”
Dr. Tait and his colleague John Chibnall, PhD, also a professor of psychiatry at Saint Louis University, examined the court records of 580 black and 892 non-Hispanic workers’ compensation claimants over 10 years—comparing the five-year period before their settlements with the five-year period after—to determine the frequency of cases involving general financial matters (e.g., bankruptcy), domestic financial matters (e.g., child support), residential financial matters (e.g., eviction) and domestic behavior (e.g., divorce). Blacks who settled workers’ compensation claims were consistently more likely to be involved in general and domestic financial cases than non-Hispanic whites, and these legal issues mounted. By the fifth post-settlement year, for example, levels of general and domestic financial cases for the black workers increased by approximately 10% above baseline, compared with 3% for white workers. Similarly, younger workers were more likely to experience financial difficulties. Those younger than 35 years old demonstrated a nearly 14% increase in general financial legal actions over baseline, a rate that was three times higher than that of the 35- to 54-year-old cohort and five times higher than that of the 55-and-older cohort.
“We believe that societal factors drive many of the differences that we have found in treatment and intermediate treatment outcomes,” Dr. Tait said. “Over the long term, racial and ethnic effects are augmented if not exceeded by socioeconomic status factors, especially the resources available to the patient in pain.”
Dr. Tait and his team focused much of their recent research on disparities in pain treatment along racial and economic lines. Like the Spine study, much of their work was partly supported by funding from the Agency for Healthcare Research and Quality. However, although Dr. Tait draws troubling conclusions from his findings, not everyone in the pain community agrees.
“The problem with this study is that it identifies these differences but can offer no insight into causation; any conclusions on the part of the reader are purely speculative,” said Mark Lema, MD, professor and chair of anesthesiology at the State University of New York at Buffalo, who was not involved in Dr. Tait’s research. “Do the number of children have an impact on these differences? Is one group of injured workers engaged in extremely hard labor? It’s almost impossible to answer the questions based on this article without offering my personal biases, but I don’t see this report as an issue regarding the availability of pain care between the groups.”
—Brian P. Dunleavy