Effect of compensation on emotional state and disability in chronic back pain.

The adversarial nature of some compensation systems could be a major source of psychological stress. To investigate this, we measured emotional state, pain and disability in 19 compensation recipients and in 18 others who had settled their claim for lower back pain. All subjects were unemployed, and sex distribution was similar in both groups. Compensation recipients showed more signs of emotional distress, had greater difficulty coping with pain, and reported that pain disrupted various aspects of their life to a greater degree than subjects who had settled their claim. However, even after settlement, there was clear evidence of emotional distress. The promise of a financial windfall on settlement of a claim could discourage workers from resuming employment after injury. Unfortunately, this course of action increases the risk of pain becoming chronic and of unemployment and financial hardship continuing after settlement. To prevent this potentially disastrous situation, the compensation system should encourage workers to resume some type of employment as soon as possible after injury.