Chronic Pain following Motor Vehicle Collision: A Systematic Review of Outcomes Associated with Seeking or Receiving Compensation.

OBJECTIVE: Motor vehicle collisions (MVC) are a major cause of injury, which frequently leads to chronic pain and prolonged disability. Several studies have found that seeking or receiving financial compensation following MVC leads to poorer recovery and worse pain. We systematically evaluated the evidence for the relationship between compensation and chronic pain following MVC within a biopsychosocial framework. METHOD: A comprehensive search of five computerized databases was conducted. Methodological quality was evaluated independently by two researchers according to formal criteria, and discrepancies were resolved with a third reviewer. RESULTS: We identified 5619 studies, 230 full-text articles were retrieved and 27 studies were retained for appraisal. A third of studies (37%) were low quality, and 44% did not measure or control for factors such as injury severity or pre-injury pain and disability. Most studies (70%) reported adverse outcomes, including all of the highest quality studies. Engagement with compensation systems was related to more prevalent self-reported chronic pain, mental health disorders and reduced return to work. Recovery was poorer when fault was attributed to another, or when a lawyer was involved. Five studies compared Tort "common law" and No-Fault schemes directly and concluded that Tort claimants had poorer recovery. CONCLUSIONS: Although causal relationships cannot be assumed, the findings imply that aspects of loss, injustice, and secondary mental health outcomes lead to chronic pain following MVC. Further robust prospective research is required to understand the complex relationship between compensation systems and pain following road trauma, particularly the role of secondary mental health outcomes.