• Melita J Giummarra, Liane Ioannou, Jennie Ponsford, Peter A Cameron, Paul A Jennings, Stephen J Gibson, and Nellie Georgiou-Karistianis.
• *School of Psychological Sciences and Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Clayton †Caulfield Pain Management and Research Centre, Caulfield Hospital ‡Department of Epidemiology and Preventive Medicine, Monash University, Melbourne §Monash-Epworth Rehabilitation Research Centre, Epworth Hospital, Richmond ¶Department of Community Emergency Health and Paramedic Practice, Monash University, Frankston #National Ageing Research Institute, University of Melbourne, Parkville, Vic., Australia ∥Emergency Department, Hamad General Hospital, Doha, Qatar.
• Clin J Pain. 2016 Sep 1; 32 (9): 817-27.

ObjectiveMotor vehicle collisions (MVC) are a major cause of injury, which frequently lead 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 evaluated the evidence for the relationship between compensation and chronic pain following MVC within a biopsychosocial framework.MethodA comprehensive search of 5 computerized databases was conducted. Methodological quality was evaluated independently by 2 researchers according to formal criteria, and discrepancies were resolved with a third reviewer.ResultsWe identified 5619 studies, from which 230 full-text articles were retrieved and 27 studies were retained for appraisal. A third of studies (37%) were of low quality, and 44% did not measure or control for factors such as injury severity or preinjury 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.ConclusionsAlthough 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.

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