Physicians and Patients Butt Heads on Chronic Pain Treatment Goals

MARCH 13, 2017
Caitlyn Fitzpatrick
pain management, addiction medicine, chronic painNew research from University of California, Davis (UC Davis) Health, it’s not uncommon for physicians and patients to disagree on the goals of chronic pain treatment.
 
While physicians want patients to have improved physical function and reduce drug side effects, patients care more about reducing pain intensity and knowing why the pain is present.
 
“We wanted to understand why discussions about pain between patients and doctors are often contentious and unproductive,” lead author, Stephen Henry, MD, MSc, (picture) assistant professor of internal medicine at UC Davis, said in a news release.
 
The researchers looked at pre-visit and post-visit questionnaires collected from 87 patients’ primary care visits from November 2014 to January 2016. The patients were taking opioids to ease their chronic musculoskeletal pain. Data were also gathered from 49 internal or family medicine physicians.
 
The questionnaires had patients and physicians rank 5 pain treatment goals from most to least important. The physicians also reported on the visits’ level of difficulty.
 
The results showed that physicians and patients did not agree on the top priority of treatment in 62% of visits. The number one priority, according to 48% of patients, was reducing pain intensity, and 22% ranked finding a diagnosis at the top. However, physicians said that improving function was the top goal for 41% of their patients and reducing medication side effects, such as dependence, was most the first for 26% of their patients.
 
“Primary care physicians treat the majority of patients with chronic pain, but they aren’t always equipped to establish clear, shared treatment goals with their patients,” Henry continued. “It is critical for doctors and patients to be on the same page and not working at cross purposes.”
 
The biggest difference among the pain treatment goals between physicians and patients was reducing pain intensity.
 
“In regression analyses, neither overall agreement on goals (ie, the physician’s first or second priority included the patient’s top priority) nor difference in patient versus physician ranking of pain intensity was significantly associated with patient-reported visit experience (b for overall agreement, -0.08; 95% confidence interval (CI), -0.45 to 0.30; P = 0.69; b for intensity, -0.06; 95% CI, -0.17 to 0.04; P = 0.24) or physician-reported visit difficulty (b for overall agreement, 1.92; 95% CI, -2.70 to 6.55; P = 0.41; b for intensity, 0.42; 95% CI, -0.87 to 1.71; P = 0.53),” the researchers detailed in The Clinical Journal of Pain.
 
Physicians reported that 41% of visits were difficult—defined as the patient interactions were challenging or emotionally taxing. But according to primary care physicians, 15 to 18% of visits were difficult. The study authors said that one surprising finding was that even when physicians didn’t rate the visit well, patients tended to say that experiences were fairly positive. Regardless, the results did not show a connection between goal disagreements and visit ratings—which may indicate positive physician-patient relationships despite contrasting views.
 
Henry said that physicians need to have both the medical and communication skills it takes to safely and effectively treat chronic pain, including in cases where both parties don’t agree.
 
The study, “Goals of Chronic Pain Management: Do Patients and Primary Care Physicians Agree and Does it Matter?” was published in The Clinical Journal of Pain. The news release and headshot were provided by UC Davis Health.
 
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