Goals of Chronic Pain Management

Do Patients and Primary Care Physicians Agree and Does it Matter?

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17 Citations (Scopus)

Abstract

OBJECTIVE:: Assess patient-physician agreement on management goals for chronic musculoskeletal pain and its associations with patient and physician visit experiences. MATERIALS AND METHODS:: Previsit and postvisit questionnaires for 87 primary care visits involved patients taking opioids for chronic musculoskeletal pain and primary care residents. After each visit, patients and physicians independently ranked 5 pain treatment goals from most to least important. RESULTS:: In total, 48% of patients ranked reducing pain intensity as their top priority, whereas 22% ranked finding a diagnosis as most important. Physicians ranked improving function as the top priority for 41% of patients, and ranked reducing medication side effects as most important for 26%. The greatest difference between patient and physician rankings was for 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 (β for overall agreement, −0.08; 95% confidence interval [CI], −0.45 to 0.30; P=0.69; β for intensity, −0.06; 95% CI, −0.17 to 0.04; P=0.24) or physician-reported visit difficulty (β for overall agreement, 1.92; 95% CI, −2.70 to 6.55; P=0.41; β for intensity, 0.42; 95% CI, −0.87 to 1.71; P=0.53). DISCUSSION:: Patients and physicians prioritize substantially different goals for chronic pain management, but there is no evidence that agreement predicts patient experience or physician-reported visit difficulty. Primary care physicians may have adapted to new recommendations that emphasize functional goals and avoidance of long-term opioid therapy, whereas patients continue to focus on reducing pain intensity.

Original languageEnglish (US)
JournalClinical Journal of Pain
DOIs
StateAccepted/In press - Feb 27 2017

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Primary Care Physicians
Pain Management
Chronic Pain
Patient Care
Physicians
Pain
Confidence Intervals
Musculoskeletal Pain
Opioid Analgesics
Primary Health Care
Regression Analysis

ASJC Scopus subject areas

  • Clinical Neurology
  • Anesthesiology and Pain Medicine

Cite this

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title = "Goals of Chronic Pain Management: Do Patients and Primary Care Physicians Agree and Does it Matter?",
abstract = "OBJECTIVE:: Assess patient-physician agreement on management goals for chronic musculoskeletal pain and its associations with patient and physician visit experiences. MATERIALS AND METHODS:: Previsit and postvisit questionnaires for 87 primary care visits involved patients taking opioids for chronic musculoskeletal pain and primary care residents. After each visit, patients and physicians independently ranked 5 pain treatment goals from most to least important. RESULTS:: In total, 48{\%} of patients ranked reducing pain intensity as their top priority, whereas 22{\%} ranked finding a diagnosis as most important. Physicians ranked improving function as the top priority for 41{\%} of patients, and ranked reducing medication side effects as most important for 26{\%}. The greatest difference between patient and physician rankings was for 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 (β for overall agreement, −0.08; 95{\%} confidence interval [CI], −0.45 to 0.30; P=0.69; β for intensity, −0.06; 95{\%} CI, −0.17 to 0.04; P=0.24) or physician-reported visit difficulty (β for overall agreement, 1.92; 95{\%} CI, −2.70 to 6.55; P=0.41; β for intensity, 0.42; 95{\%} CI, −0.87 to 1.71; P=0.53). DISCUSSION:: Patients and physicians prioritize substantially different goals for chronic pain management, but there is no evidence that agreement predicts patient experience or physician-reported visit difficulty. Primary care physicians may have adapted to new recommendations that emphasize functional goals and avoidance of long-term opioid therapy, whereas patients continue to focus on reducing pain intensity.",
author = "Henry, {Stephen G} and Bell, {Robert A} and Fenton, {Joshua J} and Kravitz, {Richard L}",
year = "2017",
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AU - Kravitz, Richard L

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N2 - OBJECTIVE:: Assess patient-physician agreement on management goals for chronic musculoskeletal pain and its associations with patient and physician visit experiences. MATERIALS AND METHODS:: Previsit and postvisit questionnaires for 87 primary care visits involved patients taking opioids for chronic musculoskeletal pain and primary care residents. After each visit, patients and physicians independently ranked 5 pain treatment goals from most to least important. RESULTS:: In total, 48% of patients ranked reducing pain intensity as their top priority, whereas 22% ranked finding a diagnosis as most important. Physicians ranked improving function as the top priority for 41% of patients, and ranked reducing medication side effects as most important for 26%. The greatest difference between patient and physician rankings was for 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 (β for overall agreement, −0.08; 95% confidence interval [CI], −0.45 to 0.30; P=0.69; β for intensity, −0.06; 95% CI, −0.17 to 0.04; P=0.24) or physician-reported visit difficulty (β for overall agreement, 1.92; 95% CI, −2.70 to 6.55; P=0.41; β for intensity, 0.42; 95% CI, −0.87 to 1.71; P=0.53). DISCUSSION:: Patients and physicians prioritize substantially different goals for chronic pain management, but there is no evidence that agreement predicts patient experience or physician-reported visit difficulty. Primary care physicians may have adapted to new recommendations that emphasize functional goals and avoidance of long-term opioid therapy, whereas patients continue to focus on reducing pain intensity.

AB - OBJECTIVE:: Assess patient-physician agreement on management goals for chronic musculoskeletal pain and its associations with patient and physician visit experiences. MATERIALS AND METHODS:: Previsit and postvisit questionnaires for 87 primary care visits involved patients taking opioids for chronic musculoskeletal pain and primary care residents. After each visit, patients and physicians independently ranked 5 pain treatment goals from most to least important. RESULTS:: In total, 48% of patients ranked reducing pain intensity as their top priority, whereas 22% ranked finding a diagnosis as most important. Physicians ranked improving function as the top priority for 41% of patients, and ranked reducing medication side effects as most important for 26%. The greatest difference between patient and physician rankings was for 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 (β for overall agreement, −0.08; 95% confidence interval [CI], −0.45 to 0.30; P=0.69; β for intensity, −0.06; 95% CI, −0.17 to 0.04; P=0.24) or physician-reported visit difficulty (β for overall agreement, 1.92; 95% CI, −2.70 to 6.55; P=0.41; β for intensity, 0.42; 95% CI, −0.87 to 1.71; P=0.53). DISCUSSION:: Patients and physicians prioritize substantially different goals for chronic pain management, but there is no evidence that agreement predicts patient experience or physician-reported visit difficulty. Primary care physicians may have adapted to new recommendations that emphasize functional goals and avoidance of long-term opioid therapy, whereas patients continue to focus on reducing pain intensity.

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