Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions
Pain Management in a Primary Care Setting
Clin J Pain; ePub 2017 Feb 27; Henry, Bell, et al
Primary care physicians and their patients ranked substantially different goals for chronic pain management, the greatest difference being in reducing pain intensity, but there is no evidence that agreement predicts patient experience or physician-reported visit difficulty, a recent study found. The study included previsit and postvisit questionnaires for 87 primary care visits and involved patients taking opioids for chronic musculoskeletal pain. Patients and physicians independently ranked 5 pain treatment goals from most to least important after each visit. Researchers found:
- Overall, 48% of patients ranked reducing pain intensity at their top priority; 22% ranked finding 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% of patients.
- The greatest difference between patient and physician rankings was for reducing pain intensity.
Henry SG, Bell RA, Fenton JJ, Kravitz RL. Goals of chronic pain management: Do patients and primary care physicians agree and does it matter? [Published online ahead of print February 27, 2017]. Clin J Pain. doi:10.1097/AJP.0000000000000488.
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Sleep Disturbance and Chronic Pain Intensity, Clin J Pain; ePub 2019 Mar 25; Burgess, et al
Dual Receipt of Rx Opioids & Overdose Death, Ann Intern Med; ePub 2019 Mar 12; Moyo, et al
Opioid-Related Mortality in US by Opioid Type, JAMA Netw Open; 2019 Feb 22; Kiang, et al
Disparities in the Prescription of Opioids, JAMA Intern Med; ePub 2019 Feb 11; Friedman, et al
Trends in Pain Prevalence in US Adults, J Pain; ePub 2019 Jan 15; Nahin, et al
Being explicit and discussing goals of care with our patients who are receiving chronic pain management care is an important part of their care, but it is difficult to help someone accomplish their goals when we don’t know their goals. There are times when it may not be realistic to have a goal of eliminating pain, and care would be more effective if the agreed upon goal was decreasing pain by 50%. It may be that increase in function in defined areas would be more readily achieved after a discussion of the increase in function as an explicit goal. This study reminds us that when we treat patients with chronic pain, we need to be careful not to assume we know their goal and we need to remember that discussion of shared goals facilitates clarity of care. —Neil Skolnik, MD