Physicians, Patients Disagree Over Pain Treatment Priorities

According to recent research from the California Davis Medical Center, doctors and patients commonly disagree over pain treatment priorities. Researchers discovered that while patients aim to reduce pain severity and identify the cause, physicians seek to improve physical function and reduce the side effects of medication, such as dependency.

Based on these findings, the authors recommend that physicians undergo pain-focused communication training.

Lead author Dr. Stephen Henry, assistant professor of internal medicine at University of California, Davis:

“We wanted to understand why discussions about pain between patients and doctors are often contentious and unproductive.”

“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 stated that the proposed training is especially critical as of late, considering new federal and state guidelines that recommend physicians work together with their patients on pain treatment goals. Recent guidelines also minimize pain intensity reduction as a primary treatment objective, thus creating still more challenges for doctors during collaboration with patients over pain management and treatment.

About The Study

The research comprised 87 patients who were currently receiving prescriptions for opioids for chronic musculoskeletal pain and 49 internal or family medicine physicians from David Medical Center clinics in Sacramento. Patients receiving treatment for cancer or palliative care were not included in the research.

Following visits to the clinic between November 2014-January 2016, patients filled out questionnaires to rate their experiences, and rank goals for the management of pain. Physicians also completed questionnaires and ranked pain management goals for each visit with patients.

As a result, 48% of patients rated pain intensity reduction as their top priority, while 22% said that knowing the origin of the pain (a diagnosis) was most important. Conversely, physicians said that improved function was the top priority for 41% of the patients, and reducing the side effects of medication was the top priority for 26%.

Overall, priorities ranked by physicians and patients didn’t mesh well. In 62% of visits, the doctor’s first and second treatment priorities did not even include the patient’s top priority for treatment.

Also, physicians rated 41% of the visits as being difficult, or that the interactions were somehow challenging. On average, primary care physicians rate just 15-38% of patients visits as difficult or challenging. Despite this, patients tended to rate their visit experiences as relatively positive, even if their clinician did not.

Next, researchers see to identify the most effective practices for doctor-patient communications to be included in the training.

The study is published online in The Clinical Journal of Pain.