Patients and physicians have substantially different goals when it comes to chronic musculoskeletal pain management, however there is no evidence to suggest these differences can predict patient experience or physician-reported visit difficulty.
These findings are part of a new study by researchers at the University of California, Davis Medical Center, and are published in the Clinical Journal of Pain. In order to assess patient-physician agreement on management goals for chronic pain, pre- and post-visit questionnaires were given to both patients (those taking opioids) and physicians (primary care residents). The groups were asked to rank five pain treatment goals from most to least important after each visit.
Results showed that 48% of patients ranked reducing pain intensity as their top priority, while 22% ranked finding a diagnosis as most important. For physicians, improving function was their top priority for 41% of patients and reducing drug side effects as most important for 26%. There was an overall agreement on goals in 38% of visits (i.e., the physician’s first- or second-ranked priority included the patient’s top-ranked priority). The greatest difference between patients and physicians was in reducing paint intensity; physician ranked reducing pain as a higher priority than the patient in just 14% of patient visits.
The authors of the study hypothesize that this disagreement on pain prioritization reflects recent recommendations to prioritize function goals and reduce opioid related harms. Despite these treatment goal differences, most patients reported positive experiences of their visits.
The authors write that, “Pain management guidelines stress the importance of collaborative goal setting for chronic pain, so we were surprised to find no evidence that either overall agreement or intensity specific agreement was associated with physician-reported visit difficulty or patient experience.” They suggest that communication initiatives may be needed to help physicians ensure their patients appreciate the importance of safe prescribing and functional goals.
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