Substantial Divergence in Pain Treatment Goals

New research conducted at UC Davis Health concludes that primary care clinicians and patients disagree substantially over the goals of pain treatment. While patients prioritize a reduction in pain intensity and, secondarily, an understanding of the cause of their pain, clinicians place greater emphasis on improving physical function and reducing or avoiding side effects from medication, including risk of dependency. Lead author Stephen Henry, MD, assistant professor of internal medicine at UCD, observed, “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.” The authors recommend a greater emphasis on communication training about pain and treatment objectives, particularly in light of emerging clinical guidelines that deemphasize pain intensity as a primary treatment goal. The findings are published online in Clinical Journal of Pain.

The study followed 87 patients with chronic musculoskeletal pain, and 49 internal or family medicine physicians from 2 UCD clinics in Sacramento. Patients and clinicians completed independent assessments of the interactive experience and of their respective goals for pain therapy. Among patients, 48% placed first priority on reducing pain intensity, while 22% prioritized determination of pain cause. Among clinicians, 41% placed improving patient functionality first, while 26% prioritized reducing medication side effects. In an unexpected outcome, the study found no evidence that this divergence affected either patient or physician perceptions of the interactive experience. The authors surmise that this may reflect that patients tend to have a positive view of their primary care providers even when not in agreement with them.

Read more about the recommendations here.

The article abstract may be read here.