Discussions about pain between patients
and doctors are often contentious and unproductive. New
research from UC Davis Health shows. Patients hope to reduce pain
intensity and identify the cause, while physicians aim to improve
physical function and reduce medication side effects, including
Based on their findings, published online in "The Clinical Journal of Pain
," the authors recommend pain-focused communication training for physicians.
‘Doctors should be given communications training to work collaboratively with patients on observable goals for pain treatment.’
Stephen Henry, assistant professor of internal medicine at UC Davis, said,
"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 proposed training is especially important now, given recent
state and federal guidelines recommending that doctors work
collaboratively with patients on observable goals for pain treatment,
Henry said. In light of the epidemic of opioid abuse and overdose, the
guidelines also minimize reducing pain intensity as a primary treatment
goal, creating new challenges for physicians when discussing pain
treatment with patients.
"It is critical for doctors and patients to be on the same page and not working at cross purposes," Henry said.
The research included 87 patients receiving opioid prescriptions for
chronic musculoskeletal pain and 49 internal or family medicine
physicians from two UC Davis Medical Center clinics in Sacramento,
Calif. In most cases, patients were seeing their regular physicians.
Patients receiving pain treatment as part of cancer or palliative care
were excluded from the study.
Immediately following clinic visits between November 2014 and
January 2016, the patients completed questionnaires to rate their
experiences and rank their goals for pain management. The physicians
independently completed questionnaires about the level of visit
difficulty, along with their own rankings of goals for the patient's
Nearly half (48%) of patients ranked reducing pain intensity
as their top priority, followed by 22% who ranked diagnosing the
reasons for their pain as most important. In contrast, physicians ranked
improving function as the top priority for 41% of patients and
reducing medication side effects as most important for 26%.
In addition, patients' and physicians' top priorities for pain
management usually did not match. In 62% of visits, the
physician's first- and second-ranked treatment priorities did not
include the patient's top-ranked treatment priority.
Physicians also rated 41% of the patient visits as
"difficult," meaning the interactions were challenging or emotionally
taxing. Primary care physicians typically rate 15 to 18% of
patient visits as difficult.
One surprising outcome was that patients rated their doctors' office
experiences as fairly positive, even when clinicians did not. There
also was no evidence that goal disagreements influenced patients'
experience ratings. This may reflect the fact that patients tend to have
positive relationships with their regular physicians, even though they
don't always agree with them, according to Henry.
The researchers next want to identify best practices for
patient-doctor communications that can be incorporated into training
aimed at helping physicians better communicate with patients suffering
from chronic pain.
"We need to make sure physicians have the medical skills it takes to
effectively and safely treat pain, as well as the communications skills
needed to discuss treatment goals and navigate instances when they
don't see eye-to-eye with patients," Henry said.