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Doctors and patients often disagree on pain management goals

By Nicole MacKee 
Doctors and patients are at odds on the goals of chronic pain management, say researchers who report that the most common top priority for doctors is to improve function, while for patients it is to reduce pain intensity. 

In a study published in the Clinical Journal of Pain, US researchers found that 48% of patients ranked reducing pain intensity as their top priority, and 22% ranked finding a diagnosis for their pain as their number one goal. Primary care doctors, however, ranked improving function as the highest priority for 41% of patients, while reducing medication side effects was the primary goal for 26%. 

This lack of agreement about treatment goals did not impact the patient experience or physician-reported visit difficulty, the researchers said. 

The study included 87 primary care visits involving patients taking opioids for musculoskeletal pain. After each visit, patients and doctors independently ranked five pain treatment goals from most to least important. 

The researchers said the findings showed that primary care doctors had adapted to new recommendations emphasising functional goals and avoidance of long-term opioids, but patients continued to focus on reducing pain intensity. 

Professor Michael Nicholas of the University of Sydney’s Pain Management Research Institute said the focus on pain relief, rather than improved function, was a ‘big problem’ in Australia. 

‘It’s not black and white because lots of physicians share the patient’s view that the goal is to relieve pain, which is appropriate in acute pain, but not with chronic pain, and we think that is one of the drivers for the overuse of opioids,’ Professor Nicholas told Pain Management Today

Professor Nicholas said the importance of improving function in chronic pain had been known for many years, and some progress had been made in shifting the focus of doctors and patients, but there was still a long way to go. 

‘Many doctors are clearly treating chronic pain as if it were acute pain,’ Professor Nicholas said. ‘There is just no good evidence supporting the ongoing use of opioids for chronic noncancer pain.’ 

Professor Nicholas said chronic pain management required a multidisciplinary approach, with the doctor taking on the role of “coach”, alongside psychologists, physiotherapists and nurses, to support patients to reduce any reliance on drugs, improve function and resume normal activities. 

Professor Nicholas said pain management also had to be more effectively addressed in medical school curricula. ‘It’s abysmal how little instruction medical students get on pain. New graduates often say they feel ill-equipped to deal with pain.’
Clin J Pain 2017. doi: 10.1097/AJP.0000000000000488.

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