Treating chronic pain: what is left out of the patient encounter.
Treating chronic pain: what is left out of the patient encounter.
复制标题
治疗慢性疼痛：患者遭遇中遗漏的内容。
DOI：
10.1002/j.1532-2149.2014.00464.x
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发表时间：
2014
期刊：
影响因子：
--
通讯作者：
Khalid,Laila
中科院分区：
文献类型：
--
作者：
Liebschutz,Jane;Khalid,Laila
In this issue, you will find a paper by Matthias et al.(2014) titled ‘Communicating about Opioids for Chronic Pain: A Qualitative Study of Patient Attributions and the Influence of the Patient-Physician Relationship’. These investigators analysed audio recordings of encounters between five primary care physicians and their 40 patients with chronic musculoskeletal conditions who had rated their pain at a level of 4 or higher in the prior visit. In addition, researchers conducted qualitative interviews with the patients immediately after the visit to assess their impression of the encounter. The most striking finding was the paucity of discussion on pain during the visits. A quarter of the group did not discuss pain at all, and the 30 patients who discussed it had mostly limited conversations, focused on opioid analgesia. What are the reasons for this lack of discussion of pain? As shown in prior literature, providers during primary care visits handle multiple issues, including multiple co-morbid diseases (Bindman et al., 2007), psychosocial concerns and preventive health maintenance (screening, immunizations). As patients being prescribed chronic opioids for musculoskeletal programmes invariably have ongoing moderate to severe pain, they are likely to have functional disability and behavioural risk factors for chronic disease (eg, lack of exercise). The primary care clinician’s agenda can swell quite large in such patients if they not only have risk factors but also have concomitant co-morbidities. At any one visit, not all the issues may be covered, including pain, as described in the post-visit qualitative interviews by Matthias etal.(2014). Patients reported that they had past discussions about pain with their physicians, as these were long-term primary care relationships.Competing interests are only part of the picture, however. Despite promotion of pain as a fifth vital sign, there is no evidence that providers make chronic pain treatment changes based on office pain scores (Morone and Weiner, 2013). The lack of a measurable outcome, such as a blood pressure reading or a glycosylated haemoglobin value, may also make pain control more subjective, and often difficult to handle.
