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Goals of Chronic Pain Management: Do Patients and Primary Care Physicians Agree and Does it Matter?

Henry, Stephen G. MD*,†; Bell, Robert A. PhD; Fenton, Joshua J. MD, MPH†,§; Kravitz, Richard L. MD, MSPH*,†

doi: 10.1097/AJP.0000000000000488
Original Articles

Objective: Assess patient-physician agreement on management goals for chronic musculoskeletal pain and its associations with patient and physician visit experiences.

Materials and Methods: Pre-visit and post-visit questionnaires for 87 primary care visits that involved patients taking opioids for chronic musculoskeletal pain and primary care resident physicians. After each visit, patients and physicians independently ranked 5 pain treatment goals from most to least important.

Results: In total, 48% of patients ranked reducing pain intensity as their top priority, whereas 22% ranked finding a diagnosis as most important. Physicians ranked improving function as the top priority for 41% of patients, and ranked reducing medication side effects as most important for 26%. The greatest difference between patient and physician rankings was for reducing pain intensity. In regression analyses, neither overall agreement on goals (ie, the physician’s first or second priority included the patient’s top priority) nor difference in patient versus physician ranking of pain intensity was significantly associated with patient-reported visit experience (β for overall agreement, −0.08; 95% confidence interval [CI], −0.45 to 0.30; P=0.69; β for intensity, −0.06; 95% CI, −0.17 to 0.04; P=0.24) or physician-reported visit difficulty (β for overall agreement, 1.92; 95% CI, −2.70 to 6.55; P=0.41; β for intensity, 0.42; 95% CI, −0.87 to 1.71; P=0.53).

Discussion: Patients and physicians prioritize substantially different goals for chronic pain management, but there is no evidence that agreement predicts patient experience or physician-reported visit difficulty. Primary care physicians may have adapted to new recommendations that emphasize functional goals and avoidance of long-term opioid therapy, whereas patients continue to focus on reducing pain intensity.

Departments of *Internal Medicine

Communication and Public Health Sciences

§Family and Community Medicine, University of California, Davis

University of California Davis Center for Healthcare Policy and Research, Sacramento, CA

Funded by the National Institutes of Health, Bethesda, MD (KL2TR000134/UL1TR000002) and the UC Davis Department of Internal Medicine, Sacramento, CA. R.L.K. is supported by National Institutes of Health, Bethesda, MD (R01NR013938). The authors declare no conflict of interest.

Reprints: Stephen G. Henry, MD, Department of Internal Medicine, University of California, Davis, 4150 V Street Suite 2400, Sacramento, CA 95817 (e-mail: sghenry@ucdavis.edu).

Received November 6, 2016

Received in revised form December 12, 2016

Accepted February 4, 2017

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