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Communication about chronic pain and opioids in primary care: impact on patient and physician visit experience

Henry, Stephen, G.a,b,*; Bell, Robert, A.c,d; Fenton, Joshua, J.b,e; Kravitz, Richard, L.a,b

doi: 10.1097/j.pain.0000000000001098
Research Paper
Global Year 2018

Patients and physicians report that communication about chronic pain and opioids is often challenging, but there is little empirical research on whether patient–physician communication about pain affects patient and physician visit experience. This study video recorded 86 primary care visits involving 49 physicians and 86 patients taking long-term opioids for chronic musculoskeletal pain, systematically coded all pain-related utterances during these visits using a custom-designed coding system, and administered previsit and postvisit questionnaires. Multiple regression was used to identify communication behaviors and patient characteristics associated with patients' ratings of their visit experience, physicians' ratings of visit difficulty, or both. After adjusting for covariates, 2 communication variables—patient–physician disagreement and patient requests for opioid dose increases—were each significantly associated with both worse ratings of patient experience and greater physician-reported visit difficulty. Patient desire for increased pain medicine was also significantly positively associated with both worse ratings of patient experience and greater physician-reported visit difficulty. Greater pain severity and more patient questions were each significantly associated with greater physician-reported visit difficulty, but not with patient experience. The association between patient requests for opioids and patient experience ratings was wholly driven by 2 visits involving intense conflict with patients demanding opioids. Patient–physician communication during visits is associated with patient and physician ratings of visit experience. Training programs focused on imparting communication skills that assist physicians in negotiating disagreements about pain management, including responding to patient requests for more opioids, likely have potential to improve visit experience ratings for both patients and physicians.

Communication during clinic visits was systematically coded and analyzed. Patient–physician disagreements and requests for more opioids impacted both patient and physician visit experience ratings.

aDepartment of Internal Medicine, University of California Davis, Sacramento, CA, USA

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

Departments of cCommunication and

dPublic Health Sciences, University of California, Davis, Davis, CA, USA

eDepartment of Family and Community Medicine, University of California, Davis, Sacramento, CA, USA

Corresponding author. Address: 4150 V St, Suite 2400, Sacramento, CA 95817, USA. Tel.: (916) 734-2177; fax: (916) 734-2732. E-mail address: (S.G. Henry).

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Received July 31, 2017

Received in revised form August 29, 2017

Accepted October 26, 2017

© 2018 International Association for the Study of Pain
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