New Study Finds That Doctors And Pain Patients Often Disagree On Goals; Details Here!

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Mar 17, 2017 12:35 PM EDT

Class participants catch their breath after completing a CrossFit workout at Ross Valley CrossFit on March 14, 2014 in San Anselmo, California. (Photo : Justin Sullivan/Getty Images)

A new study conducted by researchers at UC Davis Health suggests that disagreements between patients and physicians over the priorities of pain treatment are common during primary care office visits. This is said to be due to the fact that patients hope to reduce the intensity of pain and identify its cause, while doctors aim to improve physical function and reduce the side effects of medication, including dependency.

The researchers noted that during treatments, it is important for physicians and patients to be on the same page, work collaboratively and not work at cross-purposes. In the study, the researchers recommend pain-focused communication training for physicians based on their findings.

"We wanted to understand why discussions about pain between patients and doctors are often contentious and unproductive," lead researcher and assistant professor of internal medicine at UC Davis, Stephen Henry said. He added that the 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 researchers believe that the training is more important now than ever before, due to the recent state and federal guidelines, which recommend physicians to work hand-in-hand with patients on observable goals for pain treatment. However, given the epidemic of opioid abuse and overdose, the recent guidelines is also said to have named minimizing pain intensity as a primary treatment goal of the treatment.

According to Medical Express, this has further created new challenges for doctors when discussing pain treatment with their patients. The study was conducted on 87 patients who received opioid prescriptions for chronic musculoskeletal pain and 49 internal or family medicine physicians from two UC Davis Medical Center clinics in Sacramento, Calif.

According to Eurekalerts, the patients were seeing their regular physicians in most cases. However, it is noted that patients who were undergoing pain treatment as part of cancer or palliative care were not included in the study. The patients who participated in the study were made to complete questionnaires to rate their experiences and their goals for pain management. This was done immediately after clinic visits between November 2014 and January 2016.

Meanwhile, the doctors independently completed questionnaires on the level of visit difficulty and the physician's own rankings of goals for the patient's pain management. Amazingly, the researchers found that 48 percent (nearly half) of the patients ranked "reducing pain intensity" as their top priority. They also found that 22 percent of the patients ranked "diagnosing the causes of pain" as the most important.

Contrary to the findings above, the researchers found that the physicians ranked "improving function" as their top priority for 41 percent of patients and "reducing medication side effects" as most important for 26 percent of patients.

Judging from the findings, it is clear that the top pain management priority for both patients and physicians usually did not match. The researchers found that the physician's first and second top-ranked treatment priorities in 62 percent of visits did not include the patient's top-ranked pain management priority.

Primary care physicians are said to typically rate 15 to 18 percent of patient visits as difficult. But in the instant case, the doctors also rated 41 percent of the patient visits as difficult, as the interactions were challenging or emotionally taxing. The researchers were surprised to find that the patients rated their physician's office experiences as "fairly positive," even when clinicians did not.

They also found that disagreements on goal priority did not influence patients' experience ratings, meaning, patients tend to have positive relationships with their doctors, even though they might not always agree with them. The findings were published online in The Clinical Journal of Pain.

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