Musculoskeletal pain is a chronic and debilitating condition in the United States, and recent changes in therapeutic recommendations are changing the goals of physicians in treating their patients. As opioid-reliance and addiction have become a widespread phenomenon in our country over the past 30 years, clinical guidelines have turned away from pain-treatment as a primary outcome and moved instead towards improving physical functionality and limiting the negative effects of medication on patients. While physicians have changed their patient-related goals to comply with recent recommendations that seek to limit opioid addiction, patients continue to view pain-reduction as a primary goal of treatment, followed by diagnosis of the cause of their pain.
A recent study [1. Goals of Chronic Pain Management: Do Patients and Primary Care Physicians Agree and Does It Matter?] examined the agreement between patient and doctor-centered therapeutic goals, since goal-agreement is thought to be a positive indicator of the future success of therapy.
Patients and physicians in the story were chosen from two sets of primary care residents and their patients at the University of California, Davis Medical Center, in Sacramento. The researchers sought to determine the level of agreement between doctors’ and patients’ overall treatment goals, the correlation between goal-agreement and physician-reported patient difficulty, and the amount in which any lack of goal-agreement affected the patient’s sense of satisfaction with their physicians.
Baseline measures included physician and patient demographic information, including pain-related measures typically used, physical and mental health, the propensity for catastrophizing, income, and risk for opioid misuse. The physicians completed a questionnaire immediately after each patient visit rating the overall difficulty associated with patient dissatisfaction during the visit, the patients’ symptomatic burden and need for healthcare, and a rating of which goals the doctor employed in treating the patients. The goal-ratings ranged from reducing the patients’ pain intensity, improving the patients’ overall function, minimizing medicinal side-effects, decreasing the debilitating effects of pain on the patients’ lives, and diagnosing the cause of pain.
Patients were asked to complete a questionnaire immediately after their physician visits appraising their doctors’ communication skills and the amount of trust the patients placed in their doctors. They were assessed as to the length of their association with the doctors and asked to consider the goals they felt were most important in their treatment.
The study revealed a correlation between pain and lower-income subjects that was statistically significant. There also appeared to be a link between lower physical and mental health—particularly depression and anxiety— in patients suffering from chronic pain, as compared to the U.S. population. Two-thirds of the patients reported a current or prior history of substance abuse, and approximately one quarter of the patients reported being prescribed opioids and benzodiazepines at the same time.
Physicians are most likely responding to the changing recommendations that reduce potential opioid abuse or reliance and are instead emphasizing improved physical functionality and a reduction in medicinal risks when treating chronic pain patients. Patients, however, continue to seek symptomatic relief as their primary treatment goal, with diagnosis as their secondary goal. Though the study concluded that patients and their doctors no longer share the same primary and secondary goals, researchers found that the discrepancy between patient- and doctor-reported therapeutic goals has little bearing in overall patient-doctor satisfaction.
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