title: The influence of discordance in pain assessment on the functional status of patients with chronic nonmalignant pain.
abstract: BACKGROUND
  Chronic pain is a frequent cause of suffering and disability that seriously affects patients' quality of life and imposes a staggering socioeconomic toll on society. Little is known about the impact of patient-physician disagreement (discordance) regarding the assessment of chronic pain on patients' quality of life in primary care settings. This study evaluates the role of discordance and other potentially modifiable factors that affect the quality of life and functional status of chronic pain patients.
  
  
  METHODS
  We evaluated 436 patient-physician encounters at 12 academic medical centers in the United States. We surveyed chronic nonmalignant pain patients to understand their pain perceptions. We concurrently surveyed their physicians about their perceptions of their patient's pain in primary care settings.
  
  
  RESULTS
  More than 50% of physicians disagreed with their patient's pain. Thirty-nine percent of primary care physicians underestimated their patient's pain. In the multivariate analysis, this discordance was associated with poor physical functioning and worse bodily pain (P < 0.018 and P < 0.001 respectively). Patients with chronic, nonmalignant pain have reductions in physical function and bodily pain domains of the SF-36 compared to age-matched populations. Depression and obesity represented other associations.
  
  
  CONCLUSIONS
  Patients with chronic nonmalignant pain have poor physical functioning and worse bodily pain. Discordance, obesity, and depression are other modifiable factors. Prospective studies are needed to design interventions. However, a multifaceted approach appears to represent the best opportunity to reduce the pain and suffering of this challenging population.
authors.affiliation: Department of Medicine, University of Tennessee, College of Medicine-Chattanooga Unit, Chattanooga, Tennessee 37403, USA. mukta.panda@erlanger.org
authors.forename: Mukta
authors.initials: M
authors.lastname: Panda
authors.forename: Lisa J
authors.initials: LJ
authors.lastname: Staton
authors.forename: Ian
authors.initials: I
authors.lastname: Chen
authors.forename: James
authors.initials: J
authors.lastname: Kurz
authors.forename: Jane
authors.initials: J
authors.lastname: O'Rorke
authors.forename: Mark
authors.initials: M
authors.lastname: Pasanen
authors.forename: Madhusudan
authors.initials: M
authors.lastname: Menon
authors.forename: Inginia
authors.initials: I
authors.lastname: Genao
authors.forename: Joann
authors.initials: J
authors.lastname: Wood
authors.forename: Alex
authors.initials: A
authors.lastname: Mechaber
authors.forename: Eric
authors.initials: E
authors.lastname: Rosenberg
authors.forename: Charles
authors.initials: C
authors.lastname: Faselis
authors.forename: Tim
authors.initials: T
authors.lastname: Carey
authors.forename: Diane
authors.initials: D
authors.lastname: Calleson
authors.forename: Sam
authors.initials: S
authors.lastname: Cykert
mesh_terms: D002908:Chronic Disease; D003430:Cross-Sectional Studies; D034462:Dissent and Disputes; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement / Q000523:psychology*; D010817:Physician-Patient Relations; D011788:Quality of Life; D012044:Regression Analysis