The influence of discordance in pain assessment on the functional status of patients with chronic nonmalignant pain.
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.
Panda
Mukta
M
Department of Medicine, University of Tennessee, College of Medicine-Chattanooga Unit, Chattanooga, Tennessee 37403, USA. mukta.panda@erlanger.org
Staton
Lisa J
LJ
Chen
Ian
I
Kurz
James
J
O'Rorke
Jane
J
Pasanen
Mark
M
Menon
Madhusudan
M
Genao
Inginia
I
Wood
Joann
J
Mechaber
Alex
A
Rosenberg
Eric
E
Faselis
Charles
C
Carey
Tim
T
Calleson
Diane
D
Cykert
Sam
S
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