Assessing chronic pain in general practice: are guidelines relevant? A cluster randomized controlled trial.
OBJECTIVE
To evaluate the impact of using pain assessment scales on the management of musculoskeletal chronic pain.


METHODS
Cluster-randomized controlled multicentre trial in French general practice settings. Practices were randomized by region before patient recruitment. The inclusion concerned patients suffering from musculoskeletal chronic pain. General practitioners assigned to the scale group used two validated assessment instruments; those assigned to the control group cared for their patients according to their usual practice. The primary end-point was the level of relief obtained and the secondary changes in prescription of painkilling modalities.


RESULTS
A total of 155 general practitioners included 772 successive patients suffering from musculoskeletal chronic pain. The control group reported a mean level of relief of 50.7% compared with one of 41.1% in the scale group (p<0.0001). In the intervention group, physicians decreased significantly their prescription of level two painkillers.


CONCLUSIONS
In general practice, the use of pain assessment scales is not associated with greater pain relief. The lesser level of pain relief obtained in the scale group does provide evidence that using pain assessment scales does not enhance the relief of chronic pain in patients in primary care. Guidelines which recommend the systematic use of scales for the assessment and monitoring of chronic pain are not tailored to either the context or the patients encountered in the primary care setting.
Huas
Dominique
D
Département de médecine générale, Faculté de médecine Denis Diderot, Paris, France. dhuas@wanadoo.fr
Pouchain
Denis
D
Gay
Bernard
B
Avouac
Bernard
B
Bouvenot
Gilles
G
French College Of Teachers In General Practice
D000368:Aged; D000700:Analgesics / Q000627:therapeutic use*; D002908:Chronic Disease; D016000:Cluster Analysis; D011307:Drug Prescriptions; D005194:Family Practice; D005260:Female; D005602:France; D006801:Humans; D008297:Male; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000150:complications*; D010146:Pain / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D010147:Pain Measurement; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D012720:Severity of Illness Index; D016896:Treatment Outcome
D000700:Analgesics