title: Development of the Chronic Pain Coding System (CPCS) for Characterizing Patient-Clinician Discussions About Chronic Pain and Opioids.
abstract: To describe the development and initial application of the Chronic Pain Coding System.
  
  
  
  Secondary analysis of data from a randomized clinical trial.
  
  
  
  Six primary care clinics in northern California.
  
  
  
  Forty-five primary care visits involving 33 clinicians and 45 patients on opioids for chronic noncancer pain.
  
  
  
  The authors developed a structured coding system to accurately and objectively characterize discussions about pain and opioids. Two coders applied the final system to visit transcripts. Intercoder agreement for major coding categories was moderate to substantial (kappa = 0.5-0.7). Mixed effects regression was used to test six hypotheses to assess preliminary construct validity.
  
  
  
  Greater baseline pain interference was associated with longer pain discussions (P = 0.007) and more patient requests for clinician action (P = 0.02) but not more frequent negative patient evaluations of pain (P = 0.15). Greater clinician-reported visit difficulty was associated with more frequent disagreements with clinician recommendations (P = 0.003) and longer discussions of opioid risks (P = 0.049) but not more frequent requests for clinician action (P = 0.11). Rates of agreement versus disagreement with patient requests and clinician recommendations were similar for opioid-related and non-opioid-related utterances.
  
  
  
  This coding system appears to be a reliable and valid tool for characterizing patient-clinician communication about opioids and chronic pain during clinic visits. Objective data on how patients and clinicians discuss chronic pain and opioids are necessary to identify communication patterns and strategies for improving the quality and productivity of discussions about chronic pain that may lead to more effective pain management and reduce inappropriate opioid prescribing.
authors.affiliation: *Department of Internal Medicine, University of California Davis, Sacramento, California; sghenry@ucdavis.edu.
authors.forename: Stephen G
authors.initials: SG
authors.lastname: Henry
authors.affiliation: Department of Communication, University of California Davis, Davis, California.
authors.forename: Meng
authors.initials: M
authors.lastname: Chen
authors.affiliation: VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, Indiana.|Regenstrief Institute, Indianapolis, Indiana.|Department of Communication Studies, Indiana University-Purdue University, Indianapolis, Indiana.|Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana.
authors.forename: Marianne S
authors.initials: MS
authors.lastname: Matthias
authors.affiliation: Department of Communication, University of California Davis, Davis, California.|Department of Public Health Sciences, University of California Davis, Davis, California, USA.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Bell
authors.affiliation: *Department of Internal Medicine, University of California Davis, Sacramento, California.
authors.forename: Richard L
authors.initials: RL
authors.lastname: Kravitz
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D059350:Chronic Pain / Q000175:diagnosis* / Q000188:drug therapy*; D059019:Clinical Coding / Q000379:methods* / Q000639:trends; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement / Q000379:methods* / Q000639:trends; D010817:Physician-Patient Relations; D011320:Primary Health Care / Q000379:methods / Q000639:trends
chemical_list: D000701:Analgesics, Opioid
keywords: Chronic Pain; Communication; Negotiating; Opioid Analgesics; Primary Care; Research Methodology