Pain patients' letters: The visit before the visit - A qualitative analysis of letters from patients referred to a tertiary pain center.
Pain centers manage only selected patients, and have long waiting lists. Some patients spontaneously send letters, before the visit, and these letters represent the first contact between the patients and the pain centers. We report a study of the content and format of these letters, for a patient perspective analysis.



During a 3 month-period, all newly referred patients to a tertiary pain center were considered. If a patient letter was provided, it was collected for analysis. Qualitative analyses including semantic and content analyses were performed to identify themes and categories.



Among 138 newly referred patients, 44 had sent a letter before consultation. Content analysis of 42 letters disclosed four themes: I) pain experience; II) impact of the pain problem; III) patient history; and IV) expectations. These themes could be distributed along four pain dimensions: (1) physical; (2) psycho-affective; (3) social; and (4) temporal. This first study on patient letters reveals that a bio-psychosocial model. Patients contribute actively to their trajectory, not only as healthcare seekers but also by constructing their narrative identity.



Patient letters constitute narrative material to be integrated into clinical analysis, alongside patient interviews, especially in pain management. Pain specialists should take account of this narrative approach to better understand the unvoiced and sometimes silent experience of pain. This may increase quality of medical care by including patient-centered data in an original method. Further studies may be valuable to analyze the possible contributions of such letters to patient management.



Patients' letters constitute original narrative material to be integrated into clinical analysis, especially for pain management. Patients' letters analyses may improve the patient physician relationship, by understanding patient's perspectives, beliefs and expectations.
Pain Center, Cochin Hotel-Dieu Hospital, INSERM U 987, Paris Descartes University, Paris, France.
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Perrot
Pain Center, Cochin Hotel-Dieu Hospital, INSERM U 987, Paris Descartes University, Paris, France.
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Launay
Department of Anthropology and Education, Paris Descartes University, Paris, France.
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Desjeux
Pain Center, Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals, University of Geneva, Geneva, Switzerland.|Division of General Medical Rehabilitation, Geneva University Hospitals, University of Geneva, Geneva, Switzerland.
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Cedraschi
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000523:psychology*; D018710:Pain Clinics; D059408:Pain Management / Q000379:methods*; D010817:Physician-Patient Relations; D012017:Referral and Consultation