Chronic Pain Consultation Research Articles

Epidemiology of arthritis, chronic back pain, gout, osteoporosis, spondyloarthropathies and rheumatoid arthritis among 1.5 million patients in Australian general practice: NPS MedicineWise MedicineInsight dataset

BackgroundPrevious estimates for the prevalence of musculoskeletal conditions (MSK) and chronic pain in Australia have been based on self-report. We aimed to determine the prevalence and distribution of arthritis, chronic back pain, gout, osteoporosis, spondyloarthropathies and rheumatoid arthritis and current consultations for chronic pain among adults attending Australian general practice, and describe their distribution according to sociodemographic characteristics and presence of co-morbidities.MethodsWe investigated 1,501,267 active adult patients (57.6% females; 22.5% ≥65y) evaluated between 2013 and 2016 and included in the MedicineInsight database (a National Prescribing Service MedicineWise program), a large general practice data program that extracts longitudinal de-identified electronic medical record data from ‘active’ patients in over 550 practices. Three main groups of outcomes were investigated: 1) “prevalence” of arthritis, chronic back pain, gout, osteoporosis, spondyloarthropathies, and/or rheumatoid arthritis between 2000 and 2016; 2) “current” diagnosis/encounter for the same conditions occurring between 2013 and 2016, and; 3) “current” consultations for chronic pain of any type occurring between 2013 and 2016.ResultsThe combined “prevalence” of the investigated MSK (diagnosis between 2000 and 2016) among adults attending Australian general practice was 16.8% (95%CI 15.9;17.7) with 21.3% (95%CI 20.2;22.4) of the sample consulting for chronic pain between 2013 and 2016. The investigated MSK with the highest “prevalence” were arthritis (9.5%) and chronic back pain (6.7%). Patients with some of these MSK attended general practices more frequently than those without these conditions (median 2.0 and 1.0 contacts/year, respectively). The “prevalence” of the investigated MSK and “current” consultations for chronic pain increased with age, especially in women, but chronic pain remained stable at 22% for males aged > 40 years. The investigated MSK and chronic pain were more frequent among those in lower socioeconomic groups, veterans, Aboriginal and Torrent Strait Islanders, current and ex-smokers, and patients with chronic obstructive pulmonary disease or heart failure.ConclusionsThe investigated MSK are more frequent among lower socioeconomic groups and the elderly. Based on information collected from adults attending Australian general practices, MedicineInsight provided similar estimates to those obtained from population-based studies, with the advantage of being based on medical diagnosis and including a national sample.

Transaction cost analysis of in-clinic versus telehealth consultations for chronic pain: preliminary evidence for rapid and affordable access to interdisciplinary collaborative consultation.

With ever increasing mandates to reduce costs and increase the quality of pain management, health care institutions are faced with the challenge of adopting innovative technologies and shifting workflows to provide value-based care. Transaction cost economic analysis can provide comparative evaluation of the consequences of these changes in the delivery of care. The aim of this study was to establish proof-of-concept using transaction cost analysis to examine chronic pain management in-clinic and through telehealth. Participating health care providers were asked to identify and describe two comparable completed transactions for patients with chronic pain: one consultation between patient and specialist in-clinic and the other a telehealth presentation of a patient's case by the primary care provider to a team of pain medicine specialists. Each provider completed two on-site interviews. Focus was on the time, value of time, and labor costs per transaction. Number of steps, time, and costs for providers and patients were identified. Forty-six discrete steps were taken for the in-clinic transaction, and 27 steps were taken for the telehealth transaction. Although similar in costs per patient ($332.89 in-clinic vs. $376.48 telehealth), the costs accrued over 153 business days in-clinic and 4 business days for telehealth. Time elapsed between referral and completion of initial consultation was 72 days in-clinic, 4 days for telehealth. U.S. health care is moving toward the use of more technologies and practices, and the information provided by transaction cost analyses of care delivery for pain management will be important to determine actual cost savings and benefits.

The timings in the first chronic pain consultation

Bettencourt, M.; Matias, C.; Pedrosa, S.; Henriques, A.; Figueiredo, J.; Marques, J. Author Information

Patient Self-report Measures of Chronic Pain Consultation Measures: A Systematic Review

Earlier studies have associated improvements in chronic pain outcomes with various consultation attributes, including: the legitimization of people's chronic pain experience, affective components of the therapeutic relationship, and reaching decisions about people's care through collaboration. Although studies have used patient self-report measures to examine how certain aspects of consultations contribute to managing chronic pain. The psychometric quality of these measures seems to have not been independently appraised to date. This review aimed to evaluate the psychometric properties and administrative feasibility of published patient self-report consultation measures that were validated for people with chronic pain. Databases were searched to identify patient self-report consultation measures validated in chronic pain populations. Explicit review criteria for 8 measure attributes were developed for this review by synthesizing information from available guidelines. In total, 58 potentially relevant consultation measures were identified. Of these, 4 measures satisfied the inclusion/exclusion criteria and were critically appraised by 2 independent reviewers. Overall, the psychometric quality of the included measures was modest, particularly in terms of evidence for content validity, test-retest reliability, responsiveness, and interpretability. Each of the included measures assessed differing aspects of consultations, and their potential clinical and research uses are discussed. Recommendations are made to improve the psychometric quality of the included measures. In summary, more psychometric research needs to be undertaken to improve the existing measures' quality and broaden the scope of chronic pain consultation measures before studies may be conducted to develop a comprehensive understanding of the manner in which consultation attributes influence chronic pain outcomes.

Use of Telemedicine in Chronic Pain Consultation

Telemedicine has been used extensively in various settings, including monitoring patient treatment response and counseling. However, there are few data on the application of telemedicine to chronic pain patients. The present study was the first pilot project to determine whether telemedicine technology for chronic pain consultation was feasible, cost-saving, and satisfactory to patients and pain physicians. A prospective pilot study was conducted on chronic pain patients requiring follow-up consultations using telemedicine technology. Patients were interviewed by phone following the consultation. Eleven telemedicine anesthesia consultations involving eight patients (age 42+/-9 years; six men, two women) were performed. All were follow-up consultations. The average distance from patients' home to the clinic was 314+/-170 km. The reasons for consultation were for update of patient progress (10/11), medication change (6/11), and counseling (3/11). The time to complete the consultation was 24.5+/-9.5 minutes. The data for the time and the cost that the patient spent on the consultation are presented as median and 25% to 75% interquartile range. Patients having telemedicine consultations spent 0.9 hours (0.83-1) and Canadian dollar 3 (dollar 2-4) versus an estimate of 8 hours (6-8) and Canadian dollar 80 (dollar 46-260) for a conventional consultation (both P<0.005). Telemedicine consultation was found to be highly satisfactory to the patient and the consulting and attending anesthesiologists. This pilot study indicates that telemedicine follow-up consultations for chronic pain patients are feasible and cost-saving. Patients and anesthesiologists were highly satisfied with telemedicine consultation. Patients reported a significant saving in time and cost compared with a conventional consultation.

Chronic pain service: A retrospective descriptive analysis of in-hospital pain consultations

Abstract Aims: The objective of this study was to describe the set-up of the chronic pain consultation service (CPS) in a tertiary care university hospital and to analyse a full year of its practice. Methods: The CPS was administered by the Helsinki University Hospital Pain Clinic and was provided by a senior anaesthesiologist specialised in pain management. During the first year, 266 patients were seen and the medical records of 212 patients were analysed retrospectively. Information was collected about the requesting units, and types, duration, anatomical regions, intensity, mechanisms and treatments of pains of the patients, and the work-load expended for the consultations. Results: The reasons for consultations were cancer (37% of patients), chronic non-cancer (27%) and acute pain (20%). The most common pain mechanism was nociceptive. The number of consultations per patient varied from 1 to 32. Most (56%) of those patients with more than four visits had invasive treatments. The median total time for t...

Constructions of chronic pain in doctor–patient relationships: bridging the communication chasm

This study examined interactions between doctors and their chronic pain patients in the context of investigations for medically unexplained pain. Doctor–patient interactions were explored through the analysis of the accounts of the communication process in the chronic pain consultation of 20 chronic pain patients with their pain specialists and the accounts of 22 pain specialists with their chronic pain patients. An implicit dialogue between doctors and their patients was identified that appeared to undermine the quality of their interactions, challenged each other’s credibility and caused distress to both parties. The implicit dialogue of the chronic pain patient was based on the biogenic theory while the implicit dialogue of doctors was underpinned by psychogenic theory. Potentially healing interactions between doctors and their patients that do not rely on the biogenic model of the visible body or the psychogenic model of invisible pain are needed to assist the communication between chronic pain patients and their doctors. A systemic theoretical analysis of this process is offered.

The disability evaluation process: Provider-patient communication

This study examined interactions between doctors and their chronic pain patients in the context of investigations for medically unexplained pain. Doctor–patient interactions were explored through the analysis of the accounts of the communication process in the chronic pain consultation of 20 chronic pain patients with their pain specialists and the accounts of 22 pain specialists with their chronic pain patients. An implicit dialogue between doctors and their patients was identified that appeared to undermine the quality of their interactions, challenged each other’s credibility and caused distress to both parties. The implicit dialogue of the chronic pain patient was based on the biogenic theory while the implicit dialogue of doctors was underpinned by psychogenic theory. Potentially healing interactions between doctors and their patients that do not rely on the biogenic model of the visible body or the psychogenic model of invisible pain are needed to assist the communication between chronic pain patients and their doctors. A systemic theoretical analysis of this process is offered.

Beyond the needle: expanding the role of anesthesiologists in the management of chronic non-malignant pain.

Beyond the needle: expanding the role of anesthesiologists in the management of chronic non-malignant pain.