Chronic Pain
Conditions
Keywords
chronic pain
Brief summary
The investigators are seeking to determine factors associated with difficult patient encounters in an academic pain clinic. The investigators are examining 36 different variables to determine the association with difficult patient encounters as independently rated by a trainee and attending physician.
Detailed description
Pain is associated with significant psychosocial pathology include axis 1 diagnoses, opioid use and misuse, unemployment, and strained relationships, and treatments for chronic pain are often ineffective. Collectively, these factors may result in a higher prevalence of patients characterized as 'difficult', which can lead to missed diagnoses, barriers to care resulting in poorer outcomes (professional pessimism, mistrust, passive treatment, referrals to other providers or discharge), patient complaints and 'HERO' events, avoidable legal claims, and increased risk of professional burnout. Characterizing patients as difficult (instead of encounters) may have negative consequences for future care, and there are few studies that have explored patients' perspectives on difficult encounters. Although several articles have narratively explored this issue, there are few targeted at chronic pain patients, and no studies in this population that set out to determine what variables are associated with a difficult encounter, the congruence between patients' and providers' impressions of an encounter, or whether difficult encounters are associated with pain treatment outcome.
Interventions
OTHERPain treatment
Any pain treatment to include medications, procedures, or referrals
Sponsors
Johns Hopkins University
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Inclusion criteria
* ≥ 18 years of age * Pain duration \> 3 months * New Visit (or no visit within 3 years)
Exclusion criteria
* Referral only for diagnostic procedure * Friend or relative, or direct referral from friend or relative
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Difficulty of encounter as rated by trainee | Immediately after consult | Difficulty of encounter as rated by a 6-point Likert scale (1=very pleasant, 6=extremely difficult) |
| Difficulty of encounter as rated by attending physician | Immediately after consult | Difficulty of encounter as rated by a 6-point Likert scale (1=very pleasant, 6=extremely difficult) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Categorical success | 1-2 months post-treatment | Binary measure of success (2-point or greater decrease in average pain score coupled with a score of 5 or greater on Patient global impression of change scale) |
| Patient global impression of change | 1-2 months post-treatment | 1-7 Likert scale (1=no change or worse, 7=a great deal better) |
| Number of side effects | 1-2 months post-treatment | Side effects from medications or complications from procedures |
| Appointment status | 1-2 months post-treatment | Showed up on time or showed up late or missed appointment |
| Pain score | 1-2 months post-treatment | 0-10 numerical pain scale (0=no pain, 10= worst pain imaginable) |
Countries
United States
Outcome results
None listed