Duration of opening statement of patients attending a chronic pain clinic consultation.

BACKGROUND: The opening patient statement is an important part of the medical consultation. It is where after the initial solicitation the physician gets information about the patient's current problems and concerns. Previous research shows that 23-28% of patients are allowed to complete their opening statement un-interruptedly in the general practice setting. Interruption results in fewer patient concerns expressed and failure to gather potentially important patient information. OBJECTIVES: The objective of the study was to assess the duration of opening statements of patients attending a chronic pain clinic consultation. STUDY DESIGN: Prospective observational study SETTING: Chronic pain clinic. University teaching hospital METHODS: Following written informed consent, data was collected prospectively from 100 adult patients attending a chronic pain clinic consultation at a university hospital. We recorded the time of the opening statement following a standardized opening question by the pain physician. No verbal or non-verbal interruption by the physician was made during the patient's opening statement. RESULTS: Out of 100 adult patients, 37% (n = 37) were male and 63% (n = 63) were female. Mean age (years) was 54.4. The mean opening statement time was 89 s. LIMITATIONS: The study is limited by being a single-centered study. CONCLUSIONS: The duration of opening statements of patients attending a chronic pain clinic consultation when systematically studied takes a very short amount of time. It is important that all interruptions should be avoided. Our findings should encourage physicians to allow patients to complete their opening statements un-interruptedly in the chronic pain clinic.

Does Age Impact on Expectations and Concerns of Patients Attending a Chronic Pain Clinic?

BACKGROUND: Recognizing expectations and concerns of patients leads to more specialized management plans and greater adherence to treatment and improves outcomes. Little is known about how age impacts on expectations or concerns regarding pain in patients attending a chronic pain clinic. METHODS: We prospectively assessed the expectations and concerns of 100 adult patients at their first visit to a pain clinic. Patients reported their expectations and concerns for the clinic visit using a self-completed questionnaire. Categories of concerns and expectations were compared across age groups (≤ 65 years, > 65 years) using the chi-square test and Fisher's exact test. RESULTS: Thirty-nine patients (39%) were over 65 years of age (older patients). The most frequently stated site of pain was the lumbar spine for all patients regardless of age. Common concerns of all patients related to sleep and mobility, and the most common expectation related to analgesia. Younger patients were more concerned about employment (23% vs. 3% of older patients, P = 0.005) and social participation (21% vs. 5%, P = 0.03), whereas older patients were more likely to be concerned about mobility (46% vs. 15% of younger patients, P = 0.001). More younger patients expected education on the source of pain than did older patients (23% vs. 3%, P = 0.005), whereas older patients were more likely to be unsure or have no expectations (26% vs. 3%, P = 0.005). CONCLUSION: We found differences in patient expectations and concerns by age of those attending a chronic pain clinic. These differences can inform the communication process between physician and patient on treatment plans and outcomes.

Pain, Perceived Injustice, and Pain Catastrophizing in Chronic Pain Patients in Ireland.

Chronic pain is a public health concern affecting 20% to 30% of the population of Western countries. Psychological risk factors can worsen chronic pain patients. Themes of perceived injustice (PI) and pain catastrophizing are related to poor clinical outcomes. Particularly, perceived injustice has not been assessed systematically in patients at their first presentation in chronic pain clinics in Ireland. This study aims to assess the Injustice Experience Questionnaire (IEQ)'s internal consistency in the Irish population, assess PI in patients attending a chronic pain clinic in Ireland using the IEQ, investigate pain catastrophizing through the Pain Catastrophizing Scale (PCS) and its relationship with IEQ scores, and explore their relationships with self-reported Numeric Pain Rating Scale. One hundred adult patients were randomly selected from those attending the clinic for the first time. Eighty completed the IEQ (mean age 49 years, ranged 22 to 90 years; 59% female). The internal consistency of the IEQ was excellent (Cronbach's alpha = 0.93). Twenty-six patients (33%) had IEQ scores classified as severe. Patients whose cause of pain was trauma or road traffic accidents were more likely to have clinically severe scores than all other causes of pain (47% vs. 23%, P = 0.03). This has clinical consequences and may have legal implications. Pain catastrophizing scores were strongly correlated with IEQ (r = 0.60, P < 0.001). The correlation between IEQ and the Numeric Pain Rating Scale was weak (r = 0.25, P = 0.048). The results suggest that the IEQ may provide an additional tool to assess psychological contributors in problematic chronic pain patients and to institute targeted therapies to improve clinical outcomes.

A Comparison of Expectations of Physicians and Patients with Chronic Pain for Pain Clinic Visits.

BACKGROUND: The patient-physician encounter forms the cornerstone of every health service. However, optimal medical outcomes are often confounded by inadequate patient-physician communication. Chronic pain is estimated to affect over 25% of the population. Its effects are multifaceted with patients at increased risk of experiencing emotional and functional disturbances. Therefore, it is crucial to address all components of the patient's pain experience, including beliefs and expectations. It is our understanding that no other study to date has evaluated the expectations of physicians and compared them to those of patients for pain clinic visits. We sought to describe and compare expectations of chronic pain patients and their physicians during a clinic consultation. METHODS: We performed a retrospective review on patients attending the pain clinic for the first time who were enrolled and completed a questionnaire asking their expectations for their clinic visit as well as outcomes that would satisfy and disappoint them. Pain physicians were also included. We compared physicians' to patients' responses and evaluated relationships between patient responses and age, gender, pain location, Pain Self-Efficacy, Pain Catastrophizing Scale, and the Hospital Anxiety and Depression Scale. RESULTS: One hundred chronic pain patients and 10 pain physicians were surveyed. Patients' clinical expectations for visits focused primarily on some pain relief (34%), education on the cause of pain (24%), and a definitive diagnosis (18%). Physician's expectations included formulation and communication of a management plan (70%), patient assessment for cause of pain (50%), and the education of patients on the cause of pain (40%) as important aims. Pain relief would satisfy the majority of patients (74%) and physicians (70%). No improvement would cause greatest dissatisfaction for patients (52%), but causing more harm would be disappointing to physicians (50%). Gender, age, pain location, and sleep quality all significantly influenced patients' expectations and affective pain comorbidities. CONCLUSION: We found some agreement and some discordance of clinical expectations between pain patients and physicians. Patient factors may also impact on expectations and comorbidities. Findings from this study will help doctors consider patients' expectations in planning pain clinic visits, improve patient-doctor communication and pain management, and may lead to further hypothesis-driven studies.