“It Encourages Them to Complain”: A Qualitative Study of the Unintended Consequences of Assessing Patient-Reported Pain

Sangeeta C. Ahluwalia, Karleen F. Giannitrapani, Steven Dobscha, Risa Cromer, Karl A. Lorenz

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

The “Pain as the 5th Vital Sign” initiative intended to address undertreatment of pain by encouraging routine pain assessment and management. In the Veterans Health Administration, routine pain screening has been practiced in primary care for more than a decade, but has not improved the quality of pain management measured using several process indicators, and some have expressed concerns of potentially fostering undesirable use of prescription opioids. We sought to evaluate the consequences of routine pain screening on clinical practice. We conducted 9 interdisciplinary focus groups with 60 primary care providers and staff from 5 outpatient Veterans Health Administration clinics. We identified 5 themes reflecting 1 intended and 4 unintended consequences of routine pain screening: it 1) facilitates identification of patients with pain who might otherwise be overlooked, 2) may need to be targeted toward specific patients and contexts rather than universally applied, 3) often shifts visit focus away from more emergent concerns, 4) may encourage “false positives” and prompt providers to intervene when treatment is not a priority, and 5) engenders a “pain problem” and hinders patients from considering alternative strategies. These findings suggest changes to support patient-centered pain assessment and improve targeted screening and interventions for population pain management. Perspective: This article describes some of the potential unintended consequences of implementing routine pain screening in primary care. This information may help clinicians be more strategic in their consideration and use of pain screening among their patients.

Original languageEnglish (US)
JournalJournal of Pain
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Pain
Pain Management
Veterans Health
Primary Health Care
United States Department of Veterans Affairs
Pain Measurement
Foster Home Care
Vital Signs
Focus Groups
Opioid Analgesics
Prescriptions
Outpatients
Population

Keywords

  • focus groups
  • pain management
  • Pain measurement
  • primary health care
  • screening

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology
  • Anesthesiology and Pain Medicine

Cite this

“It Encourages Them to Complain” : A Qualitative Study of the Unintended Consequences of Assessing Patient-Reported Pain. / Ahluwalia, Sangeeta C.; Giannitrapani, Karleen F.; Dobscha, Steven; Cromer, Risa; Lorenz, Karl A.

In: Journal of Pain, 01.01.2018.

Research output: Contribution to journalArticle

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