Management of chronic pain among older patients: Inside primary care in the US

Authors

  • Ming Tai-Seale,

    Corresponding author
    1. Palo Alto Medical Foundation Research Institute, CA 94301-2302, United States
    2. Texas A&M Health Science Center, School of Rural Public Health, United States
      Palo Alto Medical Foundation Research Institute, Ames Building, 795 El Camino Real, Palo Alto, CA 94301-2302, United States. Tel.: +1 650 853 4779; fax: +650 853 4835. tai-sealem@pamfri.org
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  • Jane Bolin,

    1. Texas A&M Health Science Center, School of Rural Public Health, United States
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  • Xiaoming Bao,

    1. Texas A&M Health Science Center, School of Rural Public Health, United States
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  • Richard Street

    1. Texas A&M University, United States
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Palo Alto Medical Foundation Research Institute, Ames Building, 795 El Camino Real, Palo Alto, CA 94301-2302, United States. Tel.: +1 650 853 4779; fax: +650 853 4835. tai-sealem@pamfri.org

Abstract

Under-treatment of pain is a worldwide problem. We examine how often pain was addressed and the factors that influence how much time was spent on treating pain.

We analyzed 385 videotapes of routine office visits in several primary care practices in the Southwest and Midwest regions of the United States. We coded the visit contents and the time spent on pain and other topics. Logistic regression and survival analyses examined the effects of time constraint, physician's supportiveness, patient's health, and demographic concordance. We found that discussion of pain occurred in 48% of visits. A median of 2.3 min was spent on addressing pain. The level of pain, physician's supportiveness, and gender concordance were significantly associated with the odds of having a pain discussion. Time constraints and racial concordance significantly influenced the length of discussion.

We conclude that despite repeated calls for addressing under-treatment for pain, only a limited amount of time is used to address pain among elderly patients. This phenomenon could contribute to the under-treatment of pain.

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