General Practitioners Underestimate Intensity of Patients' Severe Pain (Reuters Health)
Originally published by Reuters Health, January 7, 2002
NEW YORK (Reuters Health) — Primary care physicians tend to rate their patients' pain intensity significantly lower than do the patients themselves, especially when the pain is chronic or severe, Finnish investigators report.
Twenty-eight primary care physicians from 25 health centres evaluated patients' pain intensity using a 100-mm visual analog scale (VAS). Data were collected for 1 week during each of the four seasons in 1996.
Dr. Pekka Mantyselka and colleagues of the University of Kuopio also requested the 738 patients, whose ages ranged from 16 to 75, to rate their pain intensity on a similar VAS as soon as possible after their office visit. The investigators divided the scales into five 20-mm units for the purpose of comparison.
As reported in the British Journal of General Practice for December, the physicians graded pain intensity at least one unit lower than did patients in 36.7% of visits, and at least two units lower in 20.5% of visits.
The nonconcordance between patients' and physicians' assessments increased with pain severity, so that at the highest grade perceived by patients, physicians rated pain lower in 82.2% of the visits. The disparity was also greater when the reason for the visit was chronic as opposed to acute pain.
Dr. Mantyselka's team recommends that general practitioners ask patients to rate their pain intensity and that that evaluation should be "accepted as a standard in assessing pain intensity, particularly in monitoring the response to treatment," they write.
In clarifying the findings, the Finnish investigators maintain that nonconcordance between the two assessments could indicate "complex problems behind the pain."
