PROPERW OF ~E “ 

PUBLICATIONS f3RANCh 

EDITORIAL
 LIBWY


The Management of New Pain in Office-Based Ambulatory 

Care National Ambulatory Medical Care Survey, 

1980 and 1981 

by Dee A. Knapp, Ph. D., University of Maryland at Baltimore, and Hugo Koch, Division of Health Care Statistics 

a 

Q 

Introduction 

The office-based practitioner is no stranger to the manageent of acute and chronic pain. The problem of diagnosing and 

sting pain-producing conditions is especially challenging 

when the pain and its associated morbidity are encountered for 

the first time in a particular patient-that is, at the sc+called 

new-pain visit. The purpose of this report is to present and 

analyze some of the defining features of these new-pain visits. 

To accomplish this end, the authors combined the 1980 and 

1981 findings of the National Ambulatory Medical Care Survey, an annual sample survey of office-based physicians conducted from 1973 through 1981 by the National Center for 

Health Statistics. 

Because the estimates presented in this report are based 

on a sample rather than on the entire universe of office visits, 

they are subject to sampling variability. A brief description of 

the sample design and guidelines for judging the precision of the 

estimates is provided in the “Technical notes” at the end of 

the report. Also provided are definitions of key terms used in 

the survey. 

The reader will fmd it useful to refer to the data collection 

instrument (figure 1: Patient Record, National Ambulatory 

Medical Care Survey) as selected aspects of new-pain visits 

are discussed. 

Data highlights 

Over the 2-year span from January 1980 through Decemr 1981, ambulatory patients made 1.2 billion visits to the 

Ices of non-Federal, oftice-based physicians practicing in 

the coterminous United States. Of this total, 70,259,000 

(6.1 percent) were new-pain visits. A new-pain visit is distinguished by the following characteristics: 

. The visit was unreferred (figure 1, item 13). 

. Pain was the chief symptom presented by the patient 

(figure 1, item 6a). 

� The physician had not previously seen the patient for the 

condition associated with the pain (figure 1, item 10). 

Symptoms 

The pain symptoms most frequently associated with the 

new-pain visits are listed in table 1. (See figure 1, item 6a.) 

Symptoms have been classified and coded according to a previous publication. 1 

Though the list is headed by such diverse complaints as 

earache, headache, and general chest pain, it is musculoskeletal 

pain-with upper or lower back pain predominant—that accounts for the largest proportion (41 percent) of the pain symptoms associated with the new-pain visits. 

Diagnostic effort 

Confronted with a new-pain symptom, the ofice-based 

practitioner tends to intensify the diagnostic effort required to 

find its cause. At virtually every new-pain visit, one or more of 

the diagnostic procedures appearing in figure 1, item 8, was 

ordered or provided. Considering the dominating presence of 

lNatio~~ cen~r for Hedti Statistics, D. Schneider, L. Appleton. and T. 

McLemore: A reason for visit classification for ambulatory care. Vital and 

Health Statistics. Series 2, No. 78. DHEW Pub. No. (PHS) 79-1352. Public 

Health Service. Washington. U.S. Government Printing OtTice, Feb. 1979. 

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service 
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ASSURANCE OF C0NF8DENTALl TV-All (“form,,,.” wh,ch WO”ld D,,m,, >d,n,#!,ca,,on Dewrl mm! 01 H@!h, Ed. cm,on, an,l Welfwt 

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by !xrmm ensawd ,0 and 10. the purpose%.1 the survey and w,l! n., be d,s.lmed .x ,0 Of f,., 01 H,,l!h R.!,, r,h S,,,, s,,., >n,, T,.co,,. I CNO.499932 I,,,o, Iea,ed to O,M, II,’,.”, ., “$?d 10, ,“, other c.., nme 

lm DATE OF VISIT PATlENT RECORD Y 

// NATIONAL AMBULATORY MEDICAL CARE SURVEY 

4mCOLOR OR RACE 5. ETHNICITY & PATI ENT’S COMPLAINT(S), SYMPTOM(S), OR OTHER 

I � WHITE 

REASON(SI FOR ~VISIT /In patient’s own words) 

I


I 

2 � BLACK 1 � Hl&:AN~ ,. MOST IMPORTANT


3 � A51ANfPAc[Flc 2 � NOT ISLANDER HISPANIC b. OTHER 

a � AMERICAN INDIAN/ 

ALASKAN NATIVE 

7. MAJOR REASON FOR THIS am DIAGNOSTIC SERVICES THIS VISIT 9mPHYSICIAN’S DIAGNOSES 

VISIT [Check onej fCheck all ordered u. provided] 

I � fdONE 8D EKG s PRlhICIPAL OIAGNOSIWPROBLEM ASSOCIATE WITH ITEM 64 

1 � ACLITEF’ROBLEM 2 � LIMITEO HISTORY/EXAM, 9 � VISION TEST 

2DCHRON,CPROBLEM, ROUT,NE 3 � GENERAL HISTORY/EXAM. 10 � ENDOSCOPY 

3 � cHRONIc PROBLEM, FLAREUP 4 � pAP TEST 11 � M:::Q,’ STATUS 

4 � PosTsuRGERY/PosT INJuRY 

5 � f40M.ILLN ESS CARE IROUTINE 

5 HCLIfWCAL LAB TEST 

6 � X.RAY 

1, � OTHEFi mp<,fj 

b, OTHER SIGNIFICANT CURRENT DIAGNOSES 

PRENATAL, GENERAL EXAM., 

WELL BABY, ETC. ) 7 � BLOOO PRESSURE CHECK 

100 HAVE YOU SEEN llm MEDICATION THERAPY THIS VISIT 

PATl ENT BEFORE? / Using brand or generic names, record all new and continued medications ordered, injected, administered, or otherwise 

provided at this visr. Include immunizing and desensitizing agen ts/ 

d. FOR PRINCIPAL DIAGNOSES IN lTEM 9,. 

,DYES 2DN0 

1, 

I 

IF YES, FOR THE 

CONOITION IN 2. 

ITEM 92.7 

3. 

] � YES 2 � NO 

4, 

lzm	 NON-MEDICATION THERAI [3. WAS PATIENT 

ordered or provided rhis visir/ REFERRED 

FOR THIS VISIT 

1 � NONE 6 � OIET COUNSELING 

BY A~HER 

PHYSICIAN? 

2 � pHy510THERAPY 7 � F*MiLy/50clAL 

COUNSELING 

[Check all services

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4DFAM!LYPLANNING 

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THERAPEUTIC LISTENING 2DN0 

F’HS-61 05-C (9/79) 

b. FOR ALL OTHER REASONS, 

1, 

2, 

3, [ 

4, 

J4. ;;I.::S:;I:HJ5JIS1T 15, ::RAT(3N 

VISIT � NO FOLLOW.UP PLANNEO [Time actually 

� RETURN AT5PECIFIED TIME	 spent with 

physician /

� RETURN IF NE EOEO, P.R, N, 

� TELEPHONE FOLLOW..PPI.ANNEO 

� REFERREOTO OTHER PHYSICIAN 

� RETURNEOTO REFERRING PHYslciAN 

� AOMITTO HOSPITAL 

M,”uw � OTHER (SPWIV 

OMB No. 6B-R149S 

Figure 1. National Ambulatory Medical Care Survey Patient Record, 1980 and 1981 

musculoskeletal pain, it is not surprising to find that X-ray was 

utilized about three times as often at the new-pain visit as it 

was at the average ofllce visit. .A visit for what is perhaps the 

most ominous of new-pain symptoms—general chest pain—is 

three times as likely to elicit an EKG as the average ofllce visit 

and twice as likely to elicit a blood pressure reading. 

Diagnoses 

Findings on the principal (first-listed) diagnoses associated 

with new-pain visits are presented in tables 2 and 3. (See figure 1, 

item 9a. ) In most cases their agreement with the symptoms in 

table 1 is Close. For example, a new earache most frequently 

signals the presence of an otitis media or a disorder of the external ear. Musculoskeletal pain, presented at 41 percent of 

new-pain visits, results in a corresponding 40 percent of diagnoses being identified as injuries or diseases of the muscul 

skeletal system. The ominous overtones of chest-pain sy 

toms are for the most part relieved by the finding that *th 

symptoms were most frequently linked to respiratory disease, 

musculoskeletal problems, or disorders of the digestive system. 

At only 6 percent of the 6,485,000 visits with new chest pain 
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Table 1. Number and percent distribution of new-pain visits by selected principal reasons for visit United Statas, 1980 and 1981 

Number of 

visits in Percent 

* 

m 

* 

enk Principal reason for pain visit and RVC codei ~ thousands distribution 

All principal reasons . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Earache, pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 355.1 

Chest pain and related symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...050.0 

Headache, pain in head . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...210.0 

Back pain, ache, soreness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...905.1 

Low bsckpain, ache, soreness.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..910.1 

Stomach pain, cramps, spasms... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 545.0 

Abdominal pain, cramps, spasms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..550.0 

Knee pain, ache, soreness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . ...925.1 

Pain, site not referrabla to specific body system . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...055.0 

Shoulder psin, ache, soreness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...940.1 

Foot andtoepain, ache, soreness. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 935.1 

Neck pain, ache, soreness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..900.1 

Painful urination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...650.0 

Leg pain, ache, soreness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...920.1 

Pain and related symptoms, generalized, site unspecified . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...060.0 

Armpain, ache, soreness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...945.1 

Eye pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 320.1 

Hand and finger pain, ache, soreness. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...960.1 

Hippain, ache,. soreness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 915.1 

Ankle pain, ache, soreness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..930.1 

Pain orsoreness of breast . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 800.0 

Elbow pain, ache, soreness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 950.1 

Wriatpain, ache, soreness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..955.1 

Pain in anus-rectum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..605.1 

Another pain reasons3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

70,259 100.0 

8,761 12.5 

6,485 9.2 

6,190 8.8 

5,939 8.5 

4,068 5.8 

3,375 4.8 

3,086 4.4 

3,068 4.4 

2,951 4.2 

2,817 4.0 

2,625 3.7 

2,334 3.3 

2,108 3.0 

2,039 2.9 

1,592 2.3 

1,509 2.1 

1,434 2.0 

1,292 1.8 

1,027 1.5 

935 1.3 

817 1.2 

743 1.1 

729 1.0 

710 1.0 

3,625 5.2 

1Based on codes in National Center for Health Statistics, D. Schneider, L Appleton, and T. McLemore A reason for visit classification for ambulatmy care [RVC]. 

Vita/ and Hea/th Statistics. Series 2, No. 78. DHEW Pub. No. (PHS) 79-1352. Public Health Service. Washington. U.S. Government Printing Office, Feb. 1979. 

nly principal reaaons accounting for al.0 percent of new-pain visits are listed. 

cludea the following symptom RVC codes 265.0,410.1, 455.2, 500.2, 510.1, 515.1, 610.1, 665.1, 670.1, 700.1.715.1, 745.2, 765.1, 775.1, 790.1, 790.4, 825.0, 

0.1, 965.1,970.1, 980.0. 

Table 2. Number and percent distribution of new-pain visits by salacted principal diagnostic classes Unitad States, 1980 and 1981 

Number of 

visits in Percent 

Rank Principal diagnostic class and ICD-9-CIU codes~,2 thousands distribution 

Allprincipal diagnostic classes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70,259 100.0 

Musculoskeletal and connective tissue diseases . . . . . . . . . . . . . . . . . . . . . ...,,..................710-739 15,711 22.4 

Injuries and poisonings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...800-999 12,336 17.6 

Nervous aystemand sense organ diseases. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...320-389 9,780 13.9 

Genitourinary diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ., ...,...................580-629 5,929 8.4 

Digestive diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...520-579 5,639 8.0 

Respiratory diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...460-519 5,509 7.8 

Symptoms, signs, andill-defined conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...780-799 3,803 5.4 

Circulato~ diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...390-459 2,641 3.8 

Supplementary classification3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. VO1-V82 1,687 2.4 

Skin andsubcutaneous tissue diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...680-709 1,659 2.4 

Infectious and parasitic diseases.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...001-139 1,650 2.3 

Mental disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...290-319 1,634 2.3 

Endocrine, nutritional, and metabolic diseases and immunity disorders . . . . . . . . . . . . . . . . . . . . . . ...240-279 743 1.1 

1Based on U.S. Public Health Sewice and Health Care Financing Administration: /ntematiorra/ C/assificat/on of Disaases, 9?h Ravision, Clinical Modification 

[ICD-9-CM]. DHHS Pub. No. (PHS) 80-1260. Public Health Service. Washington. U.S. Government Printing Office, Sept. 1980. 

20nIY pfincipal diagnosis classes accounting for >1.0 percent of new-pain viaita are fisted. 

Scontains categories for entries other than diseases and injuries. 

as the chief presenting symptom dld the pain signal a clear or Patient characteristics 

uspected angina pectoris; at only 1.5 percent was the diagnosis 

e of isehemic heart disease; and fewer than 1 percent of the It was noted earlier that new-pain visits accounted for 

sits were listed as an acute myocardial infarction. (Interest- 6.1 percent of all oflice visits. Expressed as a new-pain rate, 

ingly, another 6 percent of the chest-pain visits were treated as this amounted to an average of61 new-pain visits per 1,000 

“neurotic disordera,” more than double the average appearance ofilce visits. The extent to which this average rate fluctuates 

of these diagnoses in office practice.) with patient age and sex is shown in table 4 and figure 2. Ac-
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Tabla 3. Numbar and parcent distribution of new-pain visita by selected principal diagnoses United States, 1980 and 1981 

Number of 

visits in Percent 

Rank Principal diagnosis and ICD-9-CM code~ p thousands distribution* 

All principal diagnoses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70,259 1oo.oSuppurative andunspecified otitis media. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...382 4,176 5,9 

Peripheral enthesopathies andalliad syndromes. . ., . .,, . . . . . . . . . . . . . . .,...................,.....726 2,482 3.5 

Sprains andstrains ofother andunspecifiad parts of back.....,,.,....,,.,.. . . . . . . . . . . . . . . . . . . ...847 2,407 3.4 

Other soft tissue disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...729 2,341 3.3 

Other andunspecified back disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...724 2,214 3.2 

External ear disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...380 2,135 3.0 

Sprains andstrains of sacroiliac region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ,, . . . . . . . . . . . . . . . . . . . . . ...846 1,866 2.7 

Other andunspecified arthropathias. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ,, . . . . . . . . . . . . . . . . . . . . . . ...716 1,302 1.9 

Other synovium, tendon, and bursa disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 727 1,222 1.7 

Osteoarthrosia and allied disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..715 1,142 1.6 

Acute upper respiratory infections of multiple or unspecified sites . . . . . . . . . . . . . . . . . . . . ., . . . . . , . . . ...465 ,120 1.6 

Cystitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...596 ,110 1.6 

Other urethra andurina~ tract disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...599 ,089 1.6 

Other andill-defined sprains and strains . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...848 ,070 1.5 

Symptoms involving respirato~ system and other chest symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...786 921 1.3 

Influenza . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...487 840 1.2 

Symptoms involving head and neck. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...784 819 1.2 

Chronic sinusitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...473 811 1.2 

Other symptoms involving abdomen and pelvis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...789 771 1.1 

Intervertebral disc disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...722 766 1.1 

Sprains andstrains ofankle and foot. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .,.,.......,,....,.,,....846 757 1.1 

Special mental disorder symptoms or syndromes, not elsewhere classified. ., , ., . . . . . . . , . . . . . . . . . . ...307 748 1.1 

Gastritis andduodenitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...535 712 1.0 

Other noninfectious gaatroenteritis and colitis, ,,, , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 558 695 1.0 

Neurotic disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...300 692 1.0 

Other andunspacified joint disorders. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ., .,,.....,,.,....,.,.....719 687 1.0’ 

Muscle, ligament, and fascia disordera . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..’728 682 1.0 

1Baaed on U.S. Public Hsalth Service and Public Health Care Financing Administration: hrtemetional C/assific8tion of Diseases, 9th Revision, C/inica/ Modification 

~Cl)-9-Ck4]. DHliS l%,. No. (PHS) 80-1260. Public Health SetVice. Washington. U.S. Government Printing Office, Sept. 1980. 

Only principal diagnoaes accounting for ~1.0 percent of new-pain visits are listed. � 

Table 4. Number of office visits, number and parcent distribution of new-pain visits, and new-pain visit rate by patiant age and sex-age groups: 

United States, 1980 and 1981 

All office 

Patient age and sex visits New-pain visits 

Number in Number in Percent New-pain 

Both sexes thousands thousands distribution visit ratel 

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,160,922 70,259 100.0 61 

Under 15 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 216,129 10,982 15.6 51 

15-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 160,795 11,304 16.1 70 

25-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 310,3B4 22,313 31.8 72 

45-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 265,700 16,B53 24.0 63 

65 years and over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207,914 8,806 12.5 42 

/ 

Female 

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 699,718 40,840 58.1 58 

Under 15 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102,633 5,462 7.8 53 

15-24 yaars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107,276 6,634 9.4 62 

25-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 206,395 12,B54 18.3 62 

45-64 years................,.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157,031 10,252 14.6 65 

65 years and over . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . 1 . . . . . . . . . . . . . . . . . . . 126,383 5,63B B.O 45 

Male 

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 461,204 29,419 41.9 64 

Under 15 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

15-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

25-44 years, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

113,495 

53,519 

103,990 

5,521 

4,671 

9,459 

7.9 

6.6 

13.5 

49 

87 

91 � 

45-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108,668 6,600 9.4 61 

65 years and over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81,532 3,169 4.5 39 

1Number of new-pain visits per 1,000 office visits 
admcdaa5 

95 

r 91 

87 ~de ~-

-N 

85 \ 

/ \ 

75 / 

72 \ 

/ 70 

/p \ 

/ 

65 / 

/ #9--------

55 

53 

49 

45 

is. All patients ‘ 39 

35 = . Male patients 

_ . _ Female patients 

0 1 I I I I 

Under 15–24 25-44 45-64 65 years 

15 years years years years and over 

Age of patient 

Figure 2. New-pein visit rates bysexend ageof patient United States, 1980-1981 

cording to the findings, new-pain visits were most frequent 

among patients in age group 15–44 years. It is among these 

patients, for example, that many pain-producing injuries and 

acute diseases are most prevalent or that the physician observes 

the first warning signals of painfi,d, chronic diseases that will 

continue into the later years of life. At the older extreme of the 

age spectrum the volume and rate of new-pain visits are at their 

lowest point. With this group the physician is probably more 

concerned with the management of chronic pain, which lost its 

newness some time before. New-pain visit rates for male and 

female patients do not differ markedly in the age groups under 

15 years or over 44 years. It is in the age interval fkomthe 15th 

to the 45th year that sex differences are most notable, revealed 

in male rates that substantially exceed those for female patients. In large part, this finding is explained by diagnostic evidence that the proportion of accidents or injuries in this age 

group was almost twice as great among male office patients as 

ong females. a Variations in new-pain visit rates as they occurred among

lected racial or ethnic groups of office patients are examined 

- in table 5. Between black and white patients the apparent difference is not sufficiently marked to demonstrate statistical 

significance. (Much of it could be accounted for by sampling 

‘error.) It would be premature to infer that the sign~lcantly higher 

Hispanic rate points to any special ethnic predisposition toward 

the new-pain conditions. The difference may simply be due to 

the relative fractions of visits by patients in the 15–44 years of 

age interval-the interval with the highest volume and rate of 

new-pain visits. This proportion was about 7 percent higher 

among Hispanic patients than it was for their non-Hispanic 

counterparts. 

Physician characteristics 

The extent to which the various office-based specialties 

were involved in the new-pain visits is documented in table 6. 

In magnitude of new-pain visit rate (number of new-pain visits 

per 1,000, office visits), three specialties were appreciably 

more active than others; these were general or family practice, 

internal medicine, and orthopedic surge~. Owing to the essentially primary nature of a new-pain visit, it is not surprising that 

two of these three are conventionally classified as primary care 

specialties. In total volume of visits, the three specialties accounted for about 7 of every 10 new-pain visits. 

Chiefly owing to their traditional involvement with musculo 

skeletal problems, it was predictable that osteopathic physicians 

would reveal a higher new-pain visit rate (77 per 1,000 visits) 

than doctors of medicine (59 per 1,000). 
6 

Table 5. Number of office visits, number and percent distribution of new-pain visits, and new-pain viait rate by patient race and Hispanic origin: 

United States, 1980 and 1981 

All office 

Patient race and Hispanic origin visits New-pain visits 

Number in Number in Percent New-pain 

thousands thousands distribution visit ratel 

All patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,160,922 70,259 100.0 61 

Raca2 

White . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,037,590 61,842 88.0 60 

Black . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110,546 7,384 10.5 67 

Hispanic origin 

Hispanic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 538337 4,064 5.8 76 

Non-Hispanic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,107,585 66,195 94.2 60 

1Number of new-pain viaita per 1,000 office viaita. 

‘Excludes 12,786,000 office viaita by members of other racial groups such as American Indian or Asian. 

Tabla 6. Number of office visits, number and parcent distribution of new-pain visits, and naw-pain viait rate by physician spaciaky: United 

States, 1980 and 1981 

All office 

Physician specialty visits New-pain visits 

Number in Number in Percent New-pain 

thousands thousands distribution visit rate! 

Allspecialtias . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,160,922 70,259 100.0 61 

General and family practice . . 

Internal medicine . . . . . . . . . . 

Pediatrics . . . . . . . . . . . . . . . . 

. 

. 

. 

. . . . . . . 

. . . . . . . 

. . . . . . . 

. 

. 

. 

. 

. 

. 

. . . . . . 

. . . . . . 

. . . . . . 

. 

. 

. 

. 

. 

. 

. . . . . 

. . . . . 

. . . . . 

. . . 

. . . 

. . . 

. 

. 

. 

. 

. 

. 

. . . . . . 

. . . . . . 

. . . . . . 

. 

. 

. 

. . . . . . 

. . . . . . 

. . . . . . 

381,710 

144,172 

128,762 

33,966 

9,952 

6,181 

48.3 

14.2 

8.8 

89 

69 

48 � 

Obstetrics and gynecology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ,. 109,035 3,148 4.5 29 

Ophthalmology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62,485 1,561 2.2 25 

General surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61,013 3,207 4.6 53 

Orthopedic surge~ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55,470 6,105 8.7 110 

Otolaryngology . c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26,151 1,190 1.7 46 

Cardiovascular disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14,781 783 1.1 53 

Urology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19,470 546 0.8 28 

Another specialties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...’. 

1Number of new-pain visits per 1,000 office visits. 

Treatment 

Ordered or provided at about 62 percent of all office visits, 

drug therapy is by far the most popular form of treatment in 

‘offIcepractice. For new-pain visits, the utilization of drugs (at 

70 percent of these visits) was even more intensive. The 25 

drugs most fi’equently mentioned in the treatment of new-pain 

conditions are listed (using generic names) in table 7. On this 

list the largest single proportion of mentions (about 36 percent) 

tie analgesics; the next largest fraction (33 percent) are antiinfectives; and the balance of the mentions are distributed difl’ksely among such drug classes as autonomic drugs, antiinflammatory agents, antihistamines, diuretics, and the sedativehypnotics. Perhaps the most useful insight to be derived from 

these findings is not the expected fact that the analgesic family 

dominated other drug families in frequency of mention, but 

rather the discovery that the utilization of analgesics was substantially less intensive than might have been anticipated. After 

all, every one of the new-pain visits was, by definition, associ­

. . . . . . 157,873 3,620 5.1 23 

ated with pain of varying degrees of severity. The obvious conclusion is that it would be a mistake to assume that an analgesic 

is routinely ordered whenever new pain appears as a symptom. 

The findings suggest that drug therapy at new-pain visits is 

more strongly linked to the associated diagnosis than it is to the 

pain that attends that diagnosis. 

At 38 percent of the 70,259,000 new-pain visits, drug 

therapy was the only form of treatment utilized. At another 

32 percent it was used in conjunction with some form(s) of 

nondrug therapy. (See figure 3 and table 8.) Thus, only at the 

remaining 30 percent of the new-pain visits did physicians 

choose an alternative approach that did not involve drug treatment. At about one-half of these nondrug visits, physicians 

specified the form of nondrug therapy used. At the remaini 

half of the nondrug visits, no alternative nondrug therapy w 

specified. In these cases, it seems safe to infer that physicianm 

were at least partly relying on the self-restorative capacities of 

the body as an alternative to intervention by drugs or other 

means of treatment. 
1

2

3

4

5

6

7 .

8

9

10

11

12

7


Table 7. Number of mentions and percent distribution of the 25 drugs most frequently ordered or provided for principal diagnosas of new-pain 

visits by generic name of drug: United States, 1980 and 1981 

Number of Number of 

mentions in Percent mentions in Percent 

Rank Generic neme of drug thousendsl distribution Rank Generic name of drug thousandsl distribution 

Top25 drugs . . . . . . . . . . . . . . . . . 58,857 100.0 13 Polymixin B . . . . . . . . . . . . . . . . . . 2,201 3.7 

Aspirin . . . . . . . . . . . . . . . . . . . . . . 

Acetaminophen . . . . . . . . . . . . . . . 

6,863 

4,695 

11.7 

8.0 

14 

15 

Hydrocortisone . . . . . . . . . . . . . . . 

Bacitracin . . . . . . . . . . . . . . . . . . . . 

2,108 

1,907 

3.6 

3.2 

Ampicillin . . . . . . . . . . . . . . . . . . . . 2,662 4.5	 16 Chlorpheniramine . . . . . . . . . . . . . 1,898 3.2 

17 Sulfamethoxazole . . . . . . . . . . . . . 1,757 3.0 

Phenylpropanolamine. . . . . . . . . . 2,607 4.4 18 Hydrochlorothiazide . . . . . . . . . . . 1,709 2.9 

Amoxicillin . . . . . . . . . . . . . . . . . . . 2,560 4.3 

Neomycin . . . . . . . . . . . . . . . . . . . . 2,531 4.3 19 Erythromycin . . . . . . . . . . . . . . . . . 1,638 2.8 

2.8 

Penicillin . . . . . . . . . . . . . . . . . . . . 2,529 4.3 20 Trimethoprim . . . . . . . . . . . . . . . . . 1,632 

2.7 Caffeine . . . . . . . . . . . . . . . . . . . . . 2,481 4.2 21 Hyoscyamine . . . . . . . . . . . . . . . . . 1,612 

2.7 Phenacetin . . . . . . . . . . . . . . . . . . . 2,410 4.1 22 Propoxyphene . . . . . . . . . . . . . . . . 1,598 

2.6 

Ibuprofen . . . . . . . . . . . . . . . . . . . . 2,398 4.1 23 Phenylbutazone . . . . . . . . . . . . . . . 1,521 

24 Codeine . . . . . . . . . . . . . . . . . . . . . 1,461 2.5 

Phenylephrine . . . . . . . . . . . . . . . . 2,339 4.0 

25 Phenobarbital . . . . . . . . . . . . . . . . 1,459 2.5 

Pseudoephadrine. . . . . . . . . . . . . . 2,281 3.9 

lCombines the mentions of a ganeric substance as a single-ingrediant agent with ita mentions as an ingredient of a fixed-combination drug. 

III Alternatives 

to drug 

therapy 

� Drug 

therapy 

L. 

Figure 3. Percent of new-pain visits by treatmant modalities 

Unitad States, 1980 and 1981 

Duration and followup instruction 

Physician-patient contact was somewhat longer for the 

average new-pain visit than it was for the office visit in general 

(table 9), a difference probably due to the increased intensity of 

diagnostic effort at the new-pain visit. 

As documented in table 10, the physician’s followup of 

Table 8. Percent of visits by most frequant forms of nondrug 

therapy: United Statas, 1980 and 1981 

Nondrug therap y All visits New-pain visits 

Percent 

Physiotherapy . . . . . . . . . . . . . . . . . . . . . 4.8 12.2 

Medical counseling . . . . . . . . . . . . . . . . . 23.0 27.5 

Table 9. Percant of visits by duration of physician-patient contact: 

United States, 1980 and 1981 

Duration All visits New-pain visits 

Percent 

l-l O minutes . . . . . . . . . . . . . . . . . . . . . 42.7 38.8 

llminutes or longer . . . . . . . . . . . . . . . 54.7 60.7 

Table 10. Percent of visits by selectad forms of followup 

instructions for visits United States, 1980-81 

Fo\IowuP All visits New-pein visits 

Percent 

No followup planned . . . . . . . . . . . . . . . . 11.5 12.3 

Return at specified time . . . . . . . . . . . . . 60.7 42.8 

Return ifnaeded . . . . . . . . . . . . . . . . . . . 22.7 34.8 

Telephone followup planned . . . . . . . . . 3.4 6.5 

new-pain conditions was substantially less specii3c than it was 

for office visits in general. Helped to an undetermined extent 

by the self-restorative capacities of the body, the treating physician placed a below-average reliance on the formal return 

visit and an above-average reliance on the more tentative “tele­

@ phone followup” or “return if needed.”
8 admncedata 

Technical notes 

Source of data and sample design 

The estimates presented in this report are based on the 

findings of the National Ambulatory Medical Care Survey 

(NAMCS), a sample survey of ofice-based care conducted 

annually from 1973 through 1981 by the National Center for 

Health Statistics. The target universe of NAMCS is composed 

of office visits made by ambulatory patients to non-Federal 

and noninstitutional physicians who are principally engaged in 

oftlce-based, patient-care practice. Visits to physicians practicing in Alaska and Hawaii are excluded from the range of 

NAMCS, as are visits to anesthesiologists, pathologists, and 

radiologists. 

NAMCS uses a multistage probability sample design that 

involves a stepwise sampling of primary sampling”unit$,physicians’ practices within primary sampling units, and patient 

visits within physicians’ practices. The physician sample 

(5,805 for the combined years 1980 and 1981) was selected 

from master files maintained by the American Medical Association and the American Osteopathic Association. Those 

members of the sample who proved to be in scope participated 

at a rate of 77.3 percent. Responding physicians completed 

visit records (figure 1) for a systematic random sa&ple o?their 

ofllce visits made during a randomly assigned weekly reporting 

period. Telephone contacts were excluded. During 1980 and 

1981 responding physicians completed a 2-year total of 89,447 

Patient Record forms on which they recorded 97,796 drug 

mentions. Characteristics of the physician’s practice, such as 

prima~ specialty and type of practice, were obtained during an 

induction interview. The National Opinion Research Center, 

under contract to the National Center for Health Statistics, 

was responsible for the field operations of the survey. 

Sampling errors, statistical significance, 

and rounding 

The standard error is a measure of the sampling variability 

that occurs by chance because only a sample, rather than the 

entire universe, is surveyed. The relative standard error of an� estimate is obtained by dlvidlng the standard error by the estimate itself and is expressed as a percent of the estimate. Table I 

should be used to obtain the relative standard error for aggregates of office visits or for mentions of drugs by generic name 

(for example, hydrocortisone). Standard errors for estimated 

percents of visits (or for new-pain visit rates per 1,000 visits) 

are shown in table II. 

In this report, the determination of statistical significance 

is based on the t-test with a critical value of 1.96 (0.95 level of 

significance). Terms relating to differences, such as “higher” 

or “less,” indicate that the differences are statistically significant. Terms such as “similar” or “no difference” mean that no 

statistical significance exists between the estimates being compared. A lack of comment in a comparison between any two 

Table 1. Approximate relative standard arrors of estimated numbers 

of office visits and drug mentions, based on all physician specialties: 

National Ambulatory Medical Care Survey, 1980 and 1981 

Relative 

standard 

Estimated number	 of office visits or drug mentions error in 

in thousands parcent 

450 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30.0


600 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26,0 �


800 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22.6


1,000......................................... 20.2


2,000. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14.5


5,000. . . . . . . . . . . . . . . . . . . . . . . . ...! . . . . . . . . . . . . . 9.5


10,000
........................................ 7.1 

20,000. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.6 

50,000. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.4 

100,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.9 

200,000. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.6 

500,000. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.5 

1,000,000..................................... 3.4 

EXAMPLE OF USE OF TABLE An aggregate estimate of 35,000,000 office visits 

has a relative standard error of 5.0 psrcent or a standard error of 1,750,000 

visits (5.0 percent of 35,000,000 visits). 

Table 11. Approximate standard errors of percent of estimated numbers of office visits or of new-pain visit ratas per 1,000 visits: NAMCS, 

1980-81 

Estimated percent of office visits or estimated naw-pain 

visit rates per 1,000 visits 

Estimated number of office visits in thousands 1 or 99 5 or 95 10 or90 20 or 80 30 or 70 .50 

Standard error in percent 

500 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.8 6.2 8.5 11.3 12.9 14.1 

1,000............................................... 2.0 4.4 6.0 8.0 9.1 10.0 

2,000,. . .. . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.4 3.1 4.2 5.6 6.5 7.1 

5,000............................................... 0.9 1.9 2.7 3.6 4.1 4.5 

10,000.............................................. 0.6 1.4 1.9 2.5 2.9 3.2 

20,000. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.4 1.0 1.3 1.8 2.0 2. 

50,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.3 0.6 0.8 1.1 1.3 1. a 200,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.1 0.3 0.4 0.6 0.6 0.7 

1,000,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.1 0.1 0.2 0,3 0.3 0,3 

EXAMPLE OF USE OF TABLE An estimate of 20 percent based on an aggregate of 3,500,000 visits has a standard error of 4.6 percent or a relative standard error of 

23 parcent (4.6 percent+ 20 percent). 
adummMa9 

‘o 

estimates does not mean that the difference was tested and was 

not significant. 

In the tables of this report estimates have been rounded to 

the nearest thousand. For this reason, detailed estimates do not 

always add to the total, 

Definitions 

Ambulatory patient—An individual seeking personal 

health services who is neither bedridden nor currently admitted 

to any health care institution on the premises. 

Drug nzention-The physician’s entry of a pharmaceutical 

agent ordered or provided—by any route of administration— 

for prevention, dkgnosis, or treatment. Generic as well as brandname drugs are included, as are nonprescription as well as prescription drugs. The physician records all new drugs and continued medications when the patient is specifically instructed 

during the visit to continue the medication. (This report includes 

only those drug mentions that were associated with the principal diagnosis.) 

Medical counseling— Instructions and recommendations 

regarding any health problem, including advice or counsel 

about change of habit or behavior. Physicians were instructed 

to check this category only if medical counseling was a critical 

part of the treatment. 

O@ce—A place that physicians identifi as a location for 

ambulatory practice. Responsibility over time for patient care 

and professional services rendered there generally resides with 

the individual physician rather than an institution. 

Physiotherapy—Any form of physical therapy ordered or 

provided, including any treatment using heat, li~t, sound, physical pressure, or movement for example, ultrasonic, ultraviolet, 

infrared, whirlpool, diathermy, cold therapy, and manipulative 

therapy. 

Visit—A direct personal exchange between an ambulatory 

patient and a physician, or with a staff member working under 

the physician’s supervision, for the purpose of seeking care or 

rendering health services. 

X-ray—Any single or multiple X-ray examination for diagnostic or screening purposes. Radiation therapy is not included 

in this category. 
� 

achancedata 

Recent Issues of Advance Data From Vital and Health Statistics 

No. 96. Utilization of Analgesic Drugs in Office-Based Ambulatory 

Care: National Ambulatory Medical Care Survey, 1980-81 (Issued 

March 14, 1984) 

No. 95. 1982 Summary: National Hospital Discharge Survey (Issued 

December 27, 1983) 

No. 94. Discharge Status of Inpatients Discharged From Short-Stay 

Hospitals: United States, 1965-81 (Issued November 22, 1983) 

Suggested Citation 

National Center for Health Statistics, D. A. Knapp 

and H. Koch: The management of new pain in 

office-based am bulatow care: National Ambulatow 

Medical Care Survey, 1980 and 1981. Advarrce 

Data From Vital and Health Statistics, No. 97. 

DHHS Pub. No. (PHS) 84-1250. Public Health 

Service. Hyattsville, Md., June 13, 1984 

U.S. DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Public Health Service 

National Center for Health Statistics


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Hyattsville, Maryland 20782


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DHHS Publication No. [PHS) 84-1250


No. 93. Utilization of Sho~-Stay Hospitals by Adolescents: Unite 

States, 1980 (Issued September 14, 1983) o 

No. 92. Americans Needing Help To Function at Home (Issued 

September 14, 1983) 

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