Difficult Encounters in Pain Medicine

Study Overview
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Brief Summary
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The investigators are seeking to determine factors associated with difficult patient encounters in an academic pain clinic. The investigators are examining 36 different variables to determine the association with difficult patient encounters as independently rated by a trainee and attending physician.

Detailed Description
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Pain is associated with significant psychosocial pathology include axis 1 diagnoses, opioid use and misuse, unemployment, and strained relationships, and treatments for chronic pain are often ineffective. Collectively, these factors may result in a higher prevalence of patients characterized as 'difficult', which can lead to missed diagnoses, barriers to care resulting in poorer outcomes (professional pessimism, mistrust, passive treatment, referrals to other providers or discharge), patient complaints and 'HERO' events, avoidable legal claims, and increased risk of professional burnout. Characterizing patients as difficult (instead of encounters) may have negative consequences for future care, and there are few studies that have explored patients' perspectives on difficult encounters. Although several articles have narratively explored this issue, there are few targeted at chronic pain patients, and no studies in this population that set out to determine what variables are associated with a difficult encounter, the congruence between patients' and providers' impressions of an encounter, or whether difficult encounters are associated with pain treatment outcome.

Official Title
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Difficult Encounters in a Chronic Pain Setting: An Analysis of Factors Associated With Difficult

Conditions
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Chronic Pain

Intervention / Treatment
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* Other: Pain treatment


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: ≥ 18 years of age Pain duration > 3 months New Visit (or no visit within 3 years) Exclusion Criteria: Referral only for diagnostic procedure Friend or relative, or direct referral from friend or relative

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Chronic pain patients<br>New chronic pain consults seen by a trainee and attending pain physician | Other: Pain treatment<br>* Any pain treatment to include medications, procedures, or referrals<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Difficulty of encounter as rated by trainee | Difficulty of encounter as rated by a 6-point Likert scale (1=very pleasant, 6=extremely difficult) | Immediately after consult | 
| Difficulty of encounter as rated by attending physician | Difficulty of encounter as rated by a 6-point Likert scale (1=very pleasant, 6=extremely difficult) | Immediately after consult | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Patient global impression of change | 1-7 Likert scale (1=no change or worse, 7=a great deal better) | 1-2 months post-treatment | 
| Pain score | 0-10 numerical pain scale (0=no pain, 10= worst pain imaginable) | 1-2 months post-treatment | 
| Categorical success | Binary measure of success (2-point or greater decrease in average pain score coupled with a score of 5 or greater on Patient global impression of change scale) | 1-2 months post-treatment | 
| Appointment status | Showed up on time or showed up late or missed appointment | 1-2 months post-treatment | 
| Number of side effects | Side effects from medications or complications from procedures | 1-2 months post-treatment | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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chronic pain