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Chiropractic Research Review

Physicians Rate Patient Pain Inaccurately

Studies have shown that physicians tend to rate their patients' pain lower than the patients themselves in cancer and postoperative cases. Few studies have examined the relationship between physician and patient perceptions of pain levels in primary care.

To determine the variation between practitioner and patient perceptions of pain intensity, 28 general practitioners and 738 of their patients in Finland rated perceived pain levels.

A horizontal 100-millimeter visual analog scale (VAS) was utilized, with "no pain" appearing at one extreme and worst imaginable pain appearing at the other.

Results: There was poor concordance between doctors' and patients' ratings of pain intensity. Patients rated their pain higher than their physicians in chronic-pain cases, although not in nonchronic pain cases. General practitioners rated pain intensity at least one grade lower than the sufferer in 36.7% of cases, at least two grades lower in 20.5% of cases, and one grade higher in 30.6% of cases. The most severe pain cases showed the greatest differences between patient and practitioner assessment. In cases in which patients rated their pain very low, however, practitioners tended to overestimate pain levels. One-fifth of the patients in this study had chronic pain; 57% suffered from musculoskeletal pain.

"These findings suggest that there is considerable nonconcordance between [general practitioner]s' and patients' assessments of pain intensity," the authors write. They suggest that physician underestimation of pain levels may be one reason that patients with musculoskeletal pain may be less satisfied with treatment than other patients. The authors recommend the use of a VAS or other pain-rating scale during clinical evaluation to improve clinician awareness of patient pain levels.

Mäntyselkä P, Kumpusalo E, Ahonen R, et al. Patients' versus general practitioners assessments of pain intensity in primary care patients with non-cancer pain. British Journal of General Practice 2001:51, pp. 995-997.

Chiropractic Research Review

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