Referral practices in patients suffering from non-malignant chronic pain

• Published in: European journal of pain Vol. 14; no. 3; pp. 308.e1 - 308.e10
• Main Authors: Schulte, Erika, Hermann, Katja, Berghöfer, Anne, Hagmeister, Hartmut, Schuh-Hofer, Sigrid, Schenk, Michael, Kopf, Andreas, Vilain, Martyn, Martus, Peter, Willich, Stefan N, Boemke, Willehad
• Format: Journal Article
• Language: English
• Published: Oxford, UK Elsevier Ltd 01-03-2010; Blackwell Publishing Ltd
• Subjects: Adult; Aged; Analysis of Variance; Anesthesia & Perioperative Care; Chronic Disease; Chronic pain; Female; Health care; Humans; Male; Middle Aged; Pain Management; Pain Measurement; Pain Medicine; Practice Patterns, Physicians' - trends; Prospective Studies; Psychometrics; Quality of Life; Referral; Referral and Consultation - trends; Surveys and Questionnaires; Time Factors; Treatment Outcome; Health care; Referral; Chronic pain
• DOI: 10.1016/j.ejpain.2009.05.015
• EISSN: 1532-2149
• ISSN: 1090-3801

Abstract This paper presents the results of a prospective observational cohort study investigating referral practices to six specialized pain centres (SPCs) in 303 patients with headache (HD), low back pain (LBP), and neuropathic pain (NP). The study was divided into three parts. Part 1: The pain health care history (contacts with general practitioners and specialists, further referrals, time spans, therapies) before first contact with the SPC. Part 2: Reality of pain therapy and management in the SPC (patients’ attrition, interdisciplinarity of therapy and novel therapeutic strategies instigated). Part 3: Follow-up and assessment of pain levels (NRS, SES), disability scores (PDI), QoL scores (SF 12), and anxiety and depression scores (HADS) at 0, 6 and 12 months. Using an ordinal linear regression model, factors predicting a good treatment outcome were identified. On average it took 3 years of pain symptoms before first consultation with GP. The median time period from the first pain sensations until the appointment in the SPC was 12 years. Nearly half of the referrals to specialists or SPCs were initiated by a non-professional. In the SPC the medication was changed in 71% of cases. Care was interdisciplinary in only 32%. At 6 and 12 months after the first contact with the SPC, only 20% of the patients had improved with respect to levels of pain and psychometric data. A high degree of chronicity, a history of pain-associated surgeries and low social support were negative predictors for treatment outcome.